Stereotactic body radiation therapy (SBRT) improves local control and overall survival compared to conventionally fractionated radiation for stage I non-small cell lung cancer (NSCLC).
Stereotactic body radiation therapy (SBRT) improves local control and overall survival compared to conventionally fractionated radiation for stage I non-small cell lung cancer (NSCLC).
复制标题
与I期非小细胞肺癌（NSCLC）相比，立体定向的身体放射治疗（SBRT）可改善局部控制和总体存活率。
DOI：
10.1080/0284186x.2018.1481292
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发表时间：
2018-11
期刊：
影响因子：
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通讯作者：
Rimner A
中科院分区：
文献类型：
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作者：
von Reibnitz D;Shaikh F;Wu AJ;Treharne GC;Dick-Godfrey R;Foster A;Woo KM;Shi W;Zhang Z;Din SU;Gelblum DY;Yorke ED;Rosenzweig KE;Rimner A
立体定向全身放射治疗(SBRT)已成为不能手术的早期非小细胞肺癌(NSCLC)的标准治疗方案，局部控制率一直保持在90%以上。然而，缺乏直接比较SBRT和常规分割放射治疗(COV)的结果的数据。1990-2013年间，497例(525个病灶)早期非小细胞肺癌(T1-T2N0M0)患者接受了COV(n=127)或SBRT(n=398)治疗。在这项回顾分析中，比较了五个终点，并对临床和剂量学因素进行了调整和不调整。竞争风险分析被用来估计和比较局部衰竭(LF)、结节衰竭(NF)、远处衰竭(DF)和疾病进展的累积发生率。用Kaplan-Meier法估计总生存期(OS)，用Cox回归模型进行比较。根据7个患者和临床变量进行倾向评分(PS)匹配分析：年龄、性别、卡诺夫斯基表现状态(KPS)、组织学、T分期、生物等效剂量(BED)和吸烟史。康复组中位剂量为75.6Gy1.8~2.0Gy次(60~90Gy.中位BED=89.20Gy.)，SBRT48Gy4次(45~60Gy3~5次；中位BEED=105.60 Gy.)。中位随访期为24.4月，3年LF率分别为34.1%和13.6%(P<；0.001)。3年OS率分别为38.9%和53.1%(p=0.018)。PS配型对SBRT的OS有显著改善(p=0.0497)。T阶段是与所有五个终点相关的唯一变量。与COV相比，SBRT与改善的LF率和OS有关。我们的数据支持继续使用和扩大SBRT作为不能手术的早期NSCLC的标准护理治疗。
Stereotactic Body Radiotherapy (SBRT) has been adopted as the standard of care for inoperable early-stage non-small cell lung cancer (NSCLC), with local control rates consistently > 90%. However, data directly comparing the outcomes of SBRT with those of conventionally fractionated radiotherapy (CONV) is lacking. Between 1990 and 2013, 497 patients (525 lesions) with early-stage NSCLC (T1-T2N0M0) were treated with CONV (n=127) or SBRT (n=398). In this retrospective analysis, five endpoints were compared, with and without adjusting for clinical and dosimetric factors. Competing risks analysis was performed to estimate and compare the cumulative incidence of local failure (LF), nodal failure (NF), distant failure (DF) and disease progression. Overall survival (OS) was estimated by the Kaplan-Meier method and compared by the Cox regression model. Propensity score (PS) matched analysis was performed based on seven patient and clinical variables: age, gender, Karnofsky performance status (KPS), histology, T-stage, biologically equivalent dose (BED), and history of smoking. The median dose delivered for CONV was 75.6 Gy in 1.8 to 2.0 Gy fractions (range 60 to 90 Gy; median BED = 89.20 Gy) and for SBRT 48 Gy in 4 fractions (45 to 60 Gy in 3 to 5 fractions; median BED = 105.60 Gy). Median follow up was 24.4 months, and 3-year LF rates were 34.1% with CONV and 13.6% with SBRT (p<0.001). 3-year OS rates were 38.9% and 53.1%, respectively (p=0.018). PS matching showed a significant improvement of OS (p=0.0497) for SBRT. T-stage was the only variable correlating with all five endpoints. SBRT compared to CONV is associated with improved LF rates and OS. Our data supports the continued use and expansion of SBRT as the standard of care treatment for inoperable early-stage NSCLC.