Increased Biological Effective Dose of Radiation Correlates with Prolonged Survival of Patients with Limited-Stage Small Cell Lung Cancer: A Systematic Review.
Increased Biological Effective Dose of Radiation Correlates with Prolonged Survival of Patients with Limited-Stage Small Cell Lung Cancer: A Systematic Review.
复制标题
增加生物有效辐射剂量与局限期小细胞肺癌患者的延长生存期相关：一项系统评价
DOI：
10.1371/journal.pone.0156494
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Ma S
中科院分区：
文献类型：
--
作者：
Zhu L;Zhang S;Xu X;Wang B;Wu K;Deng Q;Xia B;Ma S
目的胸部放射治疗（TRT）是局限期小细胞肺癌（LS-SCLC）治疗的重要组成部分。然而，最佳辐射剂量/分次仍然难以捉摸。本研究回顾了目前的证据，并探讨了LS-SCLC患者接受放化疗的剂量-反应关系。材料与方法通过PubMed、Web of Science和科克伦图书馆的系统检索进行定量分析。评估生物有效剂量（BED）与中位总生存期（mOS）、中位无进展生存期（mPFS）、1年、3年和5年总生存期（OS）以及局部复发（LR）的相关性。结果共纳入19个试验的2389例患者。在这19项试验中，7项在欧洲进行，8项在亚洲进行，4项在美国进行。纳入的19项试验包括29个治疗组，其中24个同时治疗组和5个序贯治疗组。对于所有纳入的研究，结果显示较高的BED延长了mOS（R2 = 0.198，p<0.001）和mPFS（R2 = 0.045，p<0.001）。结果还表明，增加BED可改善1年、3年和5年OS。每增加10戈伊，1年、3年和5年OS的获益分别增加6.3%、5.1%和3.7%。此外，BED与LR呈负相关（R2 = 0.09，p<0.001）。同时TRT的亚组分析显示，高BED延长了mOS（p<0.001）和mPFS（p<0.001），改善了1年、3年和5年OS（p<0.001），降低了LR率（p<0.001）。结论本研究表明，接受联合化放疗的LS-SCLC患者，BED增加与OS、PFS改善和LR降低相关，这表明在有限时间内增加辐射剂量的策略值得探索在前瞻性临床试验中。
Objective Thoracic radiotherapy (TRT) is a critical component of the treatment of limited-stage small cell lung cancer (LS-SCLC). However, the optimal radiation dose/fractionation remains elusive. This study reviewed current evidence and explored the dose-response relationship in patients with LS-SCLC who were treated with radiochemotherapy. Materials and Methods A quantitative analysis was performed through a systematic search of PubMed, Web of Science, and the Cochrane Library. The correlations between the biological effective dose (BED) and median overall survival (mOS), median progression-free survival (mPFS), 1-, 3-, and 5-year overall survival (OS) as well as local relapse (LR) were evaluated. Results In all, 2389 patients in 19 trials were included in this study. Among these 19 trials, seven were conducted in Europe, eight were conducted in Asia and four were conducted in the United States. The 19 trials that were included consisted of 29 arms with 24 concurrent and 5 sequential TRT arms. For all included studies, the results showed that a higher BED prolonged the mOS (R2 = 0.198, p<0.001) and the mPFS (R2 = 0.045, p<0.001). The results also showed that increased BED improved the 1-, 3-, and 5-year OS. A 10-Gy increment added a 6.3%, a 5.1% and a 3.7% benefit for the 1-, 3-, and 5-year OS, respectively. Additionally, BED was negatively correlated with LR (R2 = 0.09, p<0.001). A subgroup analysis of concurrent TRT showed that a high BED prolonged the mOS (p<0.001) and the mPFS (p<0.001), improved the 1-, 3-, and 5-year OS (p<0.001) and decreased the rate of LR (p<0.001). Conclusion This study showed that an increased BED was associated with improved OS, PFS and decreased LR in patients with LS-SCLC who were treated with combined chemoradiotherapy, which indicates that the strategy of radiation dose escalation over a limited time frame is worth exploring in a prospective clinical trial.