采用三维适形放疗和同期化疗治疗不可手术非小细胞肺癌的 I/II 期剂量递增研究的 II 期部分的初步分析:RTOG 0117。
Primary analysis of the phase II component of a phase I/II dose intensification study using three-dimensional conformal radiation therapy and concurrent chemotherapy for patients with inoperable non-small-cell lung cancer: RTOG 0117.
机构信息
Department of Radiation Oncology, Washington University School of Medicine, Alvin J Siteman Comprehensive Cancer Center, 4921 Parkview Place, St Louis, MO, USA.
出版信息
J Clin Oncol. 2010 May 10;28(14):2475-80. doi: 10.1200/JCO.2009.27.1205. Epub 2010 Apr 5.
PURPOSE
Phase I of Radiation Therapy Oncology Group (RTOG) 0117 determined that 74 Gy was the maximum-tolerated dose with concurrent weekly carboplatin/paclitaxel chemotherapy for inoperable non-small-cell lung cancer (NSCLC). Phase II results are reported here. PATIENTS AND METHODS Patients with unresectable stages I-III NSCLC were eligible. Chemotherapy consisted of weekly paclitaxel at 50 mg/m(2) and carboplatin at area under the curve 2 mg/m(2). The radiation dose was 74 Gy given in 37 fractions. Radiation therapy volumes included those of the gross tumor and involved nodes. The volume of lung at or exceeding 20 Gy (V20) was mandated to be <or= 30%.
RESULTS
Of the combined phase I/II enrollment, a total of 55 patients received 74 Gy, of whom 53 were evaluable. The median follow-up was 19.3 months (range, 0.9 to 57.9 months) for all patients and 25.4 months (range, 13.1 to 57.9 months) for those still alive. The median survival for all patients was 25.9 months. The percentage surviving at least 12 months was 75.5% (95% CI, 65.7% to 85.2%). The median overall survival (OS) and progression-free survival (PFS) times for stage III patients (n = 44) were 21.6 months and 10.8 months, respectively. OS and PFS rates at 12 months were 72.7% and 50.0%, respectively. Twelve patients experienced grade >or= 3 lung toxicity (two patients had grade 5 lung toxicity).
CONCLUSION
The median survival time and OS rate at 12 months for this regimen are encouraging. These results serve as projection expectations for the high-dose radiation arms of the current RTOG 0617 phase III intergroup trial.
目的
放射治疗肿瘤学组(RTOG)0117 期的研究表明,对于不能手术的非小细胞肺癌(NSCLC)患者,同时接受每周卡铂/紫杉醇化疗,最大耐受剂量为 74Gy。现将 II 期结果报告如下。
患者与不能切除的 I-III 期 NSCLC 患者符合条件。化疗包括每周紫杉醇 50mg/m² 和卡铂曲线下面积 2mg/m²。放射剂量为 74Gy,分为 37 个分次。放射治疗的体积包括大体肿瘤和受累淋巴结。20Gy 及以上的肺体积(V20)需<或=30%。
结果
在 I/II 期联合入组的 55 例患者中,共有 53 例患者接受了 74Gy 的治疗,且均进行了评估。所有患者的中位随访时间为 19.3 个月(范围,0.9 至 57.9 个月),存活患者的中位随访时间为 25.4 个月(范围,13.1 至 57.9 个月)。所有患者的中位生存期为 25.9 个月。至少存活 12 个月的患者比例为 75.5%(95%可信区间,65.7%至 85.2%)。III 期患者(n=44)的中位总生存(OS)和无进展生存(PFS)时间分别为 21.6 个月和 10.8 个月。12 个月时的 OS 和 PFS 率分别为 72.7%和 50.0%。12 例患者出现>或=3 级肺部毒性(2 例患者出现 5 级肺部毒性)。
结论
该方案的中位生存时间和 12 个月时的 OS 率令人鼓舞。这些结果为当前 RTOG 0617 期 III 组间试验的高剂量放疗臂提供了预期预测。
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