Treatment of stage I lung cancer in high-risk and inoperable patients: Comparison of prospective clinical trials using stereotactic body radiotherapy (RTOG 0236), sublobar resection (ACOSOG Z4032), and radiofrequency ablation (ACOSOG Z4033)
Treatment of stage I lung cancer in high-risk and inoperable patients: Comparison of prospective clinical trials using stereotactic body radiotherapy (RTOG 0236), sublobar resection (ACOSOG Z4032), and radiofrequency ablation (ACOSOG Z4033)
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DOI：
10.1016/j.jtcvs.2012.10.038
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发表时间：
2013-03-01
影响因子：
6
通讯作者：
Meyers, Bryan
中科院分区：
文献类型：
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作者：
Crabtree, Traves;Puri, Varun;Meyers, Bryan
目的：本研究的目的是比较立体定向全身放疗（放射治疗肿瘤学组 [RTOG] 试验 0236）、亚肺叶切除（美国外科医师学会肿瘤学组 [ACOSOG] 试验 Z4032）和射频消融（ACOSOG 试验 Z4033）的 3 项前瞻性临床试验的选择标准和短期结果。 方法：比较 RTOG 之间的选择标准和结果0236 (n = 55)、ACOSOG Z4032 (n = 211) 和 ACOSOG Z4033 (n = 51)。 RTOG 0236 和 ACOSOG Z4032 中使用年龄、东部肿瘤合作组表现状态、预测 1 秒用力呼气量百分比和预测肺一氧化碳弥散能力百分比对临床 1A 期患者进行倾向匹配分析。结果：ACOSOG Z4033 中接受射频消融的患者年龄较对照组患者大（75.6 +/- 7.5 岁）。 RTOG0236（72.5 +/- 8.8 年）和 ACOSOG Z4032（70.2 +/- 8.5 年；P=.0003）。 RTOG0236 的 1 秒预测用力呼气量的预处理百分比为 61.3% +/- 33.4%，ACOSOG Z4032 为 53.8% +/- 19.6%，ACOSOG Z4033 为 48.8% +/- 20.3% (P=.15)。 RTOG 0236 的预测肺一氧化碳弥散能力的预处理百分比为 61.6% +/- 30.2%，ACOSOG Z4032 为 46.4% +/- 15.6%，ACOSOG Z4033 为 43.7% +/- 18.0% (P=.001)。立体定向放疗、手术和射频消融的总体90天死亡率分别为0%、2.4%(5/211)和2.0%(1/51)(P=.5)。总体而言，未经调整的 30 天 3 级以上不良事件在手术中比立体定向放射治疗更常见（28% vs 9.1%，P=0.004），尽管两组在 90 天时没有差异。在 ACOSOG Z4032 临床分期 IA 的患者中，29.3% 的患者在手术时病理分期更为晚期。倾向匹配比较显示，立体定向全身放疗和手术在 30 天 3 级以上不良事件方面没有差异（比值比，2.37；95% 置信区间，0.75-9.90；P=.18）。结论：在适当匹配的患者中，亚肺叶切除和立体定向全身放疗之间的早期发病率没有差异。这些结果强调需要进行随机试验来描述每种治疗方式的相对生存获益，并帮助对高危患者进行分层。 （《胸心血管外科杂志》2013 年；145：692-99）
Objective: The purpose of the present study was to compare the selection criteria and short-term outcomes among 3 prospective clinical trials using stereotactic body radiotherapy (Radiation Therapy Oncology Group [RTOG] trial 0236), sublobar resection (American College of Surgeons Oncology Group [ACOSOG] trial Z4032), and radiofrequency ablation (ACOSOG trial Z4033).Methods: The selection criteria and outcomes were compared among RTOG 0236 (n = 55), ACOSOG Z4032 (n = 211), and ACOSOG Z4033 (n = 51). Age, Eastern Cooperative Oncology Group performance status, percentage of predicted forced expiratory volume in 1 second, and percentage of predicted carbon monoxide diffusing capacity of the lung were used to perform a propensity-matched analysis among patients with clinical stage 1A in RTOG 0236 and ACOSOG Z4032.Results: The patients in ACOSOG Z4033 undergoing radiofrequency ablation were older (75.6 +/- 7.5 years) than those in RTOG0236 (72.5 +/- 8.8 years) and ACOSOG Z4032 (70.2 +/- 8.5 years; P=.0003). The pretreatment percentage of predicted forced expiratory volume in 1 second was 61.3% +/- 33.4% for RTOG0236, 53.8% +/- 19.6% for ACOSOG Z4032, and 48.8% +/- 20.3% for ACOSOG Z4033 (P=.15). The pretreatment percentage of predicted carbon monoxide diffusing capacity of the lung was 61.6% +/- 30.2% for RTOG 0236, 46.4% +/- 15.6% for ACOSOG Z4032, and 43.7% +/- 18.0% for ACOSOG Z4033 (P=.001). The overall 90-day mortality for stereotactic body radiotherapy, surgery, and radiofrequency ablation was 0%, 2.4%(5/211), and 2.0%(1/51), respectively (P=.5). Overall, the unadjusted 30-day grade 3+ adverse events were more common with surgery than with stereotactic body radiotherapy (28% vs 9.1%, P=.004), although no difference was between the 2 groups at 90 days. Among the patients with clinical stage IA inACOSOG Z4032, 29.3% had a more advanced pathologic stage at surgery. A propensity-matched comparison showed no difference between stereotactic body radiotherapy and surgery for 30-day grade 3+ adverse events (odds ratio, 2.37; 95% confidence interval, 0.75-9.90; P=.18).Conclusions: Among appropriately matched patients, no difference was seen in early morbidity between sublobar resection and stereotactic body radiotherapy. These results underscore the need for a randomized trial to delineate the relative survival benefit of each modality and to help stratify patients considered high risk. (J Thorac Cardiovasc Surg 2013; 145: 692-99)