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Comparison of survival rates between 3D conformal radiotherapy and intensity-modulated radiotherapy in patients with stage Ⅲ non–small cell lung cancer

Authors Kong M, Hong SE

Received 10 October 2016

Accepted for publication 9 November 2016

Published 24 November 2016 Volume 2016:9 Pages 7227—7234


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Manfred Beleut

Peer reviewer comments 2

Editor who approved publication: Dr Yao Dai

Moonkyoo Kong, Seong Eon Hong

Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Republic of Korea

Purpose: Randomized trials showing a clear survival benefit of intensity-modulated radiotherapy (IMRT) over 3-dimensional conformal radiotherapy (3D-CRT) in the treatment of lung cancer are lacking. This study compared the survival rates of patients with stage III non-small cell lung cancer who were treated with either 3D-CRT or IMRT and analyzed the prognostic factors for survival.
Methods: From January 2008 to July 2015, 19 patients were treated with IMRT and 30 were treated with 3D-CRT in our institution. The choice between 3D-CRT and IMRT was determined by the physician based on tumor extent and general condition of the patients. The primary endpoint of this study was overall survival. The secondary endpoints were loco-regional recurrence-free survival, distant metastasis-free survival, and the incidence of radiation-induced lung and esophageal toxicities.
Results: The 1- and 2-year overall survival rates were 94.7% and 77.1% in the IMRT group and 76.7% and 52.5% in the 3D-CRT group, respectively. The overall survival rates of the IMRT group were higher than those of the 3D-CRT group; however, these differences were not statistically significant (P=0.072). Gross tumor volume was significantly associated with the overall survival rate. The 1- and 2-year loco-regional recurrence-free survival rates were 63.2% and 51% in the IMRT group and 67.5% and 48.1% in the 3D-CRT group (P=0.897), respectively. The 1- and 2-year distant metastasis-free survival rates were 78.9% and 68.4% in the IMRT group and 62.6% and 40.9% in the 3D-CRT group (P=0.120), respectively. Chemotherapy and treatment interruption were significantly associated with distant metastasis-free survival.
Conclusion: IMRT showed comparable or better overall survival compared with 3D-CRT in patients with stage III non-small cell lung cancer. To confirm the results of this study, further randomized prospective trials comparing IMRT with 3D-CRT are warranted.

Keywords: lung cancer, intensity-modulated radiotherapy, 3-dimensional conformal radiotherapy, survival rate, radiation toxicities, prognostic factor

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