Stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer
Stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer
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DOI：
10.1016/j.jtcvs.2009.12.054
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发表时间：
2010-08-01
影响因子：
6
通讯作者：
Bradley, Jeffrey D.
中科院分区：
文献类型：
--
作者：
Crabtree, Traves D.;Denlinger, Chadrick E.;Bradley, Jeffrey D.
目的：立体定向全身放射治疗已被提议作为早期肺癌高危患者的替代局部治疗选择。立体定向放射治疗和手术切除之间的结果的直接比较尚未报道。本研究比较了立体定向全身放射治疗和手术治疗非小细胞肺癌的短期结果。方法：我们将所有接受手术（2000年1月至2006年12月）或立体定向放射治疗（2004年2月至2007年5月）治疗的患者与通过计算机断层扫描和正电子发射断层扫描分期的临床IA/B期非小细胞肺癌进行比较。使用成人合并症评估评分系统前瞻性地记录合并症评分。审查图表以确定局部肿瘤复发、疾病特异性生存率和总体生存率。使用倾向评分匹配分析来调整患者年龄、合并症指数和临床分期的混杂影响的估计治疗风险比。结果：共有 462 名患者接受了手术，76 名患者接受了立体定向身体放射治疗。总体而言，手术患者年龄较小 (P < .001)，合并症评分较低 (P < .001)，肺功能较好（1 秒用力呼气量和肺部一氧化碳扩散）(P < .001)。在手术组和立体定向放射治疗组中，分别有62.6%（291/462）和78.9%（60/76）处于临床IA期。最终病理结果抢先了 35% (161/462) 的手术患者。在一项无与伦比的比较中，手术治疗的总体 5 年生存率为 55%，放射治疗的 3 年生存率为 32%。在临床 IA 期疾病的患者中，放射治疗的 3 年局部肿瘤控制率为 89%，手术治疗的 3 年局部肿瘤控制率为 96% (P = .04)。 IB 期疾病的局部肿瘤控制没有差异 (P = .89)。在 1A (P = .33) 或 IB 疾病 (P = .69) 患者中未发现疾病特异性生存差异。倾向分析将 57 名高风险手术患者与 57 名接受立体定向身体放射治疗的患者进行匹配。在该亚组的匹配比较中，局部复发率（88% vs 90%）、无病生存率（77% vs 86%）和3年总生存率（54% vs 38%）没有差异。结论：在临床IA期疾病的匹配比较中，与接受立体定向放射治疗的患者相比，手术患者更健康，局部肿瘤控制也更好。临床 IA/B 期非小细胞肺癌的倾向分析显示，与立体定向放射治疗相比，接受手术治疗的患者的局部复发率和疾病特异性生存率相似。 (胸心血管外科杂志 2010 年；140:377-86)
Objectives: Stereotactic body radiation therapy has been proposed as an alternative local treatment option for high-risk patients with early-stage lung cancer. A direct comparison of outcomes between stereotactic body radiation therapy and surgical resection has not been reported. This study compares short-term outcomes between stereotactic body radiation therapy and surgical treatment of non-small cell lung cancer.Methods: We compared all patients treated with surgery (January 2000-December 2006) or stereotactic body radiation therapy (February 2004-May 2007) with clinical stage IA/B non-small cell lung cancer staged by computed tomography and positron emission tomography. Comorbidity scores were recorded prospectively using the Adult Co-Morbidity Evaluation scoring system. Charts were reviewed to determine local tumor recurrence, disease-specific survival, and overall survival. A propensity score matching analysis was used to adjust estimated treatment hazard ratios for confounding effects of patient age, comorbidity index, and clinical stage.Results: A total of 462 patients underwent surgery and 76 received stereotactic body radiation therapy. Overall, surgical patients were younger (P < .001), had lower comorbidity scores (P < .001), and better pulmonary function (forced expiratory volume in 1 second and carbon monoxide diffusion in the lung) (P < .001). Among the surgical and stereotactic body radiation therapy groups, 62.6% (291/462) and 78.9% (60/76) were in clinical stage IA, respectively. Final pathology upstaged 35% (161/462) of the surgery patients. In an unmatched comparison, overall 5-year survival was 55% with surgery, and the 3-year survival was 32% with radiation therapy. Among patients with clinical stage IA disease, 3-year local tumor control was 89% with radiation therapy and 96% with surgery (P = .04). There was no difference in local tumor control in stage IB disease (P = .89). No disease-specific survival differences were found in patients with 1A (P = .33) or IB disease (P = .69). Propensity analysis matched 57 high-risk surgical patients to 57 patients undergoing stereotactic body radiation therapy. In the matched comparison of this subgroup, there was no difference in freedom from local recurrence (88% vs 90%), disease-free survival (77% vs 86%), and overall survival (54% vs 38%) at 3 years.Conclusions: In an unmatched comparison of clinical stage IA disease, surgical patients were healthier and had better local tumor control compared with those receiving stereotactic body radiation therapy. Propensity analysis in clinical stage IA/B non-small cell lung cancer revealed similar rates of local recurrence and disease-specific survival in patients treated with surgery compared with stereotactic body radiation therapy. (J Thorac Cardiovasc Surg 2010;140:377-86)