Impact of introducing intensity-modulated radiotherapy (IMRT) on curative intent radiotherapy and survival for lung cancer
Chan, Clara Fornacon-Wood, Isabella Banfill, Kathryn Coote, Joanna H Garbett, Alexander Harris, Maggie A Hudson, Andrew M Kennedy, Jason Pemberton, Laura S
Chan, Clara
Fornacon-Wood, Isabella
Banfill, Kathryn
Coote, Joanna H
Garbett, Alexander
Harris, Maggie A
Hudson, Andrew M
Kennedy, Jason
Pemberton, Laura S
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Abstract
Introduction: Lung cancer survival remains poor. Intensity-modulated radiotherapy (IMRT) has allowed treatment of more
complex tumours as it improves radiotherapy dose conformity
around the tumour and greater normal tissue sparing. However,
there is limited evidence in the literature assessing the clinical
impact of IMRT. In this study, we evaluated whether the introduction
of IMRT has influenced the proportion of patients treated with
curative-intent radiotherapy over time, and patient survival.
Methods: Patients treated with thoracic radiotherapy at our institute
between 2005-2020 were retrospectively identified and grouped
into three time periods: A) 2005-2008 (pre-IMRT), B) 2009-2012
(some availability IMRT), and C) 2013-2020 (full access IMRT). Data
on performance status (PS), stage, age, gross tumour volume (GTV)
and survival were collected. The proportion of patients treated with
a curative dose between these periods was compared. Multivariable
survival models were fitted to evaluate the hazard for patients
treated in each time period, adjusting for PS, stage, age and tumour
volume.
Results: 12,499 patients were included in the analysis (n=2675 (A),
n=3127 (B), and n=6697 (C)). The proportion of patients treated with
curative-intent radiotherapy increased between the 3 time periods,
from 38.1% to 50.2% to 65.6% (p<0.001). This trend was seen across
all PS and stages. The GTV increased across time periods. Curative-intent patients treated during period C had a survival improvement
compared to time period A (HR=0.725 (0.632-0.831), p<0.001).
Conclusion: The introduction of IMRT was associated with more
patients receiving curative-intent radiotherapy across all PS and stages of disease. It also facilitated the treatment of larger tumours
that historically would have been treated palliatively. Despite
treating larger tumours, a survival benefit was seen when full access
to IMRT was available (2013-2020). This study highlights the impact
IMRT has had on our practice, accepting that improved survival may
also be attributed to other contributing factors.
Affiliation
Description
Date
2022
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Chan C, Fornacon-Wood I, Bayman N, Banfil K, Coote J, Garbett A, et al. Impact of introducing intensity modulated radiotherapy (IMRT) on curative intent radiotherapy and survival for lung cancer. Vol. 165, Lung Cancer. Elsevier BV; 2022. p. S49.