Changes in non-surgical management of stage III non-small cell lung cancer at a single institution between 2003 and 2010

Abstract

Background. Concurrent chemo-radiotherapy (CON-CRT) is recommended for selected patients with stage III non-small cell lung cancer (NSCLC), but utilization varies. We assessed the response to national guidelines introduced in 2004 and the impact on outcomes. Material and methods. Retrospective study of stage III NSCLC patients treated with radical intent non-surgical treatment during 2003–2010 in a university medical center characterized by multidisciplinary assessment, routine use of four-dimensional computed tomography for radiotherapy planning, and rapid implementation of radiotherapy advances. Results. Between 2003 and 2010, 319/435 (73%) patients with stage III NSCLC received (chemo) radiotherapy. The number receiving CON-CRT in successive two-year periods increased from 13/48 (27%) – 40/80 (50%) – 63/90 (70%), to 74/101 (73%). Median overall survival (OS) from start of radiotherapy was 18.6 months for CON-CRT (190/319) and 17.4 months for sequential (SEQ), typically hypofractionated, CRT (90/319) (p = 0.78). Eleven months OS with radiotherapy alone (39/319) was significantly shorter (p = 0.006). OS did not differ between the four periods (p = 0.87). CON-CRT was not over-represented in the 16% of patients dying within five months of starting radiotherapy. Conclusions. Between 2003 and 2010, CON-CRT for stage III NSCLC was rapidly and safely increased. However, OS did not increase and, as practiced, did not differ between CON- or SEQ-CRT.

Declaration of interest: There has been no funding for this study. The Department of Radiotherapy, VU University Medical Center has Research Agreements with Varian Medical Systems Inc. and Brainlab AG, M. Dahele has received travel support and honoraria from Varian Medical Systems and Brainlab, W. F. A. R Verbakel has received speakers honoraria from Varian Medical Systems, B. J. Slotman has received travel support and honorarium from Varian Medical Systems and Brainlab and S. Senan has received speakers honoraria from Varian Medical Systems, and is also a member of the Trial Management Group for a phase III study in lung cancer sponsored by Lilly Oncology. P. M. van de Ven, E. J. F. van Reij, P. F. de Haan and E. F. Smit has reports conflicts of interest.