Associations of Pretreatment Physical Status Parameters with Tolerance of Concurrent Chemoradiation and Survival in Patients with Non-small Cell Lung Cancer

M.J.J. Voorn*, L.P.A. Aerts, G.P. Bootsma, J.B. Bezuidenhout, V.E.M. Van Kampen-van den Boogaart, B.C. Bongers, D.K. de Ruysscher, M.L.G. Janssen-Heijnen

*Corresponding author for this work

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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.



Original languageEnglish
Pages (from-to)223-234
Number of pages12
Issue number2
Publication statusPublished - 1 Apr 2021


  • Non-small cell lung cancer
  • Concurrent chemoradiation
  • Treatment tolerance
  • Survival
  • Pretreatment risk assessment

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