Concurrent Chemoradiotherapy For Locally Advanced Non-small Cell Lung Cancer Clinical Outcomes Of Patients With Malignant Lung Lesions Treated With Stereotactic Body Radiation Therapy

PartⅠ:Effect of different concurrent chemotherapy regimens on locally advanced non-small-cell lung carcinomaPurpose:To retrospectively analyze the effects of different concurrent chemotherapy regimens on locally advanced non-small-cell lung carcinoma (NSCLC).Methods:Data were analyzed from 106 patients diagnosed as locally advanced NSCLC(Ⅲa:29Ⅲb:77) and received concurrent radiotherapy with various chemotherapy regimens. Analysis was performed for overall survival and toxicity (grade≥2).Results:Paclitaxel based chemotherapy regimen was delivered in 55 patients, whereas 21 patients with topotecan regimen and 26 patients with PE (cisplatin and etopside) regimen,4 patients with others. The median survival time was 18.6 months, the overall 1-and 3-year survival rate were 72.2% and 27.5%, respectively. Survival and toxicity analysis were performed in 102 patients which include paclitaxel, topotecan and PE groups, the median survival time was 16.3 months,27.3 months and 29.1 months, respectively. The overall survivals of topotecan and PE groups were superior to paclitaxol based group, but not signifcant (p=0.32). Howerevr, when topotecan and PE group were combined (47 patients) and compared to paclitaxel based regimen group, the median survival was poorer in patients with paclitaxol based regimen (16.3 months vs.27.3 months), and both in univariate and multivariate analysis paclitaxol based chemotherapy regimen was significantly associated with poorer survival (p< 0.05). N stage was significant in the COX multivariate regression model. Paclitaxel based regimen was associated with more acute radiation pneumonitis,27.3%versus 10.6%, (p=0.03), less blood toxicity (16.4%vs 29.8%) (p=0.108) and almost same esophagitis(29.1% vs 34.0%).Conclusions:This retrospective cohort study showed a correlation between concurrent chemotherapy regimens with survival and toxicity in patients with locally advanced NSCLC. PartⅡ:Comparison of dose distribution with Simplified IMRT to different curative radiotherapy plans of non-small cell lung cancer (NSCLC)Purpose To evaluate the dose distribution of target volume and normal tissues with different treatment planning such as three dimensional conformal radiotherapy (3DCRT), simplified intensity modulated radiotherapy (sIMRT), and intensity modulated radiotherapy (IMRT) for patients with locally advanced non-small cell lung carcinoma (NSCLC). Methods 14 patients with stage III NSCLC underwent concurrent chemotherapy were enrolled in this study.5-field 3DCRT, sIMRT and 5-field or 7-field IMRT plans were performed for each patient. The dose distributions of target volume and normal tissues, conformal index (CI) and heterogeneous index (HI) were analyzed using the dose-volume histogram for these techniques. The prescription dose was 60Gy in 30 fractions. The total MU were also analyzed to compare excution time indirectly. Results The CI for PTV was superior with MRT7f, sIMRT5f to 3DCRT5f. Conversely, the HI for PTV was 3DCRT5f>sIMRT5f>IMRT7f. The mean of total MU for 3DCRT5f, sIMRT5f, IMRT5f and IMRT7f was 476±23,523±29,764±51 and 793±44 (MRT>sIMRT>3DCRT), respectively. Conclusions Comparing with the 3DCRT plans and the IMRT plans, sIMRT plan was the optimal plan for clinical practice. sIMRT and IMRT radiotherapy techniques can protect lung and spinal cord well with this prescription dose. PartⅢ:Clinical Outcomes of Patients with Malignant Lung Lesions Treated with SBRTPurpose To investigate factors associated with local control and survival benefit of stereotactic body radiation therapy (SBRT) in patients with lung malignancies Methods and Materials Patients with pathologically proven malignant lung lesions were treated using SBRT with median prescribed dose of 50 Gy in 5 fractions. The median biologically effective dose assumingα/βratios of 10 Gy (BED 10) was 100 Gy. (GTVall and lesion average BED (10), instead of GTV and BED(10), were used in patients with multiple lesions in the overall survival related factors analysis). Results 103 lesions were treated in 84 patients between June 2004 and June 2008. No severe (Grade>2) toxicities were noted.2-year local control rates were 93.5%,91.3% for primary and recurrent/metastatic groups respectively. BED(10) was significant for local control in uni-variate (P=0.004) and multi-variate analyses (P=0.049).2 year overall survival rates were 43.0% and 33.6% for the Primary and recurrent/metastatic groups. Uni-variate analysis showed that primary tumor, peripheral location, (lesion average BED (10)≥72), lesion average BED (10)≥100 and GTVall<28ml were favorable factors. Multi-variate analysis showed that only lesion average BED (10) was significant associated with overall survival (P=0.001. Conclusions SBRT provides excellent local control for both primary and recurrent/metastatic lung malignancies. Overall survival was better in primary lung cancer patients. BED(10)-control and BED(10)-survival relationship were shown in this study. Tumor volume was shown to be important by uni-variate analysis but failed in multi-variate analysis for overall survival. Additional studies are needed to test the values of lesion average BED(10) and GTVall.