Survival and Quality of Life After Stereotactic or 3D-Conformal Radiotherapy for Inoperable Early-Stage Lung Cancer
Purpose To investigate survival and local recurrence after stereotactic ablative radiotherapy (SABR) or three-dimensional conformal radiotherapy (3D-CRT) administered for early-stage primary lung cancer and to investigate longitudinal changes of health-related quality of life (HRQOL) parameters afte...
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| creator | Widder, Joachim, M.D., Ph.D Postmus, Douwe, Ph.D Ubbels, Jan F., M.D Wiegman, Erwin M., M.D Langendijk, Johannes A., Prof., M.D., Ph.D |
| description | Purpose To investigate survival and local recurrence after stereotactic ablative radiotherapy (SABR) or three-dimensional conformal radiotherapy (3D-CRT) administered for early-stage primary lung cancer and to investigate longitudinal changes of health-related quality of life (HRQOL) parameters after either treatment. Methods and Materials Two prospective cohorts of inoperable patients with T1-2N0M0 primary lung tumors were analyzed. Patients received 70 Gy in 35 fractions with 3D-CRT or 60 Gy in three to eight fractions with SABR. Global quality of life (GQOL), physical functioning (PF), and patient-rated dyspnea were assessed using the respective dimensions of European Organization for Research and Treatment of Cancer Core Questionnaire-C30 and LC13. HRQOL was analyzed using multivariate linear mixed-effects modeling, survival and local control (LC) using the Kaplan-Meier method, Cox proportional hazards analysis, and Fine and Gray multivariate competing risk analysis as appropriate. Results Overall survival (OS) was better after SABR compared with 3D-CRT with a HR of 2.6 (95% confidence interval [CI]: 1.5–4.8; p < 0.01). 3D-CRT conferred a subhazard ratio for LC of 5.0 (95% CI: 1.7–14.7; p < 0.01) compared with SABR. GQOL and PF were stable after SABR ( p = 0.21 and p = 0.62, respectively). Dyspnea increased after SABR by 3.2 out of 100 points (95% CI: 1.0–5.3; p < 0.01), which is clinically insignificant. At 1 year, PF decreased by an excess of 8.7 out of 100 points (95% CI: 2.8–14.7; p < 0.01) after 3D-CRT compared with SABR. Conclusion In this nonrandomized comparison of two prospective cohorts of medically inoperable patients with Stage I lung cancer, OS and LC were better after SABR. GQOL, PF, and patient-rated dyspnea were stable after SABR, whereas PF decreased after 3D-CRT approaching clinical significance already at 1 year. |
| doi_str_mv | 10.1016/j.ijrobp.2011.03.052 |
| format | Article |
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Methods and Materials Two prospective cohorts of inoperable patients with T1-2N0M0 primary lung tumors were analyzed. Patients received 70 Gy in 35 fractions with 3D-CRT or 60 Gy in three to eight fractions with SABR. Global quality of life (GQOL), physical functioning (PF), and patient-rated dyspnea were assessed using the respective dimensions of European Organization for Research and Treatment of Cancer Core Questionnaire-C30 and LC13. HRQOL was analyzed using multivariate linear mixed-effects modeling, survival and local control (LC) using the Kaplan-Meier method, Cox proportional hazards analysis, and Fine and Gray multivariate competing risk analysis as appropriate. Results Overall survival (OS) was better after SABR compared with 3D-CRT with a HR of 2.6 (95% confidence interval [CI]: 1.5–4.8; p < 0.01). 3D-CRT conferred a subhazard ratio for LC of 5.0 (95% CI: 1.7–14.7; p < 0.01) compared with SABR. GQOL and PF were stable after SABR ( p = 0.21 and p = 0.62, respectively). Dyspnea increased after SABR by 3.2 out of 100 points (95% CI: 1.0–5.3; p < 0.01), which is clinically insignificant. At 1 year, PF decreased by an excess of 8.7 out of 100 points (95% CI: 2.8–14.7; p < 0.01) after 3D-CRT compared with SABR. Conclusion In this nonrandomized comparison of two prospective cohorts of medically inoperable patients with Stage I lung cancer, OS and LC were better after SABR. GQOL, PF, and patient-rated dyspnea were stable after SABR, whereas PF decreased after 3D-CRT approaching clinical significance already at 1 year.