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Effect of IMRT and 3DCRT On Survival of Stage II-III Non-Operable NSCLC Patients: Analysis of a Large Database

A Dey1*, T Podder2,3 , S Datta1 , T Biswas2,3 , (1) University of Akron, Akron, OH, (2) University Hospitals Seidman Cancer Center, Cleveland, OH, (3) Case Western Reserve University, Cleveland, OH


(Monday, 7/15/2019) 4:30 PM - 5:30 PM

Room: Exhibit Hall | Forum 3

Purpose: Both IMRT and 3DCRT are used for treating non-small cell lung cancer (NSCLC) patients. IMRT can provide improved radiation beam modulation resulting is better dose distribution and increased sparing of OARs and normal tissues. In this study, we have evaluated the pattern of practice in the United States and compared the efficacy of IMRT versus 3DCRTusing a large hospital-based database.

Methods: We have analyzed the National Cancer Database (NCDB) between 2004 and 2015 of NSCLC patients (n=32,802) with clinical Stage II-III who were non-operable and received concurrent chemotherapy. Radiation dose of 60-70Gy with 1.8-2Gy per fraction was considered valid for both IMRT and 3DCRT. Overall survival (OS) was calculated from the date of diagnosis until the date of death or last follow up. Kaplan-Meier analysis was performed for determining the OS. IBM SPSS software (version 24) was used for statistical analysis; p-value <0.05 was considered statistically significant.

Results: Median age of the patients was 67 years (range: 19-90 years); 56.6% male. Median follow-up was 19.5 months. During 2004-2015, out of 32,802 patients about 48.4% was treated with 3DCRT while 51.6% was treated with IMRT. We observed a trend of increasing use of IMRT in more recent years (~10% in 2004 vs. ~70% in 2015). Mean and median OS of the patients were: 37.4 months and 21.2 months for 3DCRT, whereas 39.5 months and 22.7 months for IMRT. One-year, and three-year OS were also better by 1.4%, and 4.3%, respectively, in IMRT group (p-value<0.01).

Conclusion: This study indicates that for clinical Stage II-III non-operable NSCLC, the overall survival of patients treated with IMRT is better. Both the modalities are quite effective, so far the survival is concerned. However, there may be additional benefits of using IMRT regarding treatment related toxicities; but, no toxicity information is available in NCDB.


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