Open AccessComparison of Involved Field Radiotherapy versus Elective Nodal Irradiation in Stage IIIB/C Non-Small-Cell Lung Carcinoma Patients Treated with Concurrent Chemoradiotherapy: A Propensity Score Matching Study
Author(s) -
Erkan Topkan,
Yurday Özdemir,
Ozan Cem Güler,
Ahmet Küçük,
Ali Ayberk Beşen,
Hüseyin Mertsoylu,
Duygu Sezen,
Eyub Yasar Akdemir,
Ahmet Sezer,
Yasemin Bölükbaşı,
Berrin Pehlivan,
Uğur Selek
Publication year - 2020
Publication title -
journal of oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.228
H-Index - 54
eISSN - 1687-8469
pISSN - 1687-8450
DOI - 10.1155/2020/7083149
Subject(s) - medicine , propensity score matching , chemoradiotherapy , leukopenia , gastroenterology , nausea , radiation therapy , lung cancer , proportional hazards model , incidence (geometry) , surgery , oncology , urology , toxicity , physics , optics
Background We retrospectively compared the incidence of isolated elective nodal failure (IENF) and toxicity rates and survival outcomes after elective nodal irradiation (ENI) versus involved-field RT (IFRT) by employing the propensity score matching (PSM) methodology in stage IIIB/C inoperable non-small-cell lung cancer (NSCLC) patients treated with definitive concurrent chemoradiotherapy (C-CRT).Methods Our PSM examination included 1048 stage IIIB/C NSCLC patients treated with C-CRT from January 2007 to December 2016: a total dose of 66 Gy (2 Gy/fraction) radiotherapy and 1–3 cycles of platinum-based doublet chemotherapy concurrently. The primary and secondary endpoints were the IENF and toxicity rates and survival outcomes after ENI versus IFRT, respectively. Propensity scores were calculated for each group to adjust for confounding variables and facilitate well-balanced comparability by creating 1 : 1 matched study groups.Results The median follow-up was 26.4 months for the whole study accomplice. The PSM analysis unveiled 1 : 1 matched 646 patients for the ENI ( N = 323) and IFRT ( N = 323) cohorts. Intergroup comparisons discovered that the 5-year isolated ENF incidence rates (3.4% versus 4.3%; P =0.52) and median overall survival (25.2 versus 24.6 months; P =0.69), locoregional progression-free survival (15.3 versus 15.1 months; P =0.52), and progression-free survival (11.7 versus 11.2 months; P =0.57) durations were similar between the ENI and IFRT cohorts, separately. However, acute grade 3-4 leukopenia ( P =0.0012), grade 3 nausea-vomiting ( P =0.006), esophagitis ( P =0.003), pneumonitis ( P =0.002), late grade 3-4 esophageal toxicity ( P =0.038), and the need for hospitalization ( P < 0.001) were all significantly higher in the ENI than in the IFRT group, respectively.Conclusion Results of the present large-scale PSM cohort established the absence of meaningful IENF or survival differences between the IFRT and ENI cohorts and, consequently, counseled the IFRT as the elected RT technique for such patients since ENI increased the toxicity rates.