Patient-reported outcomes provide valuable insight regarding quality of life for patients with NSCLC

September 23, 2013

An analysis of quality of life (QOL) data of stage III lung cancer patients who received higher doses of radiation therapy (with chemotherapy) shows a significantly lower quality of life at 3 months after treatment compared to patients who received a standard dose of radiation (with chemotherapy), according to research presented today at the American Society for Radiation Oncology's (ASTRO's) 55th Annual Meeting. The study also suggests that lung cancer patients who received intensity modulated radiation therapy (IMRT) reported less decline in their QOL compared to those receiving three-dimensional conformal radiation therapy (3-D CRT).

Patient data was compiled from the RTOG 0617 study, a phase III, of patients with locally advanced non-small cell lung cancer (NSCLC) conducted from 2007 to 2011. The randomized study compared a high-dose (HD) of 74 Gy to a standard dose (SD) of 60 Gy. All enrolled patients received concurrent chemotherapy of carboplatin/paclitaxel, and they were also randomized to be treated with or without (C225). The radiation was administered with two types of (RT): 3-D CRT, in which beams of radiation are shaped to match the tumor, or IMRT, a more sophisticated technique that uses a computer-controlled algorithm to modify the intensity of each beam to further spare normal tissue. While the study was not randomized for the radiation treatment technique (3-D CRT or IMRT), the pretreatment characteristics were not significantly different for these techniques except that higher stage tumors were treated with IMRT. Prior results of a planned analysis of the trial determined that the higher dose of radiation therapy was associated with lower overall survival (OS), and, at that point, the high-dose radiation therapy arms of the study were closed.

Because the RTOG study indicated that OS rates were lower with higher doses of radiation, despite few differences in provider-reported toxicity between the study's arms, researchers evaluated if patient-reported outcomes had any bearing on the results of the RTOG 0617 trial. Patient QOL scores were compared between the treatment arms, as well as between the RT techniques. QOL information was collected using the Functional Assessment of Cancer Therapy-Trial Outcome Index (FACT-TOI), which is a compilation of physical well being (PWB), functional well being (FWB), and lung cancer subscale (LCS) results. Results were studied at baseline, at the end of chemoradiation, and at three months and 12 months post-treatment. Two-sample t-tests?the Wilcoxon-Mann-Whitney test and the Chi-Square test?compared QOL between arms and between technologies (3-D CRT vs. IMRT) via two-sided p values and effect sizes (ES).

Baseline FACT-TOI were completed from each arm on 88 percent of patients, with no difference in patient demographics, baseline QOL scores or C225 use. Seventy-one percent of patients completed QOL data at three months, of whom approximately 60 percent of patients (225) completed it at 12 months.

The primary QOL hypothesis was that there would be a significant difference between arms at 3 months using the LCS, which focuses on key symptoms of lung cancer. A clinically meaningful decline (CMD) in LCS for patients receiving 74 Gy was significantly higher at three months post-treatment (46 percent) than for patients receiving 60 Gy (31 percent, p=0.024, ES 0.4); yet these differences resolved by 12 months, with the 74 Gy dose producing a CMD of 36 percent, and the 60 Gy dose producing a CMD of 39 percent (p=0.7, ES<0.1).

Additionally, the results suggested that IMRT, which was administered to 45 percent of patients in each arm, was associated with a much lower decline in QOL compared to those who received 3-D CRT, even a year after treatment. Indeed, at 12 months post-treatment, 23 percent of the IMRT patients in either arm had a CMD in LCS, as opposed to 47 percent of 3-D CRT patients (p=0.005, ES 0.3).

"This study further emphasizes the critical importance of patient-reported outcomes," said Benjamin Movsas, MD, FASTRO, the lead author of the study and chairman of the department of at the Henry Ford Health System in Detroit. "The fact that the QOL scores were initially lower in the high- arm was illuminating because few differences in toxicity between the arms were noted by the health care providers. Thus, the patient-reported outcomes help tell 'the rest of the story.' Another intriguing discovery with our analysis was that QOL was significantly improved with the use of more sophisticated technology, i.e. IMRT (relative to 3-D CRT), suggesting that advanced techniques may provide meaningful QOL benefits for with non-small cell ."

Explore further: Higher radiation dose does not help lung cancer patients live longer

More information: The abstract, "Quality of Life (QOL) Analysis of the Randomized Radiation (RT) Dose Escalation NSCLC Trial (RTOG 0617): The Rest of the Story," will be presented in detail today in the Plenary session at ASTRO's Annual Meeting at 2:00 p.m. Eastern time, on Monday, September 23, 2013.

Related Stories

Higher radiation dose does not help lung cancer patients live longer

October 3, 2011
A higher dose of radiation (74 Gy) does not improve overall survival for non-small cell lung cancer that has spread to the lymph nodes, compared to the standard radiation dose (60 Gy), according to an interim analysis of ...

Higher-dose RT results in inferior survival in patients with stage III lung cancer

May 29, 2013
In a randomized phase III clinical trial conducted by the Radiation Therapy Oncology Group (RTOG), high-dose (HD), compared with standard-dose (SD), radiotherapy (RT) with concurrent chemotherapy (CT) did not improve overall ...

Cisplatin combined with high-dose brachytherapy for advanced cervical cancer may be more beneficial

September 23, 2013
Adding the chemotherapy drug cisplatin to a treatment plan of radiation therapy (RT) and high-dose-rate brachytherapy (HDRB) for stage IIIB cervical cancer is beneficial, according to research presented today at the American ...

IMRT has less harmful rectal side effects than 3D-CRT for prostate cancer patients

September 26, 2011
Men with localized prostate cancer treated with a newer technology, intensity modulated radiation therapy (IMRT), have more than a quarter (26 percent) fewer late bowel and rectal side effects and a statistically improved ...

Sulfasalazine does not reduce diarrhea for patients receiving pelvic radiation therapy

September 23, 2013
Patients receiving radiotherapy (RT) for cancers in the pelvic region can experience diarrhea, a negative side effect of radiation treatment. Sulfasalazine, an oral tablet used to treat inflammation of the bowels, had been ...

Researchers investigate a less toxic radiation treatment for HPV-Positive oropharynx cancer

May 31, 2013
Researchers from Fox Chase Cancer Center and other institutions have completed a phase II clinical trial that may help identify those patients with HPV-positive oropharyngeal cancer who do not require the full radiation dose ...

Recommended for you

New therapeutic approach for difficult-to-treat subtype of ovarian cancer identified

July 24, 2017
A potential new therapeutic strategy for a difficult-to-treat form of ovarian cancer has been discovered by Wistar scientists. The findings were published online in Nature Cell Biology.

Anti-cancer chemotherapeutic agent inhibits glioblastoma growth and radiation resistance

July 24, 2017
Glioblastoma is a primary brain tumor with dismal survival rates, even after treatment with surgery, chemotherapy and radiation. A small subpopulation of tumor cells—glioma stem cells—is responsible for glioblastoma's ...

Immune cells the missing ingredient in new bladder cancer treatment

July 24, 2017
New research offers a possible explanation for why a new type of cancer treatment hasn't been working as expected against bladder cancer.

No dye: Cancer patients' gray hair darkened on immune drugs

July 21, 2017
Cancer patients' gray hair unexpectedly turned youthfully dark while taking novel drugs, and it has doctors scratching their heads.

Shooting the achilles heel of nervous system cancers

July 20, 2017
Virtually all cancer treatments used today also damage normal cells, causing the toxic side effects associated with cancer treatment. A cooperative research team led by researchers at Dartmouth's Norris Cotton Cancer Center ...

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.