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2011.03.052</identifier><identifier>PMID: 21640503</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>3D-conformal radiotherapy ; ACCURACY ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung - mortality ; Carcinoma, Non-Small-Cell Lung - pathology ; Carcinoma, Non-Small-Cell Lung - radiotherapy ; Carcinoma, Non-Small-Cell Lung - surgery ; Confidence Intervals ; Diagnostic Self Evaluation ; Dose Fractionation ; Dyspnea - diagnosis ; Female ; HAZARDS ; Health Status ; Health-related quality of life ; Hematology, Oncology and Palliative Medicine ; High-precision conformal radiotherapy ; Humans ; Lung Neoplasms - mortality ; Lung Neoplasms - pathology ; Lung Neoplasms - radiotherapy ; Lung Neoplasms - surgery ; LUNGS ; Male ; Middle Aged ; MULTIVARIATE ANALYSIS ; Neoplasm Recurrence, Local ; NEOPLASMS ; Non–small cell lung cancer ; PATIENTS ; Prospective Studies ; Quality of Life ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; Radiosurgery - methods ; Radiosurgery - mortality ; RADIOTHERAPY ; Radiotherapy, Conformal - methods ; Radiotherapy, Conformal - mortality ; Regression Analysis ; RISK ASSESSMENT ; SIMULATION ; STANDARD OF LIVING ; Stereotactic body radiotherapy ; Surveys and Questionnaires</subject><ispartof>International journal of radiation oncology, biology, physics, 2011-11, Vol.81 (4), p.e291-e297</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-dbfa39778e2af8e49ca9173ff12eb44be45c5c384cd8a532d0d0b51bf596e1113</citedby><cites>FETCH-LOGICAL-c477t-dbfa39778e2af8e49ca9173ff12eb44be45c5c384cd8a532d0d0b51bf596e1113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301611005189$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21640503$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22054379$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Widder, Joachim, M.D., Ph.D</creatorcontrib><creatorcontrib>Postmus, Douwe, Ph.D</creatorcontrib><creatorcontrib>Ubbels, Jan F., M.D</creatorcontrib><creatorcontrib>Wiegman, Erwin M., M.D</creatorcontrib><creatorcontrib>Langendijk, Johannes A., Prof., M.D., Ph.D</creatorcontrib><title>Survival and Quality of Life After Stereotactic or 3D-Conformal Radiotherapy for Inoperable Early-Stage Lung Cancer</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose To investigate survival and local recurrence after stereotactic ablative radiotherapy (SABR) or three-dimensional conformal radiotherapy (3D-CRT) administered for early-stage primary lung cancer and to investigate longitudinal changes of health-related quality of life (HRQOL) parameters after either treatment. Methods and Materials Two prospective cohorts of inoperable patients with T1-2N0M0 primary lung tumors were analyzed. Patients received 70 Gy in 35 fractions with 3D-CRT or 60 Gy in three to eight fractions with SABR. Global quality of life (GQOL), physical functioning (PF), and patient-rated dyspnea were assessed using the respective dimensions of European Organization for Research and Treatment of Cancer Core Questionnaire-C30 and LC13. HRQOL was analyzed using multivariate linear mixed-effects modeling, survival and local control (LC) using the Kaplan-Meier method, Cox proportional hazards analysis, and Fine and Gray multivariate competing risk analysis as appropriate. Results Overall survival (OS) was better after SABR compared with 3D-CRT with a HR of 2.6 (95% confidence interval [CI]: 1.5–4.8; p < 0.01). 3D-CRT conferred a subhazard ratio for LC of 5.0 (95% CI: 1.7–14.7; p < 0.01) compared with SABR. GQOL and PF were stable after SABR ( p = 0.21 and p = 0.62, respectively). Dyspnea increased after SABR by 3.2 out of 100 points (95% CI: 1.0–5.3; p < 0.01), which is clinically insignificant. At 1 year, PF decreased by an excess of 8.7 out of 100 points (95% CI: 2.8–14.7; p < 0.01) after 3D-CRT compared with SABR. Conclusion In this nonrandomized comparison of two prospective cohorts of medically inoperable patients with Stage I lung cancer, OS and LC were better after SABR. GQOL, PF, and patient-rated dyspnea were stable after SABR, whereas PF decreased after 3D-CRT approaching clinical significance already at 1 year.