Discontinuous stereotactic body radiotherapy schedule increases overall survival in early-stage non-small cell lung cancer
Discontinuous stereotactic body radiotherapy schedule increases overall survival in early-stage non-small cell lung cancer
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DOI：
10.1016/j.lungcan.2021.05.016
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发表时间：
2021-06-04
期刊：
影响因子：
5.3
通讯作者：
Castelli, J.
中科院分区：
文献类型：
--
作者：
Duverge, L.;Bondiau, P-Y;Castelli, J.
目的：立体定向体部放疗（SBRT）治疗早期非小细胞肺癌（NSCLC）的持续时间可能会影响患者的预后。我们的目的是确定连续与不连续SBRT方案对非小细胞肺癌患者局部控制（LC）和总生存期（OS）的影响。材料和方法：回顾性分析了四个中心连续接受SBRT治疗的I期非小细胞肺癌患者（475例）。照射剂量为48 ~ 75戈伊，分3-10次照射。根据治疗持续时间（TD）与分次数（n）的比值，将患者分为两组：连续方案（CS）组（TD 1.6n; 236例患者）。采用倾向评分匹配后的考克斯回归分析比较LC和OS（216对）。多变量分析显示DS（风险比（HR）：0.42; 95%置信区间（CI）：0.22-0.78）和分次数（HR：1.24; 95% CI：1.07-1.43）与LC显著相关。DS（HR：0.67; 95%可信区间：0.51-0.89）、年龄（HR：1.02; 95% CI：1-1.03）、WHO体能状态（HR：2.27; 95% CI：1.39-3.7）和T分期（HR：1.4; 95% CI：DS和CS治疗的3年LC和OS分别为92%和64%以及81%和53%（p < 0.01）。考克斯分析证实，不连续SBRT方案显着增加LC和OS。结论：DS与显着改善LC和OS在早期NSCLC患者接受SBRT治疗。
Objectives: The duration of stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) may affect patient outcomes. We aimed to determine the impact of a continuous versus discontinuous SBRT schedule on local control (LC) and overall survival (OS) in NSCLC patients.Materials and methods: Consecutive NSCLC stage I patients (475) treated with SBRT in four centers were retrospectively analyzed. The delivered dose ranged from 48 to 75 Gy in 3-10 fractions. Based on the ratio between the treatment duration (TD) and number of fractions (n), patients were divided into two groups: continuous schedule (CS) (TD 1.6n; 236 patients). LC and OS were compared using Cox regression analyses after propensity score matching (216 pairs).Results: The median follow-up period was 41 months. Multivariate analysis showed that the DS (hazard ratio (HR): 0.42; 95 % confidence interval (CI): 0.22-0.78) and number of fractions (HR: 1.24; 95 % CI: 1.07-1.43) were significantly associated with LC. The DS (HR: 0.67; 95 % CI: 0.51-0.89), age (HR: 1.02; 95 % CI: 1-1.03), WHO performance status (HR: 2.27; 95 % CI: 1.39-3.7), and T stage (HR: 1.4; 95 % CI: 1.03-1.87) were significantly associated with OS. The 3-year LC and OS were 92 % and 64 % and 81 % and 53 % for DS and CS treatments, respectively (p < 0.01). Cox analysis confirmed that the discontinuous SBRT schedule significantly increased LC and OS.Conclusion: DS is associated with significantly improved LC and OS in early-stage NSCLC patients treated with SBRT.