Radiologic-pathologic correlation of response to chemoradiation in resectable locally advanced NSCLC
Radiologic-pathologic correlation of response to chemoradiation in resectable locally advanced NSCLC
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DOI：
10.1016/j.lungcan.2016.10.002
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发表时间：
2016-12-01
期刊：
影响因子：
5.3
通讯作者：
Mak, Raymond H.
中科院分区：
文献类型：
--
作者：
Agrawal, Vishesh;Coroller, Thibaud P.;Mak, Raymond H.
目的：准确评估肿瘤对放化疗的反应有可能指导有关患者手术切除和/或剂量递增的临床决策。早期评估对可手术的局部晚期非小细胞肺癌 (LA-NSCLC) 的最佳局部治疗存在争议。本研究评估了基于 CT 的定量肿瘤测量，以预测病理反应。材料和方法：对接受放化疗和手术切除的可手术 LA-NSCLC 患者进行评估。通过手术切除前放化疗前和放化疗后获得的 CT 成像对肿瘤直径和体积进行量化。使用单变量和多变量逻辑回归来确定与病理完全缓解（pCR）主要终点的关联。总体生存率、局部区域复发和远处转移作为次要终点进行评估。结果：确定了 101 名 LA-NSCLC 患者，并接受了术前放化疗和手术切除。中位放疗剂量为 54 Gy（范围为 46-70 Gy），98% 的患者接受同步放化疗作为术前治疗的一部分。 CT 定义的肿瘤体积的减小与 pCR（OR 1.06 [1.02-1.09]，p = 0.002）和 LRR（HR 1.01 [1.00-1.02]，p = 0.048）相关。由 RECIST 确定的常规疗效评估 (p = 0.213) 与 pCR 或任何次要终点无关。结论：放化疗后 CT 测量的肿瘤体积减小与 pCR 相关，并且比常规疗效评估 (RECIST) 或绝对肿瘤大小或体积提供更多有关肿瘤反应的临床信息。这项研究表明，肿瘤体积的变化提供了更好的放射学病理相关性，因此是评估放化疗后肿瘤反应的另一个工具。 (C) 2016 Elsevier Ireland Ltd. 保留所有权利。
Objectives: Accurate assessment of tumor response to chemoradiation has the potential to guide clinical decision-making regarding surgical resection and/or dose escalation for patients. Early assessment has implications for Optimal local therapy for operable locally advanced non-small cell lung cancer (LA-NSCLC) is controversial. This study evaluated quantitative CT-based tumor measurements to predict pathologic response.Materials and methods: Patients with operable LA-NSCLC treated with chemoradiation followed by surgical resection were assessed. Tumor diameter and volume were quantified from CT imaging obtained prior to chemoradiation and post-chemoradiation prior to surgical resection. Univariate and multivariate logistic regression were used to determine association with the primary endpoint of pathologic complete response (pCR). Overall survival, locoregional recurrence, and distant metastasis were assessed as secondary endpoints.Results: 101 LA-NSCLC patients were identified and treated with preoperative chemoradiation and surgical resection. The median RT dose was 54 Gy (range, 46-70) and 98% of patients received concurrent chemoradiation as part of their preoperative treatment. Reduction of CT-defined tumor volume was associated with pCR (OR 1.06 [1.02-1.09], p = 0.002) and LRR (HR 1.01 [1.00-1.02], p = 0.048). Conventional response assessment determined by RECIST (p = 0.213) was not associated with pCR or any secondary endpoints.Conclusion: CT-measured reductions in tumor volume after chemoradiation are associated with pCR and provide greater clinical information about tumor response than conventional response assessment (RECIST) or absolute tumor sizes or volumes. This study demonstrates that change in tumor volumes provides better radiologic-pathologic correlation and is thus an additional tool to assess tumor response following chemoradiation. (C) 2016 Elsevier Ireland Ltd. All rights reserved.