Department of Radiation Oncology, Box 3085, Duke University Medical Center, Durham, NC 27710, USA.
Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e269-74. doi: 10.1016/j.ijrobp.2011.01.056. Epub 2011 Apr 7.
Cancer and Leukemia Group B (CALGB) 30105 tested two different concurrent chemoradiotherapy platforms with high-dose (74 Gy) three-dimensional conformal radiotherapy (3D-CRT) after two cycles of induction chemotherapy for Stage IIIA/IIIB non-small cell lung cancer (NSCLC) patients to determine if either could achieve a primary endpoint of >18-month median survival. Final results of 30105 demonstrated that induction carboplatin and gemcitabine and concurrent gemcitabine 3D-CRT was not feasible because of treatment-related toxicity. However, induction and concurrent carboplatin/paclitaxel with 74 Gy 3D-CRT had a median survival of 24 months, and is the basis for the experimental arm in CALGB 30610/RTOG 0617/N0628. We conducted a secondary analysis of all patients to determine predictors of treatment-related pulmonary toxicity.
Patient, tumor, and treatment-related variables were analyzed to determine their relation with treatment-related pulmonary toxicity.
Older age, higher N stage, larger planning target volume (PTV)1, smaller total lung volume/PTV1 ratio, larger V20, and larger mean lung dose were associated with increasing pulmonary toxicity on univariate analysis. Multivariate analysis confirmed that V20 and nodal stage as well as treatment with concurrent gemcitabine were associated with treatment-related toxicity. A high-risk group comprising patients with N3 disease and V20 >38% was associated with 80% of Grades 3-5 pulmonary toxicity cases.
Elevated V20 and N3 disease status are important predictors of treatment related pulmonary toxicity in patients treated with high-dose 3D-CRT and concurrent chemotherapy. Further studies may use these metrics in considering patients for these treatments.
癌症和白血病协作组 30105 对接受两个周期诱导化疗后的 IIIA/IIIB 期非小细胞肺癌（NSCLC）患者，使用两种不同的高剂量（74 Gy）三维适形放疗（3D-CRT）同步放化疗平台进行了测试，以确定是否任何一种方案都能达到中位生存期超过 18 个月的主要终点。30105 的最终结果表明，由于治疗相关毒性，诱导卡铂和吉西他滨联合同步吉西他滨 3D-CRT 是不可行的。然而，诱导和同步卡铂/紫杉醇联合 74 Gy 3D-CRT 的中位生存期为 24 个月，这是 CALGB 30610/RTOG 0617/N0628 试验的实验组的基础。我们对所有患者进行了二次分析，以确定与治疗相关的肺毒性的预测因素。
分析患者、肿瘤和治疗相关变量，以确定它们与治疗相关的肺毒性之间的关系。
年龄较大、较高的 N 分期、较大的计划靶区（PTV）1、较小的全肺体积/PTV1 比值、较大的 V20 和平均肺剂量，在单因素分析中与肺毒性增加相关。多因素分析证实，V20 和淋巴结分期以及同步给予吉西他滨与治疗相关毒性相关。包括 N3 疾病和 V20 >38%的高危组与 80%的 3-5 级肺毒性病例相关。
在接受高剂量 3D-CRT 和同步化疗的患者中，V20 升高和 N3 疾病状态是治疗相关肺毒性的重要预测因素。进一步的研究可能会使用这些指标来考虑这些治疗方法的患者。
