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    Pulmonary toxicity in Stage III non-small cell lung cancer patients treated with high-dose (74 Gy) 3-dimensional conformal thoracic radiotherapy and concurrent chemotherapy following induction chemotherapy: a secondary analysis of Cancer and Leukemia Group B (CALGB) trial 30105

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    Authors
    Salama, Joseph K.
    Stinchcombe, Thomas E.
    Gu, Lin
    Wang, Xiaofei
    Morano, Karen
    Bogart, Jeffrey A.
    Crawford, Jeffrey C.
    Socinski, Mark A.
    Blackstock, A. William
    Vokes, Everett E.
    UMass Chan Affiliations
    Quality Assurance Review Center
    Department of Radiation Oncology
    Document Type
    Journal Article
    Publication Date
    2011-11-15
    Keywords
    Adult
    Aged
    Analysis of Variance
    Antineoplastic Combined Chemotherapy Protocols
    Area Under Curve
    Carboplatin
    Carcinoma, Non-Small-Cell Lung
    Chemoradiotherapy
    Deoxycytidine
    Female
    Humans
    Induction Chemotherapy
    Lung
    Lung Neoplasms
    Male
    Middle Aged
    Organs at Risk
    Paclitaxel
    Radiotherapy Dosage
    Radiotherapy Planning, Computer-Assisted
    Radiotherapy, Conformal
    Neoplasms
    Oncology
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    Link to Full Text
    http://dx.doi.org/10.1016/j.ijrobp.2011.01.056
    Abstract
    PURPOSE: Cancer and Leukemia Group B (CALGB) 30105 tested two different concurrent chemoradiotherapy platforms with high-dose (74 Gy) three-dimensional conformal radiotherapy (3D-CRT) after two cycles of induction chemotherapy for Stage IIIA/IIIB non-small cell lung cancer (NSCLC) patients to determine if either could achieve a primary endpoint of >18-month median survival. Final results of 30105 demonstrated that induction carboplatin and gemcitabine and concurrent gemcitabine 3D-CRT was not feasible because of treatment-related toxicity. However, induction and concurrent carboplatin/paclitaxel with 74 Gy 3D-CRT had a median survival of 24 months, and is the basis for the experimental arm in CALGB 30610/RTOG 0617/N0628. We conducted a secondary analysis of all patients to determine predictors of treatment-related pulmonary toxicity. METHODS AND MATERIALS: Patient, tumor, and treatment-related variables were analyzed to determine their relation with treatment-related pulmonary toxicity. RESULTS: Older age, higher N stage, larger planning target volume (PTV)1, smaller total lung volume/PTV1 ratio, larger V20, and larger mean lung dose were associated with increasing pulmonary toxicity on univariate analysis. Multivariate analysis confirmed that V20 and nodal stage as well as treatment with concurrent gemcitabine were associated with treatment-related toxicity. A high-risk group comprising patients with N3 disease and V20 >38% was associated with 80% of Grades 3-5 pulmonary toxicity cases. CONCLUSIONS: Elevated V20 and N3 disease status are important predictors of treatment related pulmonary toxicity in patients treated with high-dose 3D-CRT and concurrent chemotherapy. Further studies may use these metrics in considering patients for these treatments.
    Source
    Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e269-74. doi: 10.1016/j.ijrobp.2011.01.056. Epub 2011 Apr 7. Link to article on publisher's site
    DOI
    10.1016/j.ijrobp.2011.01.056
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47941
    PubMed ID
    21477940
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ijrobp.2011.01.056
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