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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Thursday, January 26, 2023
Use of postoperative intensity-modulated radiation therapy among patients with non–small cell lung cancer (NSCLC) appears to have increased in the United States from 2004 to 2019. Additionally, Anurag K. Singh, MD, of Roswell Park Comprehensive Cancer Center, Buffalo, and colleagues reported that postoperative intensity-modulated radiation therapy was associated with improved survival compared with three-dimensional (3D) conformal radiation therapy. These findings were published in JAMA Network Open.
“The extent and proximity of clinical target volume to organs at risk may also explain our findings that patients with higher tumor stage and those who underwent pneumonectomy were more likely to undergo intensity-modulated radiation therapy as well as the increasing trend in intensity-modulated radiation therapy use over time,” said the study authors.
Data were analyzed from the National Cancer Database for patients diagnosed with incompletely resected NSCLC between January 2004 and December 2019. All patients needed to have undergone upfront surgery with positive surgical margins and then have received postoperative radiation therapy.
A total of 4,483 patients were included in the study, of whom 2,116 (47.2%) underwent 3D conformal radiation therapy and 2,367 (52.8%) underwent intensity-modulated radiation therapy. The median age was 67 years. The median follow-up was 48.5 months. The proportion of patients who underwent intensity-modulated radiation therapy increased from 14.3% (13 of 91 patients) in 2004 to 70.7% (33 of 471 patients) in 2019 (P < .001). Overall, intensity-modulated radiation therapy was associated with improved overall survival compared with 3D conformal radiation therapy (P < .001). Additionally, having nonsquamous tumors and receipt of a recent diagnosis, lobectomy, multiagent chemotherapy, and treatment at an academic facility were associated with improved overall survival. Patients with grade 3 tumors, T3 and T4 stage tumors (P = .005), and N2 and N3 stage tumors (P = .02) were associated with worse overall survival. Similarly, propensity score matching identified 1,463 matched pairs. Compared with 3D conformal radiation therapy, intensity-modulated radiation therapy was associated with improved 5-year overall survival (32.2% vs. 37.3%; P = .003).
Disclosure: The study authors reported no conflicts of interest.
