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. 2001 Oct;85(8):1113–1118. doi: 10.1054/bjoc.2001.2049

Failure-specific prognostic factors after continuous hyperfractionated accelerated radiotherapy (CHART) or conventional radiotherapy in locally advanced non-small-cell lung cancer: A competing risks analysis

Ö U Ataman 1,3, S M Bentzen 1, M I Saunders 2, S Dische 2
PMCID: PMC2375163  PMID: 11710822

Abstract

The aim of this study was to identify possible failure-specific prognostic factors in non-small-cell lung cancer. Clinical outcome was analysed in 549 patients participating in the randomized controlled trial of CHART vs conventional radiotherapy. Local failure and distant failure with or without concurrent local relapse were subjected to a competing risk analysis using an accelerated failure-time model with a log-logistic hazard function. Randomization to CHART (2 P = 0.005), increasing age (2 P = 0.036) and female sex (2 P = 0.09) was all associated with a prolonged interval to failure. Advanced clinical stage was associated with a decreased interval to failure (2 P = 0.004) and a significantly increased risk (2 P = 0.009) of failing in distant rather than in local position. From this model, prognostic indices for local and distant failure were estimated for each individual patient. Competing risk analysis allows identification of patients with different failure patterns, and may provide a means of stratifying patients for intensified local or systemic therapy. © 2001 Cancer Research Campaign  http://www.bjcancer.com

Keywords: NSCLC, CHART, competing risks, failure-specific prognostic factors

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Selected References

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  1. Albain K. S., Crowley J. J., LeBlanc M., Livingston R. B. Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol. 1991 Sep;9(9):1618–1626. doi: 10.1200/JCO.1991.9.9.1618. [DOI] [PubMed] [Google Scholar]
  2. Ardizzoni A., Grossi F., Scolaro T., Giudici S., Foppiano F., Boni L., Tixi L., Cosso M., Mereu C., Ratto G. B. Induction chemotherapy followed by concurrent standard radiotherapy and daily low-dose cisplatin in locally advanced non-small-cell lung cancer. Br J Cancer. 1999 Sep;81(2):310–315. doi: 10.1038/sj.bjc.6990693. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Arriagada R., Kramar A., Le Chevalier T., De Cremoux H. Competing events determining relapse-free survival in limited small-cell lung carcinoma. The French Cancer Centers' Lung Group. J Clin Oncol. 1992 Mar;10(3):447–451. doi: 10.1200/JCO.1992.10.3.447. [DOI] [PubMed] [Google Scholar]
  4. Ball D., Bishop J., Smith J., O'Brien P., Davis S., Ryan G., Olver I., Toner G., Walker Q., Joseph D. A randomised phase III study of accelerated or standard fraction radiotherapy with or without concurrent carboplatin in inoperable non-small cell lung cancer: final report of an Australian multi-centre trial. Radiother Oncol. 1999 Aug;52(2):129–136. doi: 10.1016/s0167-8140(99)00093-6. [DOI] [PubMed] [Google Scholar]
  5. Bentzen S. M., Poulsen H. S., Kaae S., Jensen O. M., Johansen H., Mouridsen H. T., Daugaard S., Arnoldi C. Prognostic factors in osteosarcomas. A regression analysis. Cancer. 1988 Jul 1;62(1):194–202. doi: 10.1002/1097-0142(19880701)62:1<194::aid-cncr2820620129>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  6. Bentzen S. M., Thames H. D., Travis E. L., Ang K. K., Van der Schueren E., Dewit L., Dixon D. O. Direct estimation of latent time for radiation injury in late-responding normal tissues: gut, lung, and spinal cord. Int J Radiat Biol. 1989 Jan;55(1):27–43. doi: 10.1080/09553008914550041. [DOI] [PubMed] [Google Scholar]
  7. Chapman J. W., Fish E. B., Link M. A. Competing risks analyses for recurrence from primary breast cancer. Br J Cancer. 1999 Mar;79(9-10):1508–1513. doi: 10.1038/sj.bjc.6690240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ciampi A., Lawless J. F., McKinney S. M., Singhal K. Regression and recursive partition strategies in the analysis of medical survival data. J Clin Epidemiol. 1988;41(8):737–748. doi: 10.1016/0895-4356(88)90160-6. [DOI] [PubMed] [Google Scholar]
  9. Cox J. D., Scott C. B., Byhardt R. W., Emami B., Russell A. H., Fu K. K., Parliament M. B., Komaki R., Gaspar L. E. Addition of chemotherapy to radiation therapy alters failure patterns by cell type within non-small cell carcinoma of lung (NSCCL): analysis of radiation therapy oncology group (RTOG) trials. Int J Radiat Oncol Biol Phys. 1999 Feb 1;43(3):505–509. doi: 10.1016/s0360-3016(98)00429-5. [DOI] [PubMed] [Google Scholar]
  10. Komaki R., Scott C. B., Byhardt R., Emami B., Asbell S. O., Russell A. H., Roach M., Parliament M. B., Gaspar L. E. Failure patterns by prognostic group determined by recursive partitioning analysis (RPA) of 1547 patients on four radiation therapy oncology group (RTOG) studies in inoperable nonsmall-cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys. 1998 Sep 1;42(2):263–267. doi: 10.1016/s0360-3016(98)00213-2. [DOI] [PubMed] [Google Scholar]
  11. Kramar A., Pejovic M. H., Chassagne D. A method of analysis taking into account competing events: application to the study of digestive complications following irradiation for cervical cancer. Stat Med. 1987 Oct-Nov;6(7):785–794. doi: 10.1002/sim.4780060709. [DOI] [PubMed] [Google Scholar]
  12. Saunders M., Dische S., Barrett A., Harvey A., Griffiths G., Palmar M. Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trial. CHART Steering committee. Radiother Oncol. 1999 Aug;52(2):137–148. doi: 10.1016/s0167-8140(99)00087-0. [DOI] [PubMed] [Google Scholar]
  13. Stevens C. W., Lee J. S., Cox J., Komaki R. Novel approaches to locally advanced unresectable non-small cell lung cancer. Radiother Oncol. 2000 Apr;55(1):11–18. doi: 10.1016/s0167-8140(00)00163-8. [DOI] [PubMed] [Google Scholar]
  14. Takigawa N., Segawa Y., Okahara M., Maeda Y., Takata I., Kataoka M., Fujii M. Prognostic factors for patients with advanced non-small cell lung cancer: univariate and multivariate analyses including recursive partitioning and amalgamation. Lung Cancer. 1996 Aug;15(1):67–77. doi: 10.1016/0169-5002(96)00571-5. [DOI] [PubMed] [Google Scholar]
  15. Werner-Wasik M., Scott C., Cox J. D., Sause W. T., Byhardt R. W., Asbell S., Russell A., Komaki R., Lee J. S. Recursive partitioning analysis of 1999 Radiation Therapy Oncology Group (RTOG) patients with locally-advanced non-small-cell lung cancer (LA-NSCLC): identification of five groups with different survival. Int J Radiat Oncol Biol Phys. 2000 Dec 1;48(5):1475–1482. doi: 10.1016/s0360-3016(00)00801-4. [DOI] [PubMed] [Google Scholar]
  16. Wigren T. Confirmation of a prognostic index for patients with inoperable non-small cell lung cancer. Radiother Oncol. 1997 Jul;44(1):9–15. doi: 10.1016/s0167-8140(97)00087-x. [DOI] [PubMed] [Google Scholar]

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