Heart Dose Is an Independent Dosimetrie Predictor of Overall Survival in Locally Advanced Non-Small Cell Lung Cancer
Heart Dose Is an Independent Dosimetrie Predictor of Overall Survival in Locally Advanced Non-Small Cell Lung Cancer
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DOI：
10.1016/j.jtho.2016.09.134
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发表时间：
2017-02-01
影响因子：
20.4
通讯作者：
Robinson, Cliff G.
中科院分区：
文献类型：
--
作者：
Speirs, Christina K.;DeWees, Todd A.;Robinson, Cliff G.
导言：在局部晚期(LA)NSCLC标准剂量与大剂量放化疗的随机试验(放射治疗肿瘤组0617)中，高剂量组的总体存活率(OS)较差。虽然心脏剂量被认为是一个促成因素，但可操作的参数尚未确定。方法：收集在同一机构接受治疗的416例LA NSCLC患者的临床数据，根据放射治疗肿瘤组0617正常组织指南重新绘制333个可用治疗计划的子集。对322名患者的毒性和剂量学数据进行了分析；对251名患者进行了多因素分析。结果：患者接受放射治疗的剂量为50.0~84.9Gy.中位数为66.0Gy.中位随访期14.5个月。中位OS为16.8个月。1年和2年OS率分别为61.4%和38.8%。多因素分析显示，心脏V-50(受照体积=50Gy)、心脏体积、肺V-5(肺结构的比例[不包括靶体积])、双侧纵隔淋巴结受累和未同时化疗是OS恶化的独立相关因素。当按心脏V50<25%或25%或以上分层时，1年OS率分别为70.2%和46.8%，2年OS率分别为45.9%和26.7%(P<；0.0001)。心脏毒性患者的心脏V50中位数显著高于心脏毒性患者(20.8%比13.9%，p<；0.0001)。结论：接受放化疗的LA非小细胞肺癌患者心脏剂量与OS和心脏毒性有关。(C)2016年国际肺癌研究协会。爱思唯尔公司出版，版权所有。
Introduction: In the randomized trial of standard-versus high-dose chemoradiotherapy for locally advanced (LA) NSCLC (Radiation Therapy Oncology Group 0617), overall survival (OS) was worse in the high-dose arm. Although heart dose was suggested as a contributing factor, actionable parameters have not been established. We present an analysis of clinical and dosimetric parameters affecting OS in this patient population, focusing on heart dose.Methods: Clinical data were collected on 416 patients with LA NSCLC treated at a single institution, with a subset of 333 available treatment plans recontoured using Radiation Therapy Oncology Group 0617 normal tissue guidelines. Toxicity and dosimetry data were analyzed for 322 patients; multivariate analysis was performed on 251 patients. Dosimetric parameters of radiation to tumor and organs at risk were analyzed with clinical data pertaining to OS, disease-free survival, and toxicity.Results: Patients were treated with radiation therapy to prescribed doses of 50.0 to 84.9 Gy (median 66.0 Gy). Median follow-up was 14.5 months. Median OS was 16.8 months. The 1- and 2-year OS rates were 61.4% and 38.8%, respectively. On multivariate analysis, factors independently associated with worse OS were increasing heart V-50 (volume receiving >= 50 Gy), heart volume, lung V-5 (proportion of the lung structure [excluding the target volume]) receiving at least 5 Gy), bilateral mediastinal lymph node involvement, and lack of concurrent chemotherapy. When stratified by heart V50 less than 25% versus 25% or greater, the 1-year OS rates were 70.2% versus 46.8% and the 2-year OS rates were 45.9% versus 26.7% (p < 0.0001). Median heart V50 was significantly higher (20.8% versus 13.9%, p < 0.0001) for patients with cardiac toxicity with a Common Terminology Criteria for Adverse Events grade of 1 or higher.Conclusions: Heart dose is associated with OS and cardiac toxicity for patients with LA NSCLC treated with chemoradiotherapy. (C) 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.