Increasing Heart Dose Reduces Overall Survival in Patients Undergoing Postoperative Radiation Therapy for NSCLC.
Increasing Heart Dose Reduces Overall Survival in Patients Undergoing Postoperative Radiation Therapy for NSCLC.
复制标题
DOI：
10.1016/j.jtocrr.2021.100209
复制
发表时间：
2021-08
影响因子：
--
通讯作者：
Rimner A
中科院分区：
文献类型：
--
作者：
Shepherd AF;Yu AF;Iocolano M;Leeman JE;Wild AT;Imber BS;Chaft JE;Offin M;Huang J;Isbell JM;Wu AJ;Gelblum DY;Shaverdian N;Simone CB 2nd;Gomez D;Yorke E;Jackson A;Rimner A
考虑到对接受术后放疗（PORT）的NSCLC患者的心肺毒性的担忧，本研究的目的是评价采用现代技术接受PORT的患者的心脏剂量与总生存期（OS）之间的相关性。这是一项对2004年5月至2017年1月期间接受PORT治疗的连续NSCLC患者进行的回顾性研究。回顾临床记录，分析放射剂量分布与OS的关系。共分析了284例患者。在手术时，大多数患者的病理为美国癌症联合委员会第七版III期疾病（91.2%），并接受术前或辅助化疗（92.3%）。大多数患者接受了肺叶切除术（81.3%），并进行了R0（80.6%）或R1（19.4%）切除。PORT的中位辐射剂量为54戈伊，70.4%的患者接受了调强放射治疗。在大范围的心脏剂量范围内，剂量学变量对OS具有高度显著性（p < 0.05）。接受8戈伊的心脏体积（HV 8）是最显著的剂量学变量（p < 0.001），中位HV 8为35.5%。HV8高于或低于35.5%的患者的中位OS分别为33.2和53.6个月（p < 0.005）。在考虑其他潜在预后混杂因素的多变量分析中，HV 8仍然非常显着（p < 0.001）。数据显示，在接受PORT的NSCLC患者中，增加心脏剂量与OS之间存在强相关性。结合近期的LungART试验，降低PORT患者的心脏剂量可能有助于降低PORT的发病率和死亡率，提高PORT的治疗率。
Given the concern for cardiopulmonary toxicity in patients with NSCLC undergoing postoperative radiation therapy (PORT), the purpose of this study was to evaluate the association between heart dose and overall survival (OS) in patients undergoing PORT with modern techniques. This is a retrospective study of consecutive patients with NSCLC treated with PORT between May 2004 and January 2017. Clinical records were reviewed and radiation dose distributions were analyzed for association with OS. A total of 284 patients were analyzed. At the time of surgery, most patients had pathologic American Joint Committee on Cancer seventh edition stage III disease (91.2 %) and received either preoperative or adjuvant chemotherapy (92.3 %). Most patients underwent a lobectomy (81.3 %) and had R0 (80.6 %) or R1 (19.4 %) resection. PORT was delivered with a median radiation dose of 54 Gy, and 70.4 % of patients were treated with intensity-modulated radiation therapy. Dosimetric variables across a large range of doses to the heart were highly significant (p < 0.05) for OS. The volume of the heart receiving 8 Gy (HV8) was the most significant dosimetric variable (p < 0.001), and the median HV8 was 35.5 %. The median OS was 33.2 versus 53.6 months (p < 0.005) for patients with HV8 above or below 35.5 %, respectively. On multivariable analysis accounting for other potential prognostic confounders, HV8 remained highly significant (p < 0.001). The data reveal a strong correlation between increasing heart dose and OS in patients with NSCLC undergoing PORT. Taken together with the recently presented LungART trial, lowering heart dose in PORT patients may help to decrease the risk of morbidity and mortality and improve the therapeutic ratio of PORT.
登录
查看更多内容
影响因子：
20.4
作者：
Speirs, Christina K.;DeWees, Todd A.;Robinson, Cliff G.
通讯作者：
Robinson, Cliff G.
DOI：
10.1016/j.ijrobp.2008.01.044
发表时间：
2008-11-01
影响因子：
7
作者：
Douillard, Jean-Yves;Rosell, Rafael;Mahe, Marc-Andre
通讯作者：
Mahe, Marc-Andre
影响因子：
45.3
作者：
Bradley, Jeffrey D.;Hu, Chen;Choy, Hak
通讯作者：
Choy, Hak
影响因子：
158.5
作者：
Wu, Yi-Long;Tsuboi, Masahiro;Herbst, Roy S.
通讯作者：
Herbst, Roy S.
DOI：
10.1200/jco.2017.74.0720
发表时间：
2018-06-20
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Liao Z;Lee JJ;Komaki R;Gomez DR;O'Reilly MS;Fossella FV;Blumenschein GR Jr;Heymach JV;Vaporciyan AA;Swisher SG;Allen PK;Choi NC;DeLaney TF;Hahn SM;Cox JD;Lu CS;Mohan R
通讯作者：
Mohan R