Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer

Frontiers in Oncology

Gareth Price¹  Philip Whitehurst¹  Ahmed Salem²  Joanna Coote²  Alex Garbett²  David Woolf²  Neil Bayman²  Laura Pemberton²  Clara Chan²  Margaret Harris²  Corinne Faivre-Finn²  Kathryn Banfill²  Hamid Sheikh²  Andrew Hudson²  Isabella Fornacon-Wood³  Jason Kennedy⁴ 

[1] Christie Medical Physics and Engineering, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom;Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom;Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom;Radiotherapy Related Research, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom;

关键词: IMRT;    lung cancer;    radiotherapy;    real-world data;    big data;   

DOI  :  10.3389/fonc.2022.835844

来源: DOAJ

【 摘 要 】

BackgroundLung cancer survival remains poor. The introduction of Intensity-Modulated Radiotherapy (IMRT) allows treatment of more complex tumours as it improves conformity around the tumour and greater normal tissue sparing. However, there is limited evidence assessing the clinical impact of IMRT. In this study, we evaluated whether the introduction of IMRT had an influence on the proportion of patients treated with curative-intent radiotherapy over time, and whether this had an effect on patient survival.Materials and MethodsPatients treated with thoracic radiotherapy at our institute between 2005 and 2020 were retrospectively identified and grouped into three time periods: A) 2005-2008 (pre-IMRT), B) 2009-2012 (selective use of IMRT), and C) 2013-2020 (full access to IMRT). Data on performance status (PS), stage, age, gross tumour volume (GTV), planning target volume (PTV) and survival were collected. The proportion of patients treated with a curative dose between these periods was compared. Multivariable survival models were fitted to evaluate the hazard for patients treated in each time period, adjusting for PS, stage, age and tumour volume.Results12,499 patients were included in the analysis (n=2675 (A), n=3127 (B), and n=6697 (C)). The proportion of patients treated with curative-intent radiotherapy increased between the 3 time periods, from 38.1% to 50.2% to 65.6% (p<0.001). When stage IV patients were excluded, this increased to 40.1% to 58.1% to 82.9% (p<0.001). This trend was seen across all PS and stages. The GTV size increased across the time periods and PTV size decreased. Patients treated with curative-intent during period C had a survival improvement compared to time period A when adjusting for clinical variables (HR=0.725 (0.632-0.831), p<0.001).ConclusionIMRT was associated with to more patients receiving curative-intent radiotherapy. In addition, it facilitated the treatment of larger tumours that historically would have been treated palliatively. Despite treating larger, more complex tumours with curative-intent, a survival benefit was seen for patients treated when full access to IMRT was available (2013-2020). This study highlights the impact of IMRT on thoracic oncology practice, accepting that improved survival may also be attributed to a number of other contributing factors, including improvements in staging, other technological radiotherapy advances and changes to systemic treatment.

【 授权许可】

Unknown