Histology, Tumor Volume, and Radiation Dose Predict Outcomes in NSCLC Patients After Stereotactic Ablative Radiotherapy
Histology, Tumor Volume, and Radiation Dose Predict Outcomes in NSCLC Patients After Stereotactic Ablative Radiotherapy
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DOI：
10.1016/j.jtho.2018.06.007
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发表时间：
2018-10-01
影响因子：
20.4
通讯作者：
Lautenschlaeger, Tim
中科院分区：
文献类型：
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作者：
Shiue, Kevin;Cerra-Franco, Alberto;Lautenschlaeger, Tim
在选择非小细胞肺癌立体定向消融体放疗剂量处方时，是否应独立考虑组织学因素尚不清楚。方法：研究人群包括2000 - 2016年508例561个病灶，其中442例482个病灶具有完整的剂量学信息。符合条件的患者经组织学或临床诊断为早期非小细胞肺癌，接受3 - 5组治疗。主要终点是现场肿瘤控制，因死亡或进展而中断。累及的脑叶控制也被评估。结果：在6.7年的中位随访、3年的现场对照、累及肺叶对照、总生存率和无进展生存率分别为88.1%、80.0%、49.4%和37.2%。总肿瘤体积（GTV）（风险比[HR] = 1.01 / mL, p = 0.0044）和组织学（p = 0.0225）与受累肺叶衰竭独立相关。GTV （HR = 1.013, p = 0.001）和GTV剂量（截止剂量为110 Gy，生物有效剂量α / β = 10 [BED10], HR = 2.380, p = 0.0084）与现场失效独立相关。对于鳞状细胞癌，较低的处方剂量与较差的现场控制相关（12 Gy x 4或10 Gy x 5 vs 18 Gy或20 Gy x 3: HR = 3.530, p = 0.0447，经倾向评分匹配证实），并且与GTV无关（HR = 1.014 / mL， 95%可信区间：1.005-1.022,p = 0.0012）。对于腺癌，使用上述剂量组观察到的现场对照没有差异（p = 0.12和p = 0.31分别）。结论：在缺乏一级资料的情况下，立体定向消融体放疗应结合GTV和组织学来确定个体化放疗剂量。我们建议，如果满足正常组织耐受性，应避免使用较低的处方剂量（即12戈瑞x 4或10戈瑞x 5）。(C) 2018年国际肺癌研究协会。Elsevier Inc.出版。版权所有。
Introduction: It remains unclear if histology should be independently considered when choosing stereotactic ablative body radiotherapy dose prescriptions for NSCLC.Methods: The study population included 508 patients with 561 lesions between 2000 and 2016, of which 442 patients with 482 lesions had complete dosimetric information. Eligible patients had histologically or clinically diagnosed early-stage NSCLC and were treated with 3 to 5 fractions. The primary endpoint was in-field tumor control censored by either death or progression. Involved lobe control was also assessed.Results: At 6.7 years median follow-up, 3-year in-field control, involved lobe control, overall survival, and progression-free survival rates were 88.1%, 80.0%, 49.4%, and 37.2%, respectively. Gross tumor volume (GTV) (hazard ratio [HR] = 1.01 per mL, p = 0.0044) and histology (p = 0.0225) were independently associated with involved lobe failure. GTV (HR = 1.013, p = 0.001) and GTV dose (cutoff of 110 Gy, biologically effective dose with alpha/beta = 10 [BED10], HR = 2.380, p = 0.0084) were independently associated with in-field failure. For squamous cell carcinomas, lower prescription doses were associated with worse in-field control (12 Gy x 4 or 10 Gy x 5 versus 18 Gy or 20 Gy x 3: HR = 3.530, p = 0.0447, confirmed by propensity score matching) and was independent of GTV (HR = 1.014 per mL, 95% confidence interval: 1.005-1.022, p = 0.0012). For adenocarcinomas, there were no differences in in-field control observed using the above dose groupings (p = 0.12 and p = 0.31, respectively).Conclusions: In the absence of level I data, GTV and histology should be considered to personalize radiation dose for stereotactic ablative body radiotherapy. We suggest lower prescription doses (i.e., 12 Gy x 4 or 10 G x 5) should be avoided for squamous cell carcinomas if normal tissue tolerances are met. (C) 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.