Outcomes of concurrent chemoradiotherapy in patients with stage III non-small-cell lung cancer and significant comorbidity
Outcomes of concurrent chemoradiotherapy in patients with stage III non-small-cell lung cancer and significant comorbidity
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DOI：
10.1093/annonc/mdq316
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发表时间：
2011-01-01
影响因子：
50.5
通讯作者：
Senan, S.
中科院分区：
文献类型：
--
作者：
Phernambucq, E. C. J.;Spoelstra, F. O. B.;Senan, S.
背景资料：已发表的III期非小细胞肺癌（NSCLC）同步放化疗（CCRT）试验通常排除了有显著合并症的患者。我们评估的结果，选择使用放射计划参数的患者，并认为，尽管合并症，适合足够接受顺铂为基础的chemotherapy.Patients和方法：从2003年至2008年，89例III期NSCLC适合接受顺铂为基础的化疗和V（20）< 42%接受CCRT在一个中心的临床试验外。大多数接受了一个周期的顺铂，吉西他滨，其次是两到三个周期的顺铂，依托泊苷同时涉及领域的胸部放疗46和66戈伊。结果：中位年龄为64岁，性能状态（PS）的零，一个或两个20/64/5例患者，一个或多个合并症，41.6%，14%以前接受过治疗的NSCLC。中位V20为26.6%（范围4%-39.4%）。III级食管炎和肺炎分别发生在28.1%和7.9%的患者中，而4.5%的患者在治疗期间死亡。中位总生存期为18.2个月[95%置信区间（CI）13.1-23.3个月]。总生存率的独立预后因素为PS（0 vs>= 1，P = 0.041）和计划靶体积（P = 0.022）。结论：适合接受以顺铂为基础的CCRT的显著合并症患者的中位生存率与III期试验报告的中位生存率相似，且晚期毒性反应相对较少。
Background: Published trials of concurrent chemoradiotherapy (CCRT) in stage III non-small-cell lung cancer (NSCLC) generally excluded patients with significant comorbidity. We evaluated outcomes in patients who were selected by using radiation planning parameters and were considered, despite comorbidity, fit enough to receive cisplatin-based chemotherapy.Patients and methods: From 2003 to 2008, 89 patients with stage III NSCLC fit to receive cisplatin-based chemotherapy and a V(20) < 42% underwent CCRT at one center outside clinical trials. Most received one cycle of cisplatin-gemcitabine, followed by two to three cycles of cisplatin-etoposide concurrent with involved-field thoracic radiotherapy between 46 and 66 Gy.Results: Median age was 64 years; performance status (PS) of zero, one or two in 20/64/5 patients; one or more comorbidities in 41.6%; 14% were treated previously for NSCLC. Median V20 was 26.6% (range 4%-39.4%). Grade III esophagitis and pneumonitis occurred in 28.1% and 7.9% of patients, respectively, while 4.5% died during treatment. Median overall survival was 18.2 months [95% confidence interval (CI) 13.1-23.3 months]. Independent prognostic factors for overall survival were PS (0 versus >= 1, P = 0.041) and planning target volume (P = 0.022).Conclusions: Patients with significant comorbidity who are fit to undergo cisplatin-based CCRT achieve median survivals similar to that reported in phase III trials and with relatively few late toxic effects.