Dose of radiation affects quality of life in NSCLC trial
An analysis of quality-of-life (QOL) data of stage III lung cancer patients who received higher doses of radiation therapy with chemotherapy showed a significantly lower QOL at 3 months after treatment compared with patients who received a standard dose of radiation with chemotherapy. This study was presented at the American Society for Radiation Oncology's 55th Annual Meeting in Atlanta, Georgia. The study also suggested that patients who received intensity-modulated radiation therapy (IMRT) reported less decline in their QOL compared with those who received three-dimensional conformal radiation therapy (3-D CRT).
The research team compiled data from the RTOG 0617 study, which was a phase III, randomized clinical trial of patients with locally advanced non–small cell lung cancer (NSCLC) conducted from 2007 to 2011. The randomized study compared a high-dose (HD) of 74 Gy to a standard dose (SD) of 60 Gy. All enrolled patients received concurrent chemotherapy of carboplatin/paclitaxel, and they were also randomized to be treated with or without cetuximab (C225). The radiation was administered with two types of radiation therapy: 3-D CRT, in which beams of radiation are shaped to match the tumor, or IMRT, a more sophisticated technique that uses a computer-controlled algorithm to modify the intensity of each beam to further spare normal tissue.
While the study was not randomized for the radiation-treatment technique (3-D CRT or IMRT), the pretreatment characteristics were not significantly different for these techniques except that higher stage tumors were treated with IMRT. Prior results of a planned analysis of the trial determined that the higher dose of radiation therapy was associated with lower overall survival, and, at that point, the high-dose radiation therapy arms of the study were closed. Information on QOL was collected using the Functional Assessment of Cancer Therapy-Trial Outcome Index (FACT-TOI), which compiles results on physical well-being, functional well-being, and lung cancer subscale.
The patients who received 74 Gy had a significantly higher clinically meaningful decline in lung cancer subscale (46%) compared with the patients who received 60 Gy (31%). Notably, those differences were resolved by 12 months. IMRT was associated with a much lower decline in QOL than 3-D CRT, even a year after treatment.
"This study further emphasizes the critical importance of patient-reported outcomes," said lead author Benjamin Movsas, MD, FASTRO, chairman of the department of radiation oncology at the Henry Ford Health System in Detroit, Michigan. "The fact that the QOL scores were initially lower in the high-dose radiation arm was illuminating because few differences in toxicity between the arms were noted by the health care providers. Thus, the patient-reported outcomes help tell 'the rest of the story.' Another intriguing discovery with our analysis was that QOL was significantly improved with the use of more sophisticated technology, ie, IMRT, relative to 3-D CRT, suggesting that advanced radiation-treatment techniques may provide meaningful QOL benefits for patients with non–small cell lung cancer."