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Prognostic Impact of Missed Chemotherapy Doses During Chemoradiation Therapy for Non–Small Cell Lung Cancer

Deek, Matthew, P., BA*; Kim, Sinae, PhD†,‡; Ahmed, Inaya, MD*; Fang, Bruno, S., MD§; Zou, Wei, PhD*; Malhotra, Jyoti, MD; Aisner, Joseph, MD; Jabbour, Salma, K., MD*

American Journal of Clinical Oncology: April 2018 - Volume 41 - Issue 4 - p 362–366
doi: 10.1097/COC.0000000000000293
Original Articles: Soft Tissue

Objective: The aim of this study is to investigate the impact of missed chemotherapy administrations (MCA) on the prognosis of non–small cell lung cancer (NSCLC) patients treated with definitive chemoradiation therapy (CRT).

Materials and Methods: In total, 97 patients with NSCLC treated with definitive CRT were assessed for MCA due to toxicities. Logistic regression was used to determine factors associated with MCA. Kaplan-Meier curves, log-rank tests, and Cox Proportional Hazards models were conducted.

Results: MCA occurred in 39% (n=38) of the patients. Median overall survival was 9.6 months for patients with MCA compared with 24.3 months for those receiving all doses (P=0.004). MCA due to decline in performance status was associated with the worst survival (4.6 mo) followed by allergic reaction (10.0 mo), hematologic toxicity (11 mo), and esophagitis (17.2 mo, P=0.027). In multivariate models, MCA was associated with higher mortality (hazard ratio, 1.97; P=0.01) and worse progression-free survival (hazard ratio, 1.96; P=0. 009).

Conclusions: MCA correlated with worse prognosis and increased mortality. Methods to reduce toxicity may improve administration of all chemotherapy doses and increase overall survival in NSCLC treated with CRT.

*Department of Radiation Oncology

Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University

Biometrics Division, Rutgers Cancer Institute of New Jersey, New Brunswick

Department of Biostatistics, School of Public Health, Rutgers University, Piscataway

§Regional Cancer Care Associates LLC, Central Jersey Division, East Brunswick, NJ

The authors declare no conflicts of interest.

Reprints: Salma K. Jabbour, MD, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903. E-mail:

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