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

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Abstract

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/m2 (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/m2 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.

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Acknowledgements

The authors would like to thank the registration team of the MAASTRO clinic for their dedicated data collection.

Funding

This study was supported by an unconditional research grant from the Research and Innovation fund VieCuri (Fonds Wetenschap and Innovatie VieCuri, Venlo, the Netherlands, E.17.31.033–6). This research did not receive any specific grants from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Clinical Epidemiology, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands

    Melissa J. J. Voorn & Maryska L. G. Janssen-Heijnen

  2. Adelante Rehabilitation Centre, Venlo, The Netherlands

    Melissa J. J. Voorn

  3. Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

    Melissa J. J. Voorn & Maryska L. G. Janssen-Heijnen

  4. Funqtio, Venlo, The Netherlands

    Loes P. A. Aerts

  5. Department of Pulmonology, Zuyderland Medical Centre, Heerlen, The Netherlands

    Gerbern P. Bootsma

  6. Department of Radiation Oncology, University Hospital Brussels, Brussels, Belgium

    Jacques B. Bezuidenhout

  7. Department of Pulmonology, VieCuri Medical Centre, Venlo, The Netherlands

    Vivian E. M. van Kampen-van den Boogaart

  8. Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

    Bart C. Bongers

  9. Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

    Bart C. Bongers

  10. Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Dirk K. de Ruysscher

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  1. Melissa J. J. Voorn
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Contributions

MV: Guarantor of integrity of the entire study. MV, LA and MJ: Study concepts and design. MV and LA: Literature research. LA, MV, JB and MJ: Data analysis. LA, MV, MJ and DR: Statistical analysis. LA and MV: Manuscript preparation. LA, MV, MJ, BB, VK, DR, JB and GB: Manuscript editing.

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Correspondence to Melissa J. J. Voorn.

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Voorn, M.J.J., Aerts, L.P.A., Bootsma, G.P. et al. Associations of Pretreatment Physical Status Parameters with Tolerance of Concurrent Chemoradiation and Survival in Patients with Non-small Cell Lung Cancer. Lung 199, 223–234 (2021). https://doi.org/10.1007/s00408-021-00427-9

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