TY - JOUR
T1 - Associations of Pretreatment Physical Status Parameters with Tolerance of Concurrent Chemoradiation and Survival in Patients with Non-small Cell Lung Cancer
AU - Voorn, M.J.J.
AU - Aerts, L.P.A.
AU - Bootsma, G.P.
AU - Bezuidenhout, J.B.
AU - Van Kampen-van den Boogaart, V.E.M.
AU - Bongers, B.C.
AU - de Ruysscher, D.K.
AU - Janssen-Heijnen, M.L.G.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Objective: The aim of this study was to evaluate associations between pretreatment physical status parameters and tolerance of concurrent chemoradiation (cCHRT) and survival among patients with stage III non-small cell lung cancer (NSCLC). Methods: A retrospective cohort study was conducted among patients with stage III NSCLC who had received cCHRT between 2006 and 2015. Multivariate independent associations were analysed between the pretreatment parameters age, Charlson comorbidity index, World Health Organization performance status (WHO performance status), body mass index (BMI), fat-free mass index (FFMI), maximal handgrip strength, forced expiratory volume in one second and carbon monoxide lung diffusion capacity on the one hand with tolerance of cCHRT (defined as a received radiation dose at least equal to the prescribed radiation dose) and survival on the other hand. Results: 527 of 577 patients (91.3%) tolerated cCHRT. A WHO performance status ≥ 2 (odds ratio (OR) 0.43) and BMI < 18.5 kg/m
2 (OR 0.36) were associated with poorer tolerance of cCHRT. In the total group, a WHO performance status ≥ 2 (hazard ratio (HR) 1.73), low FFMI (HR 1.23) and intolerance of cCHRT (HR 1.55) were associated with poorer survival. Conclusion: In patients with stage III NSCLC receiving cCHRT, poor WHO performance status and BMI < 18.5 kg/m
2 were independently associated with tolerance of cCHRT. Physical status parameters and intolerance of cCHRT were independently associated with poorer survival. Besides using this information for treatment decisions, optimizing physical status in patients at risk for intolerance of cCHRT might be a next step for improving treatment outcomes. Graphic Abstract: [Figure not available: see fulltext.]
AB - Objective: The aim of this study was to evaluate associations between pretreatment physical status parameters and tolerance of concurrent chemoradiation (cCHRT) and survival among patients with stage III non-small cell lung cancer (NSCLC). Methods: A retrospective cohort study was conducted among patients with stage III NSCLC who had received cCHRT between 2006 and 2015. Multivariate independent associations were analysed between the pretreatment parameters age, Charlson comorbidity index, World Health Organization performance status (WHO performance status), body mass index (BMI), fat-free mass index (FFMI), maximal handgrip strength, forced expiratory volume in one second and carbon monoxide lung diffusion capacity on the one hand with tolerance of cCHRT (defined as a received radiation dose at least equal to the prescribed radiation dose) and survival on the other hand. Results: 527 of 577 patients (91.3%) tolerated cCHRT. A WHO performance status ≥ 2 (odds ratio (OR) 0.43) and BMI < 18.5 kg/m
2 (OR 0.36) were associated with poorer tolerance of cCHRT. In the total group, a WHO performance status ≥ 2 (hazard ratio (HR) 1.73), low FFMI (HR 1.23) and intolerance of cCHRT (HR 1.55) were associated with poorer survival. Conclusion: In patients with stage III NSCLC receiving cCHRT, poor WHO performance status and BMI < 18.5 kg/m
2 were independently associated with tolerance of cCHRT. Physical status parameters and intolerance of cCHRT were independently associated with poorer survival. Besides using this information for treatment decisions, optimizing physical status in patients at risk for intolerance of cCHRT might be a next step for improving treatment outcomes. Graphic Abstract: [Figure not available: see fulltext.]
KW - Non-small cell lung cancer
KW - Concurrent chemoradiation
KW - Treatment tolerance
KW - Survival
KW - Pretreatment risk assessment
U2 - 10.1007/s00408-021-00427-9
DO - 10.1007/s00408-021-00427-9
M3 - Article
C2 - 33693986
SN - 0341-2040
VL - 199
SP - 223
EP - 234
JO - Lung
JF - Lung
IS - 2
ER -