Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced non-small cell lung cancer in Chinese population: A retrospective study

Yujin Xu, Xiao Zheng, Xue Bai, Pu Li, Honglian Ma, Jin Wang, Xiao Hu, Ming Chen, Yujin Xu, Xiao Zheng, Xue Bai, Pu Li, Honglian Ma, Jin Wang, Xiao Hu, Ming Chen

Abstract

Objectives: To evaluate the clinical efficacy and toxicity of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for patients with locally advanced non-small cell lung cancer (NSCLC).

Results: All patients completed definitive radiotherapy and 74 (85.1%) patients administrated platinum-based chemotherapy. The median radiation dose was 50.4Gy to PTV and 64.4 Gy simultaneously to the PGTV. The overall response rate (ORR) was 57.5% (50/87). The median duration of follow up was 24.6 months. The 1, 2, 3-year local control rate was 79.0%, 66.1%, and 60.5%, respectively. The 1, 2, 3-year overall survival (OS) rate was 89.7%, 56.7%, and 30.6%, respectively. Subgroup analysis showed that the median OS in concurrent chemoradiation (CCRT) was much better than non-CCRT (35.7 vs. 26.4 months) (HR: 0.52, 95% CI: 0.32-0.95, P = 0.033). Twenty-two (25.3%) patients experienced acute grade 3 esophagitis and 10 (11.5%) experienced acute grade ≥ 3 radiation pneumonitis. There were 2 (2.6%) late grade 3 pulmonary toxicity and no late grade ≥ 3 esophageal toxicity was observed.

Materials and methods: A total of 87 patients with locally advanced NSCLC who received SIB-IMRT from Jan. 2009 to Dec. 2012 in our hospital were retrospectively analyzed. Male accounted for 88.5%, with a median age of 61 years old. The SIB-IMRT plans were designed to deliver 50.4-64.0 Gy in 28-33 fractions (1.8-2.1 Gy/fraction) to PTV while simultaneously delivering 60.0-74.3 Gy in 28-33 fractions (2.0-2.5 Gy/fraction) to PGTV.

Conclusions: SIB-IMRT, especially with concurrent chemotherapy, appears to be an effective and safe option to treat patients with locally advanced NSCLC. More prospective clinical studies should be warranted.

Keywords: integrated boost intensity-modulated radiotherapy; local control; non-small cell lung cancer; overall survival.

Conflict of interest statement

CONFLICTS OF INTEREST

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The survival curves in all patients who received SIB-IMRT, local recurrence-free survival (A); disease-free survival (B); Overall survival (C).
Figure 2. The comparative overall survival curves…
Figure 2. The comparative overall survival curves in patients who received CCRT or not
CCRT: concurrent chemoradiation.
Figure 3. The comparative overall survival curves…
Figure 3. The comparative overall survival curves in patients with different clinical stages after SIB-IMRT
Figure 4. The comparative overall survival curves…
Figure 4. The comparative overall survival curves in patients with different pathological types after SIB-IMRT
Figure 5
Figure 5
Isodose curves (left) and dose-volume histograms (right) of a simultaneously integrated boost intensity-modulated radiotherapy plan for a patients with locally advanced NSCLC (Left: green line represents the internal gross target volume (IGTV), blue line represents the planning target volume (PTV); Right: the yellow line outlines IGTV (61.6 Gy/28 fractions), and the green line area includes the PTV (50.4 Gy/28 fractions), red for heart, blue for spinal cord, gray for lung).

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