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Massaro M, Franceschini D, Spoto R, Dominici L, Franzese C, Baldaccini D, Marini B, di Cristina L, Marzo MA, lo Faro L, Paganini L, Reggiori G, Galdieri C, Testori A, Scorsetti M. Locally Advanced Non-Small Cell Lung Cancer: Clinical Outcome, Toxicity and Predictive Factors in Patients Treated with Hypofractionated Sequential or Exclusive Radiotherapy. Curr Oncol 2022; 29:4893-4901. [PMID: 35877248 PMCID: PMC9325151 DOI: 10.3390/curroncol29070388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This study evaluated the outcome, toxicity and predictive factors in patients unfit for concurrent chemo-radiotherapy (CT-RT) treated with hypofractionated sequential CT-RT or exclusive radiotherapy (RT) for locally advanced non-small cell lung cancer (LA-NSCLC). Methods: We included patients affected by LA-NSCLC (stage IIA-IVA) treated with a total dose of 50–60 Gy in 20 fractions. The primary outcomes were local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS) and overall survival (OS). Univariate analysis was used to correlate outcomes with prognostic factors. Results: Between 2011 and 2019, 210 patients were treated, 113 (53.8%) with sequential CT-RT and 97 (46.2%) with exclusive RT. After a median follow-up of 15.3 months, 74 patients (35.2%) had a local progression and 133 (63.3%) had a distant progression. The one-, two- and five-year LC were 73.6%, 55.3% and 47.9%, respectively. At the time of analysis, 167 patients (79.5%) died. The one-, two- and five-year OS were 64.7%, 36% and 20%, respectively. PTV volume correlated with PFS (p = 0.001) and LC (p = 0.005). Acute and late toxicity occurred in 82% and 26% of patients. Conclusions: Albeit with the known limitations of a retrospective and heterogeneous study, our work shows that hypofractionated sequential CT-RT or exclusive RT offer a good local control and toxicity profile and a promising survival rate in LA-NSCLC patients unfit for the concurrent CT-RT scheme.
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Affiliation(s)
- Maria Massaro
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
- Correspondence:
| | - Ruggero Spoto
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
| | - Luca Dominici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
| | - Ciro Franzese
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Davide Baldaccini
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
| | - Beatrice Marini
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Luciana di Cristina
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Marco A. Marzo
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Lorenzo lo Faro
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Lucia Paganini
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
| | - Giacomo Reggiori
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
| | - Carmela Galdieri
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.M.); (R.S.); (L.D.); (C.F.); (D.B.); (B.M.); (L.d.C.); (M.A.M.); (L.l.F.); (L.P.); (G.R.); (C.G.); (M.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
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