</description><subject>3D-conformal radiotherapy</subject><subject>ACCURACY</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>Carcinoma, Non-Small-Cell Lung - radiotherapy</subject><subject>Carcinoma, Non-Small-Cell Lung - surgery</subject><subject>Confidence Intervals</subject><subject>Diagnostic Self Evaluation</subject><subject>Dose Fractionation</subject><subject>Dyspnea - diagnosis</subject><subject>Female</subject><subject>HAZARDS</subject><subject>Health Status</subject><subject>Health-related quality of life</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>High-precision conformal radiotherapy</subject><subject>Humans</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - radiotherapy</subject><subject>Lung Neoplasms - surgery</subject><subject>LUNGS</subject><subject>Male</subject><subject>Middle Aged</subject><subject>MULTIVARIATE ANALYSIS</subject><subject>Neoplasm Recurrence, Local</subject><subject>NEOPLASMS</subject><subject>Non–small cell lung cancer</subject><subject>PATIENTS</subject><subject>Prospective Studies</subject><subject>Quality of Life</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radiosurgery - methods</subject><subject>Radiosurgery - mortality</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy, Conformal - methods</subject><subject>Radiotherapy, Conformal - mortality</subject><subject>Regression Analysis</subject><subject>RISK ASSESSMENT</subject><subject>SIMULATION</subject><subject>STANDARD OF LIVING</subject><subject>Stereotactic body radiotherapy</subject><subject>Surveys and Questionnaires</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk-LFDEQxRtR3HH1G4gEPOilx6pOp_9chGXc1YUB0VHwFtLpym7Gns5skh6Yb296Z_XgQS8JCb_3iqpXWfYSYYmA1bvt0m696_bLAhCXwJcgikfZApu6zbkQPx5nC-AV5DzBZ9mzELYAiazLp9lZgVUJAvgiC5vJH-xBDUyNPfsyqcHGI3OGra0hdmEiebZJB7modLSaOc_4h3zlRuP8Lsm-qt66eEte7Y8s_bHr0e3TqxuIXSo_HPNNVDfE1tN4w1Zq1OSfZ0-MGgK9eLjPs-9Xl99Wn_L154_Xq4t1rsu6jnnfGcXbum6oUKahstWqxZobgwV1ZdlRKbTQvCl13yjBix566AR2RrQVISI_z16ffF2IVgZtI-lb7caRdJRFAaLkdZuoNydq793dRCHKnQ2ahkGN5KYgW0AOVVE1iXz7TxKrpq4qjvem5QnV3oXgyci9tzvljxJBzvHJrTzFJ-f4JHCZ4kuyVw8Vpm5H_R_R77wS8P4EUJrbwZKf26I01N76uave2f9V-NtAD3a0Wg0_6Uhh6yY_pkwkylBIkJt5heYNQgQQ2LT8F-3lwc0</recordid><startdate>20111115</startdate><enddate>20111115</enddate><creator>Widder, Joachim, M.D., Ph.D</creator><creator>Postmus, Douwe, Ph.D</creator><creator>Ubbels, Jan F., M.D</creator><creator>Wiegman, Erwin M., M.D</creator><creator>Langendijk, Johannes A., Prof., M.D., Ph.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope><scope>7X8</scope><scope>OTOTI</scope></search><sort><creationdate>20111115</creationdate><title>Survival and Quality of Life After Stereotactic or 3D-Conformal Radiotherapy for Inoperable Early-Stage Lung Cancer</title><author>Widder, Joachim, M.D., Ph.D ; Postmus, Douwe, Ph.D ; Ubbels, Jan F., M.D ; Wiegman, Erwin M., M.D ; Langendijk, Johannes A., Prof., M.D., Ph.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-dbfa39778e2af8e49ca9173ff12eb44be45c5c384cd8a532d0d0b51bf596e1113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>3D-conformal radiotherapy</topic><topic>ACCURACY</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Carcinoma, Non-Small-Cell Lung - mortality</topic><topic>Carcinoma, Non-Small-Cell Lung - pathology</topic><topic>Carcinoma, Non-Small-Cell Lung - radiotherapy</topic><topic>Carcinoma, Non-Small-Cell Lung - surgery</topic><topic>Confidence Intervals</topic><topic>Diagnostic Self Evaluation</topic><topic>Dose Fractionation</topic><topic>Dyspnea - diagnosis</topic><topic>Female</topic><topic>HAZARDS</topic><topic>Health Status</topic><topic>Health-related quality of life</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>High-precision conformal radiotherapy</topic><topic>Humans</topic><topic>Lung Neoplasms - mortality</topic><topic>Lung Neoplasms - pathology</topic><topic>Lung Neoplasms - radiotherapy</topic><topic>Lung Neoplasms - surgery</topic><topic>LUNGS</topic><topic>Male</topic><topic>Middle Aged</topic><topic>MULTIVARIATE ANALYSIS</topic><topic>Neoplasm Recurrence, Local</topic><topic>NEOPLASMS</topic><topic>Non–small cell lung cancer</topic><topic>PATIENTS</topic><topic>Prospective Studies</topic><topic>Quality of Life</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radiosurgery - methods</topic><topic>Radiosurgery - mortality</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy, Conformal - methods</topic><topic>Radiotherapy, Conformal - mortality</topic><topic>Regression Analysis</topic><topic>RISK ASSESSMENT</topic><topic>SIMULATION</topic><topic>STANDARD OF LIVING</topic><topic>Stereotactic body radiotherapy</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Widder, Joachim, M.D., Ph.D</creatorcontrib><creatorcontrib>Postmus, Douwe, Ph.D</creatorcontrib><creatorcontrib>Ubbels, Jan F., M.D</creatorcontrib><creatorcontrib>Wiegman, Erwin M., M.D</creatorcontrib><creatorcontrib>Langendijk, Johannes A., Prof., M.D., Ph.