Concurrent chemoradiotherapy in locally advanced non-small cell lung cancer: A retrospective analysis of the correlation between radiotherapy-related factors and tumor response

Background: To determine which radiotherapy parameters are associated with the tumor response of locally advanced non-small cell lung cancer (NSCLC) patients undergoing concurrent chemoradiotherapy. Materials and Methods: Thirty one patients with IIIA/IIIB NSCLC underwent chemoradiotherapy with a median dose of 63 Gy. On our actual treatments, we made radiotherapy planning to cover the planning target volume (PTV) with 95% of the prescribed dose, and checked the second CT simulation when a cumulative dose was about 36 Gy. For this study, each PTV of primary tumor was re-defined with even margins from the gross target volume (GTV), and the actual plan overlaid the re-defined PTV. The correlations between the tumor response rate during chemoradiotherapy and a2er chemoradiotherapy, and the dose distribution parameters (D95, V95, mean tumor dose and homogeneity index), total dose and GTV, were evaluated. Results: Median overall survival was 15.5 months and the two-year survival 42.3%. At first recurrence, radiation-field recurrence, distant metastases and simultaneous recurrence were developed in 35.5%, 41.9% and 9.7% of the cases, respectively. The dose distribution parameters were generally favorable and were not related with tumor response rate. The tumor response rate a2er chemoradiotherapy was correlated with the residual GTV at second simulation (γ=-0.627, p<0.001) and the tumor response rate during chemoradiotherapy (γ=0.541, p=0.003). Conclusion: Minimal correlation was found between the dose distribution parameters that were over the minimal dose requirement and tumor response in NSCLC with concurrent chemoradiotherapy. The small residual volume during chemoradiotherapy could indicate good tumor response a2er chemoradiotherapy.