ACCELERATED FRACTIONATION RADIATION-THERAPY FOR LIVER METASTASES - SELECTION OF AN OPTIMAL PATIENT POPULATION FOR THE EVALUATION OF LATE HEPATIC-INJURY IN RTOG STUDIES
ACCELERATED FRACTIONATION RADIATION-THERAPY FOR LIVER METASTASES - SELECTION OF AN OPTIMAL PATIENT POPULATION FOR THE EVALUATION OF LATE HEPATIC-INJURY IN RTOG STUDIES
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DOI：
10.1016/0360-3016(90)90055-o
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发表时间：
1990-03-01
影响因子：
7
通讯作者：
PAJAK, TF
中科院分区：
文献类型：
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作者：
LEIBEL, SA;GUSE, C;PAJAK, TF
肝转移的姑息治疗是肿瘤学中的一个主要治疗问题。肝转移患者的总体不良预后可能使各种治疗方式的疗效和毒性评估变得复杂。放射治疗肿瘤学组 (RTOG) 正在评估新的肝脏照射加速分割方案。在设计本研究时，有必要确定预期中位生存期为 6 个月的有利患者亚群，在这些亚群中可以评估治疗的后期效果。使用多变量技术分析了两项 RTOG 肝转移研究（7605 和 8003）的数据。血清胆红素水平大于1.5 mg%、体能评分小于50以及胃癌或胰腺原发癌的病例最初被排除，因为这些因素对生存有不利影响。一百九十个案例符合纳入本次分析的标准。对数线性模型用于识别与良好生存预后相关的患者特征。其中包括 80-100 分的表现、结直肠癌原发性和无肝外转移。推导出逻辑回归方程并确认存活至少 6 个月的概率取决于性能评分、原发部位以及是否存在肝外转移的影响。具有所有三个有利因素的患者占可评估研究人群的 30%，预计 6 个月生存率为 50%。具有这些特征的患者群体将用于研究加速分割放射治疗对肝脏的后期影响。
The palliation of hepatic metastases represents a major therapeutic problem in oncology. The generally unfavorable prognosis of patients with liver metastasis may complicate the evaluation of the efficacy and toxicity of various therapeutic modalities. The Radiation Therapy Oncology Group (RTOG) is evaluating new accelerated fractionation schemes for hepatic irradiation. In designing this study it became necessary to identify a favorable subpopulation of patients with an expected median survival of 6 months in whom the late effects of treatment could be evaluated. Data from two RTOG liver metastases studies (7605 and 8003) were analyzed using multi-variate techniques. Cases with a serum bilirubin level of greater than 1.5 mg%, performance score of less than 50, and gastric or pancreatic primary carcinomas were initially excluded because of the adverse influence of these factors on survival. One hundred and ninety cases met the criteria for inclusion in this analysis. A loglinear model was used to identify the patient characteristics associated with a favorable prognosis for survival. These included a performance score of 80-100, colorectal carcinoma primary, and no extrahepatic metastases. A logistic regression equation was derived and confirmed that the probability of surviving at least 6 months depended on the effects of performance score, primary site and the presence or absence of extra-hepatic metastases. Patients with all three favorable factors constituted 30% of the evaluable study population and had a predicted survival of 50% at 6 months. A patient population with these characteristics will be used to study the late effects of accelerated fractionated radiation therapy on the liver.