Definitive Radiotherapy for Inoperable Stage IIB Non-small-cell Lung Cancer: Patterns of Care and Comparative Effectiveness.
Definitive Radiotherapy for Inoperable Stage IIB Non-small-cell Lung Cancer: Patterns of Care and Comparative Effectiveness.
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DOI：
10.1016/j.cllc.2019.10.005
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发表时间：
2020-05
影响因子：
3.6
通讯作者：
Torok JA
中科院分区：
文献类型：
--
作者：
Jacobs CD;Gao J;Wang X;Clarke JM;Tong B;Ready NE;Suneja G;Kelsey CR;Torok JA
有一个缺乏的数据，以指导病人的管理不可手术的IIB期（美国癌症联合委员会第八版）非小细胞肺癌。对2004年至2015年期间诊断的国家癌症数据库中的10，081名成年人进行了实践模式和比较有效性分析，并接受了立体定向体部放疗，大分割放疗或常规分割放疗。T3N0M0非小细胞肺癌的立体定向体部放疗使用率正在迅速增加，并与生存率的提高相关。本研究的目的是分析实践模式，并进行比较有效的确定性放射治疗技术不能手术IIB期（美国癌症联合委员会第八版）非小细胞肺癌（NSCLC）。确定了2004年至2015年期间国家癌症数据库中诊断为T3N0M0或T1 - 2N1M0 NCSLC并接受明确放疗的成人。病例分为立体定向体部放疗（SBRT）、大分割放疗（HFRT）或常规分割放疗（CFRT），并按全身治疗（ST）分层。考克斯比例风险模型评价了协变量对总生存期（OS）的影响。根据肿瘤大小、胸壁侵犯、多灶性和ST使用进行亚组分析，使用Kaplan-Meier估计OS。共有10，081例受试者符合入选标准：4401例T3N0M0（66.5% CFRT、11.0% HFRT和22.5% SBRT）和5680例T1 - 2N1M0（92.5% CFRT和7.5% HFRT）。对于T3N0M0 NSCLC，SBRT利用率从2006年的3.7%增加到2015年的35.4%。接受SBRT治疗的受试者更可能患有较小的肿瘤、多灶性肿瘤或腺癌组织学。对于> 5 cm的肿瘤、侵犯胸壁的肿瘤或多灶性肿瘤，SBRT的OS与CFRT相似或优于CFRT。多变量分析显示SBRT与OS改善显著相关（风险比，0.715; P <0.001）。对于T1 - 2N1M0 NSCLC，接受HFRT治疗的患者年龄明显较大，接受ST的可能性较小;然而，多变量分析显示HFRT和CFRT之间的OS无差异。CFRT + ST在美国最常用于治疗不进行手术的IIB期NSCLC，尽管它正在减少。T3N0M0 NSCLC的SBRT利用率正在增加，并与OS改善相关。
There is a paucity of data to guide management of patients with inoperable stage IIB (American Joint Committee on Cancer eighth edition) non–small-cell lung cancer. Practice patterns and comparative effectiveness analyses were performed for 10,081 adults in the National Cancer Database diagnosed between 2004 and 2015 and treated with stereotactic body radiotherapy, hypofractionated radiotherapy, or conventionally fractionated radiotherapy. Stereotactic body radiotherapy utilization for T3N0M0 non–small-cell lung cancer is increasing rapidly and was associated with improved survival. The purpose of this study was to analyze practice patterns and perform comparative effectiveness of definitive radiotherapy techniques for inoperable stage IIB (American Joint Committee on Cancer eighth edition) non–small-cell lung cancer (NSCLC). Adults in the National Cancer Database diagnosed with T3N0M0 or T1–2N1M0 NCSLC between 2004 and 2015 who received definitive radiotherapy were identified. Cases were divided as stereotactic body radiotherapy (SBRT), hypofractionated radiotherapy (HFRT), or conventionally fractionated radiotherapy (CFRT) and stratified by systemic therapy (ST). Cox proportional hazards models evaluated the effect of covariates on overall survival (OS). Subgroup analysis by tumor size, chest wall invasion, multifocality, and ST use was performed with Kaplan-Meier estimates of OS. A total of 10,081 subjects met inclusion criteria: 4401 T3N0M0 (66.5% CFRT, 11.0% HFRT, and 22.5% SBRT) and 5680 T1–2N1M0 (92.5% CFRT and 7.5% HFRT). For T3N0M0 NSCLC, SBRT utilization increased from 3.7% in 2006% to 35.4% in 2015. Subjects treated with SBRT were more likely to have smaller tumors, multifocal tumors, or adenocarcinoma histology. SBRT resulted in similar or superior OS compared with CFRT for tumors > 5 cm, tumors invading the chest wall, or multifocal tumors. SBRT was significantly associated with improved OS on multivariate analysis (hazard ratio, 0.715; P < .001). For T1–2N1M0 NSCLC, patients treated with HFRT were significantly older and less likely to receive ST; nevertheless, there was no difference in OS between HFRT and CFRT on multivariate analysis. CFRT + ST is utilized most frequently to treat stage IIB NSCLC in the United States when surgery is not performed, though it is decreasing. SBRT utilization for T3N0M0 NSCLC is increasing and was associated with improved OS.
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DOI：
10.1016/j.jtho.2016.05.022
发表时间：
2016-10
期刊：
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
影响因子：
--
作者：
Morgensztern D;Du L;Waqar SN;Patel A;Samson P;Devarakonda S;Gao F;Robinson CG;Bradley J;Baggstrom M;Masood A;Govindan R;Puri V
通讯作者：
Puri V
影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY
影响因子：
3.6
作者：
Peterson, Justin;Niles, Christian;Kubicek, Gregory J.
通讯作者：
Kubicek, Gregory J.
影响因子：
2
作者：
Eriguchi T;Takeda A;Sanuki N;Nishimura S;Takagawa Y;Enomoto T;Saeki N;Yashiro K;Mizuno T;Aoki Y;Oku Y;Yokosuka T;Shigematsu N
通讯作者：
Shigematsu N
影响因子：
20.4
作者：
Salazar, Michelle C.;Rosen, Joshua E.;Boffa, Daniel J.
通讯作者：
Boffa, Daniel J.