Despite minimal differences in clinician-reported toxicities between 74 Gy and 60 Gy radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab, 74 Gy radiotherapy is associated with a clinically meaningful decline in quality of life at 3 months in patients with non-small cell lung cancer (NSCLC), a new study published online ahead of print in JAMA Oncology has shown.1
Recent evidence from a radiation dose-escalation trial in patients with unresectable stage 3 NSCLC demonstrated a lower survival rate in the 74 Gy high-dose radiotherapy arm compared with the 60 Gy low-dose arm in combination with concurrent chemotherapy. Researchers expected that the high-dose radiation arm would be associated with reduced quality of life at 3 months.
In the phase 3 study, researchers enrolled 424 patients with stage 3 NSCLC and randomly assigned them to receive 74 Gy or 60 Gy radiation via 3-dimensional conformal radiation therapy (3D-CRT) or intensity-modulated radiation therapy (IMRT) with concurrent and consolidation carboplatin/paclitaxel with or without cetuximab. Of those, 313 completed baseline quality of life assessments. A total of 219 patients completed the 3-month assessments and 137 completed the 12-month assessment.
Results showed that 45% of patients in the high-dose arm had clinically meaningful decline in Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS) scores compared with 30% in the low-dose radiation arm (P = .02).
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Researchers found that at 12 months, 46% of patients who received 3D-CRT had clinically meaningful decline in FACT-LCS vs 21% of those who received IMRT (P = .003).
The study also demonstrated that baseline FACT Trial Outcome Index was associated with overall survival, suggesting that “baseline [quality of life] was an independent prognostic factor for survival,” the authors concluded.
- Movsas B, Hu C, Sloan J, et al. Quality of life analysis of a radiation dose-escalation study of patients with non-small-cell lung cancer: a secondary analysis of the Radiation Therapy Oncology Group 0617 Randomized Clinical Trial [published online ahead of print November 25, 2015]. JAMA Oncol. doi: 10.1001/jamaoncol.2015.3969.