Dose to heart substructures is associated with non-cancer death after SBRT in stage I-II NSCLC patients
Dose to heart substructures is associated with non-cancer death after SBRT in stage I-II NSCLC patients
复制标题
DOI：
10.1016/j.radonc.2017.04.017
复制
发表时间：
2017-06-01
影响因子：
5.7
通讯作者：
Sonke, Jan-Jakob
中科院分区：
文献类型：
--
作者：
Stam, Barbara;Peulen, Heike;Sonke, Jan-Jakob
背景和目的：探讨在接受立体定向全身放射治疗（SBRT）的早期非小细胞肺癌（NSCLC）患者中，心脏（亚）结构剂量与非癌性死亡之间的潜在关联。方法：803例早期NSCLC患者接受SBRT治疗，主要方案为3 × 18 Gy（59%）或4 × 12 Gy（19%）。所有患者均登记为平均解剖，其计划剂量相应变形，并获得心脏亚结构的剂量学参数。使用多变量Cox回归和敏感性分析分别确定对心脏亚结构或心脏区域的剂量与非癌症死亡有显著关联。结果：中位随访时间为34.8个月。2年Kaplan-Meier总生存率为67%。在死亡的患者中，26.8%死于癌症。多因素分析显示，左心房最大剂量（中位数为6.5 Gy EQD2，范围= 0.009-197,HR = 1.005， p值= 0.035）和上腔静脉90%的剂量（中位数为0.59 Gy EQD2，范围= 0.003-70,HR = 1.025， p值= 0.008）与非癌性死亡显著相关。敏感性分析确定心脏上部区域（心房+血管）与非癌症死亡显著相关。结论：主要作用于心脏上部区域的剂量与非癌性死亡显著相关。因此，特别是心脏上部区域的剂量节约可能潜在地改善结果，应该进一步研究。(C) 2017 Elsevier B.V.版权所有
Background and purpose: To investigate potential associations between dose to heart (sub)structures and non-cancer death, in early stage non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT).Methods: 803 patients with early stage NSCLC received SBRT with predominant schedules of 3 x 18 Gy (59%) or 4 x 12 Gy (19%). All patients were registered to an average anatomy, their planned dose deformed accordingly, and dosimetric parameters for heart substructures were obtained. Multivariate Cox regression and a sensitivity analysis were used to identify doses to heart substructures or heart region with a significant association with non-cancer death respectively.Results: Median follow-up was 34.8 months. Two year Kaplan-Meier overall survival rate was 67%. Of the deceased patients, 26.8% died of cancer. Multivariate analysis showed that the maximum dose on the left atrium (median 6.5 Gy EQD2, range = 0.009-197, HR = 1.005, p-value = 0.035), and the dose to 90% of the superior vena cava (median 0.59 Gy EQD2, range = 0.003-70, HR = 1.025, p-value = 0.008) were significantly associated with non-cancer death. Sensitivity analysis identified the upper region of the heart (atria + vessels) to be significantly associated with non-cancer death.Conclusions: Doses to mainly the upper region of the heart were significantly associated with non-cancer death. Consequently, dose sparing in particular of the upper region of the heart could potentially improve outcome, and should be further studied. (C) 2017 Elsevier B.V. All rights reserved.