The impact of overall treatment time on outcomes in radiation therapy for non-small cell lung cancer
The impact of overall treatment time on outcomes in radiation therapy for non-small cell lung cancer
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DOI：
10.1016/s0169-5002(99)00113-0
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发表时间：
2000-04-01
期刊：
影响因子：
5.3
通讯作者：
Liu, TF
中科院分区：
文献类型：
--
作者：
Chen, M;Jiang, GL;Liu, TF
目的：回顾性研究了总治疗时间（OTT）对非小细胞肺癌（NSCLC）放射治疗结果的影响。材料和方法：1990年1月至1996年12月，256例I-IIIb期NSCLC患者纳入本研究。所有患者均接受了确定性放疗。用生物有效剂量（BED）来规范辐照效应。采用线性回归和考克斯比例风险模型分析OTT与局部无进展生存期的相关性。生存和远处转移的预后变量也进行了简要研究。结果如下：64例患者因加速超分割照射而缩短了OTT，114例患者因照射过程中断而延长了OTT。中断的主要原因是机器故障或延迟准备塞罗本阻滞剂（55%）、假期（11%）和治疗毒副作用（34%）。长期OTT（> 45天）患者的局部无进展生存率明显低于≤ 45天者，1、3、5年的精确局部无进展生存率分别为49、17、15%和74、35、25%（P < 0.001）。含DTT因子的BED-T与局部对照直接相关，说明BED-T能准确反映放射生物学效应，即OTT对放射生物学效应起决定作用。对103例接受80-85戈伊BED治疗的患者进行线性回归分析（10），结果显示，在30-76天的OTT范围内，随着OTT的延长，3年局部无进展生存期每周减少9%，反之，随着OTT的缩短，3年局部无进展生存期每周增加9%。考克斯多变量分析证实OTT是局部对照的独立预后因素。结论：OTT可能在确定非小细胞肺癌放疗的局部控制方面发挥了重要作用。应始终牢记，只要患者能够耐受，就应尽可能缩短OTT，并将因任何原因造成的照射中断减少到最低限度。(C)2000爱思唯尔科学爱尔兰有限公司保留所有权利。
Purpose: A retrospective study was carried out to evaluate the impact of overall treatment time (OTT) on the results of radiation therapy for non-small cell lung cancer (NSCLC). Materials and methods: From Jan. 1990 to Dec. 1996, 256 patients with stages I-IIIb NSCLC entered this analysis. All patients received definitive radiotherapy. Biologically effective dose (BED) was used to standardize the irradiation effects. The correlation between OTT and local progression-free survival was analyzed by linear-regression and Cox proportional hazard models. The prognostic variables for survival and distant metastasis were also briefly studied. Results: OTT had been shortened in 64 patients because of an accelerated hyperfractionated irradiation, while OTT was prolonged in 114 patients due to interruptions of irradiation courses. The main causes of interruption were machine breakdown or delayed preparations of cerrobend block for boost fields (55%), holidays (11%) and treatment toxicity and side-effects (34%). Patients treated with prolonged OTT (> 45 days) had significant poorer local progression-free survival than whom with OTT of less than or equal to 45 days, 1, 3 and 5 year actuarial local progression-free survivals being 49, 17 and 15% for the former, and 74, 35 and 25% for the latter, respectively (P < 0.001). BED-T that contained the factor of DTT correlated directly to local controls, which implied that BED-T represented radiobiological effects accurately, in other words, OTT had played a role in determining the radiobiological effects. Linear-regression on 103 cases treated with BED of 80-85 Gy(10) showed that 3 year local progression-free survival decreased by 9% per week with prolongation of OTT, or vice versa it increased by 9% per week with shortening OTT in an OTT range of 30-76 days. Cox multivariate analyses confirmed that OTT was an independent prognostic factor for local controls. Conclusion: OTT may have played an important role in determining local controls in radiotherapy for NSCLC. One should always keep in mind to make the OTT as short as possible, provided the patients can tolerate it, and to reduce irradiation interruptions for whatever reasons to a minimum. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.