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Widder, Joachim, M.D., Ph.D</au><au>Postmus, Douwe, Ph.D</au><au>Ubbels, Jan F., M.D</au><au>Wiegman, Erwin M., M.D</au><au>Langendijk, Johannes A., Prof., M.D., Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Survival and Quality of Life After Stereotactic or 3D-Conformal Radiotherapy for Inoperable Early-Stage Lung Cancer</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2011-11-15</date><risdate>2011</risdate><volume>81</volume><issue>4</issue><spage>e291</spage><epage>e297</epage><pages>e291-e297</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose To investigate survival and local recurrence after stereotactic ablative radiotherapy (SABR) or three-dimensional conformal radiotherapy (3D-CRT) administered for early-stage primary lung cancer and to investigate longitudinal changes of health-related quality of life (HRQOL) parameters after either treatment. Methods and Materials Two prospective cohorts of inoperable patients with T1-2N0M0 primary lung tumors were analyzed. Patients received 70 Gy in 35 fractions with 3D-CRT or 60 Gy in three to eight fractions with SABR. Global quality of life (GQOL), physical functioning (PF), and patient-rated dyspnea were assessed using the respective dimensions of European Organization for Research and Treatment of Cancer Core Questionnaire-C30 and LC13. HRQOL was analyzed using multivariate linear mixed-effects modeling, survival and local control (LC) using the Kaplan-Meier method, Cox proportional hazards analysis, and Fine and Gray multivariate competing risk analysis as appropriate. Results Overall survival (OS) was better after SABR compared with 3D-CRT with a HR of 2.6 (95% confidence interval [CI]: 1.5–4.8; p < 0.01). 3D-CRT conferred a subhazard ratio for LC of 5.0 (95% CI: 1.7–14.7; p < 0.01) compared with SABR. GQOL and PF were stable after SABR ( p = 0.21 and p = 0.62, respectively). Dyspnea increased after SABR by 3.2 out of 100 points (95% CI: 1.0–5.3; p < 0.01), which is clinically insignificant. At 1 year, PF decreased by an excess of 8.7 out of 100 points (95% CI: 2.8–14.7; p < 0.01) after 3D-CRT compared with SABR. Conclusion In this nonrandomized comparison of two prospective cohorts of medically inoperable patients with Stage I lung cancer, OS and LC were better after SABR. GQOL, PF, and patient-rated dyspnea were stable after SABR, whereas PF decreased after 3D-CRT approaching clinical significance already at 1 year.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>21640503</pmid><doi>10.1016/j.ijrobp.2011.03.052</doi></addata></record> |
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| subjects | 3D-conformal radiotherapy ACCURACY Aged Aged, 80 and over Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - pathology Carcinoma, Non-Small-Cell Lung - radiotherapy Carcinoma, Non-Small-Cell Lung - surgery Confidence Intervals Diagnostic Self Evaluation Dose Fractionation Dyspnea - diagnosis Female HAZARDS Health Status Health-related quality of life Hematology, Oncology and Palliative Medicine High-precision conformal radiotherapy Humans Lung Neoplasms - mortality Lung Neoplasms - pathology Lung Neoplasms - radiotherapy Lung Neoplasms - surgery LUNGS Male Middle Aged MULTIVARIATE ANALYSIS Neoplasm Recurrence, Local NEOPLASMS Non–small cell lung cancer PATIENTS Prospective Studies Quality of Life Radiology RADIOLOGY AND NUCLEAR MEDICINE Radiosurgery - methods Radiosurgery - mortality RADIOTHERAPY Radiotherapy, Conformal - methods Radiotherapy, Conformal - mortality Regression Analysis RISK ASSESSMENT SIMULATION STANDARD OF LIVING Stereotactic body radiotherapy Surveys and Questionnaires |
| title | Survival and Quality of Life After Stereotactic or 3D-Conformal Radiotherapy for Inoperable Early-Stage Lung Cancer |
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