更高的生物有效剂量放疗与同期放化疗治疗局部晚期非小细胞肺癌的改善结局相关：放射治疗肿瘤学组的分析。
Higher biologically effective dose of radiotherapy is associated with improved outcomes for locally advanced non-small cell lung carcinoma treated with chemoradiation: an analysis of the Radiation Therapy Oncology Group.
机构信息
University Hospitals/Case Western Reserve University, Cleveland, OH 44106, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):425-34. doi: 10.1016/j.ijrobp.2010.09.004. Epub 2010 Oct 25.
PURPOSE
Patients treated with chemoradiotherapy for locally advanced non-small-cell lung carcinoma (LA-NSCLC) were analyzed for local-regional failure (LRF) and overall survival (OS) with respect to radiotherapy dose intensity.
METHODS AND MATERIALS
This study combined data from seven Radiation Therapy Oncology Group (RTOG) trials in which chemoradiotherapy was used for LA-NSCLC: RTOG 88-08 (chemoradiation arm only), 90-15, 91-06, 92-04, 93-09 (nonoperative arm only), 94-10, and 98-01. The radiotherapeutic biologically effective dose (BED) received by each individual patient was calculated, as was the overall treatment time-adjusted BED (tBED) using standard formulae. Heterogeneity testing was done with chi-squared statistics, and weighted pooled hazard ratio estimates were used. Cox and Fine and Gray's proportional hazard models were used for OS and LRF, respectively, to test the associations between BED and tBED adjusted for other covariates.
RESULTS
A total of 1,356 patients were analyzed for BED (1,348 for tBED). The 2-year and 5-year OS rates were 38% and 15%, respectively. The 2-year and 5-year LRF rates were 46% and 52%, respectively. The BED (and tBED) were highly significantly associated with both OS and LRF, with or without adjustment for other covariates on multivariate analysis (p < 0.0001). A 1-Gy BED increase in radiotherapy dose intensity was statistically significantly associated with approximately 4% relative improvement in survival; this is another way of expressing the finding that the pool-adjusted hazard ratio for survival as a function of BED was 0.96. Similarly, a 1-Gy tBED increase in radiotherapy dose intensity was statistically significantly associated with approximately 3% relative improvement in local-regional control; this is another way of expressing the finding that the pool-adjusted hazard ratio as a function of tBED was 0.97.
CONCLUSIONS
Higher radiotherapy dose intensity is associated with improved local-regional control and survival in the setting of chemoradiotherapy.
目的
对接受化学放疗的局部晚期非小细胞肺癌（LA-NSCLC）患者，分析放疗剂量强度与局部区域失败（LRF）和总体生存（OS）的关系。
方法和材料
本研究结合了七个放射治疗肿瘤学组（RTOG）临床试验的数据，这些试验均使用化学放疗治疗 LA-NSCLC：RTOG 88-08（仅放化疗组）、90-15、91-06、92-04、93-09（仅非手术组）、94-10 和 98-01。对每位患者的放射治疗生物有效剂量（BED）进行了计算，并使用标准公式计算了总治疗时间调整后的 BED（tBED）。采用卡方检验进行异质性检验，采用加权汇总风险比估计进行检验。采用 Cox 和 Fine 和 Gray 的比例风险模型分别对 OS 和 LRF 进行分析，以检验 BED 和 tBED 与其他协变量调整后的相关性。
结果
共对 1356 例患者进行了 BED 分析（1348 例进行了 tBED 分析）。2 年和 5 年 OS 率分别为 38%和 15%。2 年和 5 年 LRF 率分别为 46%和 52%。BED（和 tBED）在多变量分析中无论是否调整其他协变量，均与 OS 和 LRF 高度相关（p < 0.0001）。放疗剂量强度增加 1 Gy，生存相对改善约 4%；这是表示生存与 BED 关系的池调整风险比为 0.96 的另一种方式。同样，放疗剂量强度增加 1 Gy 的 tBED 与局部区域控制的相对改善约 3%相关；这是表示 tBED 与池调整风险比作为函数关系的发现的另一种方式为 0.97。
结论
在化学放疗中，较高的放疗剂量强度与局部区域控制和生存的改善相关。
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