Impact of Intensity-Modulated Radiation Therapy Technique for Locally Advanced Non-Small-Cell Lung Cancer: A Secondary Analysis of the NRG Oncology RTOG 0617 Randomized Clinical Trial
Impact of Intensity-Modulated Radiation Therapy Technique for Locally Advanced Non-Small-Cell Lung Cancer: A Secondary Analysis of the NRG Oncology RTOG 0617 Randomized Clinical Trial
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DOI：
10.1200/jco.2016.69.1378
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发表时间：
2017-01-01
影响因子：
45.3
通讯作者：
Bradley, Jeffrey D.
中科院分区：
文献类型：
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作者：
Chun, Stephen G.;Hu, Chen;Bradley, Jeffrey D.
目的：虽然调强放疗（IMRT）越来越多地用于局部晚期非小细胞肺癌（NSCLC）的治疗，但IMRT和三维适形外束放疗（3D-CRT）的前瞻性比较尚未得到证实。本研究在一项大型前瞻性临床试验中比较了3D-CRT和IMRT治疗局部晚期NSCLC的结果。在NRG肿瘤学临床试验RTOG 0617中，患者接受卡铂和紫杉醇联合或不联合西妥昔单抗的化疗，以及60 gy和74 gy的辐射剂量，进行了二次分析，比较IMRT和3D-CRT。比较包括2年总生存期（OS）、无进展生存期、局部衰竭、远处转移和不良事件的选定通用术语标准（版本3）>= 3级毒性。结果中位随访时间为21.3个月。在482例患者中，53%接受3D-CRT治疗，47%接受IMRT治疗。IMRT组计划治疗量较大（中位数为427 v 486mL， P = 0.005）；较大的计划治疗容积/肺容积比（中位数，0.13 v 0.15; P = 0.013）；IIIB期患者较多（30.3% vs 38.6%, P = 0.056）。IMRT和3D-CRT的2年生存率、无进展生存期、局部失败和无远处转移生存期无差异。在校正分析中，IMRT与较少的>= 3级肺炎（7.9% vs 3.5%, P = 0.039）和降低的风险相关（优势比0.41;95% CI, 0.171 ~ 0.986; P = 0.046）。IMRT也产生较低的心脏剂量（P < 0.05），校正分析显示，接受40 Gy的心脏体积（V40）与OS显著相关（P, 0.05）。多变量分析显示，肺V5与>= 3级毒性无关，而肺V20与>= 3级肺炎风险增加相关（P = 0.026）。结论在NRG肿瘤临床试验RTOG 0617中，IMRT与较低的严重肺炎和心脏剂量相关，支持局部晚期NSCLC常规使用IMRT。(C) 2016年由美国临床肿瘤学会出版
PurposeAlthough intensity-modulated radiation therapy (IMRT) is increasingly used to treat locally advanced non-small-cell lung cancer (NSCLC), IMRT and three-dimensional conformal external beam radiation therapy (3D-CRT) have not been compared prospectively. This study compares 3D-CRT and IMRT outcomes for locally advanced NSCLC in a large prospective clinical trial.Patients and MethodsA secondary analysis was performed to compare IMRT with 3D-CRT in NRG Oncology clinical trial RTOG 0617, in which patients received concurrent chemotherapy of carboplatin and paclitaxel with or without cetuximab, and 60-versus 74-Gy radiation doses. Comparisons included 2-year overall survival (OS), progression-free survival, local failure, distant metastasis, and selected Common Terminology Criteria for Adverse Events (version 3) >= grade 3 toxicities.ResultsThe median follow-up was 21.3 months. Of 482 patients, 53% were treated with 3D-CRT and 47% with IMRT. The IMRT group had larger planning treatment volumes (median, 427 v 486mL; P = .005); a larger planning treatment volume/ volume of lung ratio (median, 0.13 v 0.15; P = .013); and more stage IIIB disease (30.3% v 38.6%, P = .056). Two-yearOS, progression-free survival, local failure, and distantmetastasis-free survival were not different between IMRT and 3D-CRT. IMRT was associated with less >= grade 3 pneumonitis (7.9% v 3.5%, P = .039) and a reduced risk in adjusted analyses (odds ratio, 0.41; 95% CI, 0.171 to 0.986; P = .046). IMRT also produced lower heart doses (P < .05), and the volume of heart receiving 40 Gy (V40) was significantly associated with OS on adjusted analysis (P,.05). The lung V5 was not associated with any >= grade 3 toxicity, whereas the lung V20 was associated with increased >= grade 3 pneumonitis risk onmultivariable analysis (P = .026).ConclusionIMRT was associated with lower rates of severe pneumonitis and cardiac doses in NRG Oncology clinical trial RTOG 0617, which supports routine use of IMRT for locally advanced NSCLC. (C) 2016 by American Society of Clinical Oncology