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    Impact of introducing intensity modulated radiotherapy on curative intent radiotherapy and survival for lung cancer

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    Authors
    Fornacon-Wood, Isabella
    Chan, Clara
    Bayman, Neil A
    Banfill, Kathryn
    Coote, Joanna H
    Garbett, Alexander
    Harris, Maggie A
    Hudson, Andrew M
    Kennedy, Jason
    Pemberton, Laura S
    Salem, Ahmes
    Sheikh, Hamid Y
    Whitehurst, Philip
    Woolf, David K
    Price, Gareth J
    Faivre-Finn, Corinne
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    Affiliation
    Division of Cancer Sciences, University of Manchester, Manchester
    Issue Date
    2022
    
    Metadata
    Show full item record
    Abstract
    Background: Lung cancer survival remains poor. The introduction of Intensity-Modulated Radiotherapy (IMRT) allows treatment of more complex tumours as it improves conformity around the tumour and greater normal tissue sparing. However, there is limited evidence assessing the clinical impact of IMRT. In this study, we evaluated whether the introduction of IMRT had an influence on the proportion of patients treated with curative-intent radiotherapy over time, and whether this had an effect on patient survival. Materials and methods: Patients treated with thoracic radiotherapy at our institute between 2005 and 2020 were retrospectively identified and grouped into three time periods: A) 2005-2008 (pre-IMRT), B) 2009-2012 (selective use of IMRT), and C) 2013-2020 (full access to IMRT). Data on performance status (PS), stage, age, gross tumour volume (GTV), planning target volume (PTV) 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). When stage IV patients were excluded, this increased to 40.1% to 58.1% to 82.9% (p<0.001). This trend was seen across all PS and stages. The GTV size increased across the time periods and PTV size decreased. Patients treated with curative-intent during period C had a survival improvement compared to time period A when adjusting for clinical variables (HR=0.725 (0.632-0.831), p<0.001). Conclusion: IMRT was associated with to more patients receiving curative-intent radiotherapy. In addition, it facilitated the treatment of larger tumours that historically would have been treated palliatively. Despite treating larger, more complex tumours with curative-intent, a survival benefit was seen for patients treated when full access to IMRT was available (2013-2020). This study highlights the impact of IMRT on thoracic oncology practice, accepting that improved survival may also be attributed to a number of other contributing factors, including improvements in staging, other technological radiotherapy advances and changes to systemic treatment.
    Citation
    Fornacon-Wood I, Chan C, Bayman N, Banfill K, Coote J, Garbett A, et al. Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer. Vol. 12, Frontiers in Oncology. Frontiers Media SA; 2022.
    Journal
    Frontiers in Oncology
    URI
    http://hdl.handle.net/10541/625379
    DOI
    10.3389/fonc.2022.835844
    PubMed ID
    35712515
    Additional Links
    https://dx.doi.org/10.3389/fonc.2022.835844
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.3389/fonc.2022.835844
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