JOURNAL ARTICLE

The effect of tumor volume and its change on survival in stage III non-small cell lung cancer treated with definitive concurrent chemoradiotherapy

Tae Ryool Koo, Sung Ho Moon, Yu Jin Lim, Ja Young Kim, Yeonjoo Kim, Tae Hyun Kim, Kwan Ho Cho, Ji-Youn Han, Young Joo Lee, Tak Yun, Heung Tae Kim, Jin Soo Lee
Radiation Oncology 2014, 9: 283
25498887

BACKGROUND: To investigate a prognostic role of gross tumor volume (GTV) changes on survival outcomes following concurrent chemoradiotherapy (CCRT) in stage III non-small-cell lung cancer (NSCLC) patients.

METHODS: We enrolled 191 patients with stage III NSCLC from 2001 to 2009 undergoing definitive CCRT. The GTV of 157 patients was delineated at the planning CT prior to CCRT and with a follow-up CT 1 month after CCRT. We assessed the volumetric parameters of pre-treatment GTV (GTVpre) post-treatment GTV (GTVpost), and volume reduction ratio of GTV (VRR). The primary endpoint was overall survival (OS) and secondary endpoints were progression-free survival (PFS) and locoregional progression-free survival (LRPFS). The best cut-off value was defined as that which exhibited the maximum difference between the two groups.

RESULTS: The median follow-up duration was 52.7 months in surviving patients. Median survival, 3-year OS, PFS and LRPFS rates were 25.5 months, 36.4%, 23.0%, and 45.0%, respectively. The selected cut-off values were 50 cm(3) for GTVpre, 20 cm(3) for GTVpost, and 50% for VRR. The smaller GTVpre and GTVpost values were associated with better OS (p<0.001 and p=0.015) and PFS (p=0.001 and p=0.004), respectively, upon univariate analysis. The higher VRR of > 50% was associated with a trend toward poorer OS (p=0.004) and PFS (p=0.054). Upon multivariate analysis, smaller GTVpre indicated significantly improved OS (p=0.001), PFS (p=0.013) and LRPFS (p=0.002), while smaller GTVpost was marginally significant for PFS (p=0.086). Higher VRR was associated with a trend toward poorer OS (p=0.075).

CONCLUSIONS: In patients with stage III NSCLC undergoing definitive CCRT, GTVpre was an independent prognostic factor of survival. Notably, improved outcome was not correlated with higher VRR after short-term follow-up with CT alone.

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