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

Figures & data

Table I. Patient and treatment characteristics of all stage III NSCLC patients treated with curative non-surgical (chemo) radiotherapy (n = 319). Patients receiving concurrent (n = 190) and sequential chemo-radiotherapy (n = 90) are also shown separately.

	All patients n = 319	CON-CRT n = 190	SEQ-CRT n = 90	P-value
Sex
• Male (%)	213 (67)	128 (67)	59 (66)	0.76*
• Female (%)	106 (33)	62 (33)	31 (34)
Age in years
• Mean (SD)	63.4 (9.3)	62.7 (8.8)	64.8 (10.2)	0.072**
•> 70 yrs (%)	105 (33)	44 (23)	31 (34)	0.046*
Stage
• IIIA (%)	161 (51)	93 (49)	43 (48)	0.86*
• IIIB (%)	158 (49)	97 (51)	47 (52)
PTV volume in cm^3
• Median (IQR)	682 (503–914)	666 (514–913)	702 (473–964)	0.61***
Delivered dose in Gray
• Median (IQR)	59.8 (50.0–66.0)	60.0 (52.0–66.0)	59.8 (39.0–59.8)****	< 0.001***

CON-CRT, concurrent chemo-radiotherapy; PTV, planning target volume; RT, radical radiotherapy; SEQ-CRT, sequential chemo-radiotherapy.

*χ²-test to compare the proportions in CON-CRT and SEQ-CRT group; **Independent samples t-test to compare the means in CON-CRT and SEQ-CRT group; ***Mann-Whitney-test to compare the distributions in CON-CRT and SEQ-CRT group; ****Typically 2.6 Gy per fraction in SEQ-CRT compared to 2 Gy per fraction in CON-CRT (see text).

Figure 1. Treatment of stage III non-small cell lung cancer in each two-year time period: concurrent chemo-radiotherapy (light grey dots), sequential chemo-radiotherapy (solid grey) and radical radiotherapy (white).

Table II. Differences in patient characteristics and overall survival between four time periods in the total group of stage III NSCLC patients treated with curative-intent non-surgical (chemo) radiotherapy (n = 319) and in the group treated with concurrent chemo-radiotherapy (n = 190).

Time period	2003/4	2005/6	2007/8	2009/10	P-value for difference/P-value for trend
Total group (n = 319)
Number patients	48	80	90	101
Mean age in years (SD)	66.5 (11.3)	65.2 (12.0)	63.7 (9.9)	66.0 (9.4)	0.37/0.82**
Patients > 70 yrs [n (%)]	18 (38)	27 (34)	26 (29)	34 (34)	0.76/0.63*
Stage					0.27/0.11*
• IIIA [n (%)]	27 (56)	42 (53)	49 (54)	43 (43)
• IIIB [n (%)]	21 (44)	38 (47)	41 (46)	58 (57)
Median PTV volume in cm^3 (IQR)	604 (388–764)	722 (566–1124)	706 (533–903)	664 (464–944)	0.011/0.97***
Number of patients with PTV > 700 cm^3 (%)	17 (35)	44 (55)	46 (51)	44 (44)	0.13/0.87*
Median delivered dose in Gray (IQR)	59.8 (39.0–59.8)	59.8 (47.0–59.8)	59.9 (50.0–66.0)	66.0 (59.9–66.0)	< 0.001/< 0.001***
Number of patients receiving CON-CRT (%)	13 (27)	40 (50)	63 (70)	74 (73)	< 0.001/< 0.001*
Number of patients receiving SEQ-CRT (%)	24 (50)	28 (35)	16 (18)	22 (22)	< 0.001/< 0.001*
Median overall survival (95% CI)	17.3 (10.9–23.6)	17.3 (9.3–25.3)	15.7 (11.0–20.3)	17.9 (13.4–22.4)	0.87****
CON-CRT group (n = 190)
Number patients	13	40	63	74
Mean age in years (SD)	63.0 (6.9)	61.0 (9.5)	62.3 (9.8)	63.8 (7.7)	0.42/0.21**
Patients > 70 yrs [n (%)]	2 (15%)	7 (18%)	16 (25%)	19 (26%)	0.66/0.26*
Stage					0.27/0.091*
• IIIA [n (%)]	9 (69)	20 (50)	33 (52)	31 (42)
• IIIB [n (%)]	4 (31)	20 (50)	30 (48)	43 (58)
PS					0.43/0.12*
• 0 [n (%)]	2 (15)	8 (21)	14 (22)	23 (31)
•≥ 1 [n (%)]	11 (85)	31 (79)	49 (78)	51 (69)
Median PTV volume in cm^3 (IQR)	614 (409–790)	710 (527–1219)	670 (542–874)	664 (480–943)	0.48/0.45***
Number of patients with PTV > 700 cm^3 (%)	6 (46)	20 (50)		32 (43)	0.91/0.57*
Median delivered dose in Gray (IQR)	60.0 (50.0–60.0)	57.3 (50.0–60.0)		66.0 (60.0–66.0)	< 0.001/< 0.001***
Median overall survival (95% CI)	18.9 (8.0–29.7)	13.1 (8.2–18.2)		19.5 (15.5–23.3)	0.96****

