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Int J Radiat Oncol Biol Phys. 2014 Mar 15;88(4):872-84. doi: 10.1016/j.ijrobp.2013.12.010. Epub 2014 Feb 1.

A population-based comparative effectiveness study of radiation therapy techniques in stage III non-small cell lung cancer.

Author information

1
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
2
Department of Radiation Medicine and Applied Science, University of California- San Diego, Moores Cancer Center, La Jolla, California.
3
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
4
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
5
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California. Electronic address: BWLoo@Stanford.edu.
6
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: diehn@Stanford.edu.

Abstract

PURPOSE:

Concerns have been raised about the potential for worse treatment outcomes because of dosimetric inaccuracies related to tumor motion and increased toxicity caused by the spread of low-dose radiation to normal tissues in patients with locally advanced non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy (IMRT). We therefore performed a population-based comparative effectiveness analysis of IMRT, conventional 3-dimensional conformal radiation therapy (3D-CRT), and 2-dimensional radiation therapy (2D-RT) in stage III NSCLC.

METHODS AND MATERIALS:

We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify a cohort of patients diagnosed with stage III NSCLC from 2002 to 2009 treated with IMRT, 3D-CRT, or 2D-RT. Using Cox regression and propensity score matching, we compared survival and toxicities of these treatments.

RESULTS:

The proportion of patients treated with IMRT increased from 2% in 2002 to 25% in 2009, and the use of 2D-RT decreased from 32% to 3%. In univariate analysis, IMRT was associated with improved overall survival (OS) (hazard ratio [HR] 0.90, P=.02) and cancer-specific survival (CSS) (HR 0.89, P=.02). After controlling for confounders, IMRT was associated with similar OS (HR 0.94, P=.23) and CSS (HR 0.94, P=.28) compared with 3D-CRT. Both techniques had superior OS compared with 2D-RT. IMRT was associated with similar toxicity risks on multivariate analysis compared with 3D-CRT. Propensity score matched model results were similar to those from adjusted models.

CONCLUSIONS:

In this population-based analysis, IMRT for stage III NSCLC was associated with similar OS and CSS and maintained similar toxicity risks compared with 3D-CRT.

PMID:
24495591
DOI:
10.1016/j.ijrobp.2013.12.010
[Indexed for MEDLINE]
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