Failure patterns by prognostic group determined by recursive partitioning analysis (RPA) of 1547 patients on four radiation therapy oncology group (RTOG) studies in inoperable nonsmall-cell lung cancer (NSCLC)
Failure patterns by prognostic group determined by recursive partitioning analysis (RPA) of 1547 patients on four radiation therapy oncology group (RTOG) studies in inoperable nonsmall-cell lung cancer (NSCLC)
复制标题
DOI：
10.1016/s0360-3016(98)00213-2
复制
发表时间：
1998-09-01
影响因子：
7
通讯作者：
Gaspar, LE
中科院分区：
文献类型：
--
作者：
Komaki, R;Scott, CB;Gaspar, LE
目的：根据无法切除的NSCLC仅接受放射治疗（RT）时的失败模式，确定可能受益于更积极的全身或局部治疗的患者组。方法：从4项RTOG试验中，分析了1547例单独接受RT治疗的患者的首次失败模式，这些失败模式通过预后因素（包括KPS、体重减轻、淋巴结分期、胸腔积液、年龄和放射治疗剂量。所有患者均患有NSCLC AJCC II、IIIA或IIIB期，KPS > 50，既往未接受过RT或化疗。小学的进展情况（照射野内），胸部通过RPA对每个失败类别的（照射区域外，但在胸部内）、脑和脑以外的远处转移进行比较（双侧）。RPA分类是4个不同的亚组，I、II、III和IV类的中位生存期分别为12.6、8.3、6.3和3.3个月，具有显著差异。（所有组，p = 0.0002）。分别有583、667、249和48例患者属于I、II、In和IV类。I类、II类、III类和IV类的原发性失效率分别为27%、25%、21%和10%（I vs. IV，p = 0.014; II vs. IV，p = 0.022）。远处转移，包括脑转移，在I类和II类（58%和54%）中发生率显著高于III类和IV类（42%和27%）。一个更高的死亡率（58%），没有一个可识别的失败的网站被发现在IV类比在I类，II类和III类（27%，28%和36%，分别）。结论：数据表明，生理妥协从胸内疾病IV类患者是足以导致死亡之前，特定的网站失败变得明显。针对特定失效部位进行治疗的临床研究可能会改善I类、II类和可能的III类患者的结局。在临床试验中纳入IV类患者可能会掩盖结局。(C)1998年爱思唯尔科学公司
Purpose: To identify groups of patients who might benefit from more aggressive systemic or local treatment, based on failure patterns when unresectable NSCLC was treated by radiation therapy (RT) alone.Methods: From 4 RTOG trials, 1547 patients treated by RT alone were analyzed for patterns of first failure by RPA class defined by prognostic factors, including KPS, weight loss, nodal stage, pleural effusion, age and radiation therapy dose. All patients had NSCLC AJCC Stage II, IIIA, or IIIB, KPS > 50, with no previous RT or chemotherapy. Progressions in the primary (within irradiated fields), thorax (outside irradiated area, but within thorax), brain and distant metastasis other than brain were compared (2-sided) for each failure category by RPA.Results: The RPA classes were 4 distinct subgroups that had significantly different median survivals of 12.6, 8.3, 6.3 and 3.3 months for Classes I, II, III and IV, respectively, (all groups, p = 0.0002). There were 583, 667, 249 and 48 patients in Classes I, II, In and IV, respectively. Primary failure was seen in 27%, 25%, 21% and 10% for Classes I, II, III, and IV, respectively (I vs. IV, p = 0.014; II vs. IV, p = 0.022). Distant metastasis, including brain metastasis, occurred at significantly higher rates among Classes I and II (58% and 54%) than in Classes III and IV (42% and 27%). A higher rate (58 %) of death without an identifiable site of failure was found in Class IV than in Classes I, II and III (27%, 28% and 36%, respectively).Conclusions: The data suggest that physiologic compromise from the intrathoracic disease in Class IV patients is sufficient to cause death before specific sites of failure became evident. Clinical investigations using treatments directed at specific sites of failure could lead to improved outcome for Class I, II and, possibly, Class III patients. Inclusion of Class IV patients in clinical trials may obscure outcomes. (C) 1998 Elsevier Science Inc.