PV QA 4 - Poster Viewing Q&A 4
Purpose/Objective(s): We analyzed whether receipt of induction chemotherapy (ICT) or adjuvant chemotherapy (ACT) influenced radiation pneumonitis (RP) grade as rated by physicians, and by patient-reported outcomes (PROs), and lung uptake of 18F-fluorodeoxyglucose (FDG) among patients treated with concurrent chemoradiation therapy for stage III non-small cell lung cancer (NSCLC).
Materials/Methods: Subjects were 131 patients who received either ACT or ICT in addition to concurrent chemoradiation (CCRT) or CCRT alone as part of a randomized clinical trial involving both IMRT and protons; information on RP grade, mean standardized uptake values for FDG (SUVmean), and PRO scores were obtained from all patients and compared at various time points during and after therapy.
Results: Analysis of all patients as well as case-matched patients revealed that receiving either ACT or ICT in addition to CCRT resulted in significantly increased SUVmean at 4-6 months after CCRT. For all patients, those that received ACT or ICT in addition to CCRT had an SUVmean of 0.83 compared to an SUVmean of 0.73 for those that received CCRT alone (p=.04). In the case matched analysis, the ACT or ICT in addition to CCRT group had a SUVmean of 0.86, while the CCRT alone group had a SUVmean of 0.75 in the CCRT group (p=.04). A comparison of all patients treated with ICT plus CCRT with all patients treated with only CCRT revealed an increased SUVmean 4-6 months after CCRT. The SUVmean was 0.84 in the ICT plus CCRT group and 0.73 in the CCRT only group. In the analysis of all patients and in the case matched analysis, there was no statistically significant difference between the SUVmean of the ACT plus CCRT group and the CCRT alone group at any time period. There was no statistically significant difference in PRO or RP grade scores between the CCRT alone group and the CCRT plus ACT or ICT group, the CCRT plus ACT group, or CCRT plus ICT group. However, there was a trend for patients who received ICT to have higher RP scores at 4-6 months compared to patients treated with CCRT alone. The results of radiation modality on RP grade, SUVmean and PRO are presented elsewhere.
Conclusion: Adding sequential chemotherapy to CCRT, particularly ICT, was associated with increased SUVmean at 4-6 months after treatment. Since previous studies have shown that SUVmean is associated with RP and there was a trend for increased RP grade in patients treated with ICT, more randomized controlled trials are needed to see if the addition of ICT to CCRT causes an increase in severity of RP.
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