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Radiat Oncol. 2014 Dec 13;9:283. doi: 10.1186/s13014-014-0283-6.

The effect of tumor volume and its change on survival in stage III non-small cell lung cancer treated with definitive concurrent chemoradiotherapy.

Author information

1
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. kootaeryool@gmail.com.
2
Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. shmoon@ncc.re.kr.
3
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. shmoon@ncc.re.kr.
4
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. yujindw@naver.com.
5
Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. hontas0809@hotmail.com.
6
Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. jane2000md@gmail.com.
7
Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. k2onco@naver.com.
8
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. kwancho@ncc.re.kr.
9
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. jymama@ncc.re.kr.
10
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. yjlee@ncc.re.kr.
11
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. hmotakyun@ncc.re.kr.
12
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. htkim@ncc.re.kr.
13
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. jslee@ncc.re.kr.

Abstract

BACKGROUND:

To investigate a prognostic role of gross tumor volume (GTV) changes on survival outcomes following concurrent chemoradiotherapy (CCRT) in stage III non-small-cell lung cancer (NSCLC) patients.

METHODS:

We enrolled 191 patients with stage III NSCLC from 2001 to 2009 undergoing definitive CCRT. The GTV of 157 patients was delineated at the planning CT prior to CCRT and with a follow-up CT 1 month after CCRT. We assessed the volumetric parameters of pre-treatment GTV (GTVpre) post-treatment GTV (GTVpost), and volume reduction ratio of GTV (VRR). The primary endpoint was overall survival (OS) and secondary endpoints were progression-free survival (PFS) and locoregional progression-free survival (LRPFS). The best cut-off value was defined as that which exhibited the maximum difference between the two groups.

RESULTS:

The median follow-up duration was 52.7 months in surviving patients. Median survival, 3-year OS, PFS and LRPFS rates were 25.5 months, 36.4%, 23.0%, and 45.0%, respectively. The selected cut-off values were 50 cm(3) for GTVpre, 20 cm(3) for GTVpost, and 50% for VRR. The smaller GTVpre and GTVpost values were associated with better OS (p<0.001 and p=0.015) and PFS (p=0.001 and p=0.004), respectively, upon univariate analysis. The higher VRR of > 50% was associated with a trend toward poorer OS (p=0.004) and PFS (p=0.054). Upon multivariate analysis, smaller GTVpre indicated significantly improved OS (p=0.001), PFS (p=0.013) and LRPFS (p=0.002), while smaller GTVpost was marginally significant for PFS (p=0.086). Higher VRR was associated with a trend toward poorer OS (p=0.075).

CONCLUSIONS:

In patients with stage III NSCLC undergoing definitive CCRT, GTVpre was an independent prognostic factor of survival. Notably, improved outcome was not correlated with higher VRR after short-term follow-up with CT alone.

PMID:
25498887
PMCID:
PMC4268851
DOI:
10.1186/s13014-014-0283-6
[Indexed for MEDLINE]
Free PMC Article

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