CON-CRT, concurrent chemo-radiotherapy; PTV, planning target volume; SD, standard deviation.

*χ²-test to compare the proportions between periods and Mantel-Haenszel linear-by-linear association test for trend; **ANOVA to compare means between periods and linear regression to test for trend; ***Kruskal-Wallis test to compare the distributions between periods and Jonckheere-Terpstra test for trend; ****Log-rank test to compare overall survival between the four time-periods.

Figure 2. Overall survival (OS) in stage III non-small cell lung cancer treated with concurrent chemo-radiotherapy CON-CRT (bold dotted line), radical radiotherapy RTH (dotted line) and sequential chemo-radiotherapy SEQ-CRT (unbroken line).

Table III. Patient characteristics in the early mortality group (within 5 months of starting radiotherapy).

	Patients early mortality N = 52 (16%)	Remaining patients N = 267 (84%)	Results univariate logistic regression analyses
			Odds ratio (95% CI)	P-value
Sex
• Male (%)	33 (64)	180 (67)	(Reference)	0.58
• Female (%)	19 (36)	87 (33)	1.19 (0.64–2.21)
Age in years
• Mean (range)	68 (44–86)	65 (39–96)	1.03 (1.00–1.06)^1	0.09
Age (dichotomized)
•< 70 years (%)	31 (60)	183 (69)	(Reference)	0.21
•≥ 70 yrs (%)	21 (40)	84 (31)	1.48 (0.80–2.72)
Stage
• IIIA (%)	24 (46)	137 (51)	(Reference)	0.50
• IIIB (%)	28 (54)	130 (49)	1.23 (0.68–2.23)
PTV
• < 700 cm^3 (%)	17 (33)	151 (57)	(Reference)	0.002
• ≥ 700 cm^3 (%)	35 (68)	116 (43)	2.68 (1.43–5.02)
Treatment schedule
• CON-CRT (%)	27 (52)	163 (61)	(Reference)	0.22
• SEQ-CRT (%)	10 (19)	75 (28)	1.21 (0.61–2.40)
• RT (%)	15 (29)	29 (11)	2.08 (0.91–4.76)
Delivered dose in Gray
• Median (IQR)	50 (39.0–59.8)	60.0 (50.0–66.0)	0.54 (0.45–0.69)^2	< 0.001
Completed planned treatment
• No (%)	15 (29)	12 (4)	(Reference)
• Yes (%)	37 (71)	255 (96)	0.12 (0.05–0.27)	< 0.001

CON-CRT: concurrent chemo-radiotherapy, SEQ-CRT: sequential chemo-radiotherapy, RT: radical radiotherapy, PTV: planning target volume.

¹OR for 1 year increase in age; ²OR for 10 Gray increase in delivered dose.