Department of Radiation Oncology, Fudan University Shanghai Cancer Centre, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Radiat Oncol. 2011 May 19;6:50. doi: 10.1186/1748-717X-6-50.
To investigate the biological radiation dose-response for patients of limited-stage small-cell lung cancer (LS-SCLC) treated with high radiation dose.
Two hundred and five patients of LS-SCLC treated with sequential chemotherapy and thoracic radiotherapy with involved-field between 1997 and 2006 were reviewed retrospectively. Biologically effective dose (BED) was calculated for dose homogenization and was corrected with the factor of overall radiation time. Patients were divided into low BED group (n = 70) and high BED group (n = 135) with a cut-off of BED 57 Gy (equivalent to 60 Gy in 30 fractions over 40 days). Outcomes of the two groups were compared.
Median follow-up was 20.7 months for all analyzable patients and 50.8 months for surviving patients. Considering all patients, median survival was 22.9 months (95% confidence interval, 20.6-25.2 months); 2- and 5-year survival rates were 47.2% and 22.3%, respectively. Patients in high BED group had a significantly better local control (p = 0.024), progression-free survival (p = 0.006) and overall survival (p = 0.005), with a trend toward improved distant-metastasis free survival (p = 0.196). Multivariable Cox regression demonstrated that age (p = 0.003), KPS (p = 0.009), weight loss (p = 0.023), and BED (p = 0.004) were significant predictors of overall survival.
Our data showed that a high BED was significantly associated with favourable outcomes in the Chinese LS-SCLC population, indicating that a positive BED-response relationship still existed even in a relatively high radiation dose range.
为了研究高剂量放射治疗局限期小细胞肺癌（LS-SCLC）患者的生物辐射剂量反应。
回顾性分析了 1997 年至 2006 年间接受序贯化疗和累及野胸部放疗的 205 例 LS-SCLC 患者。为了剂量均匀化，计算了生物有效剂量（BED），并用总放射时间的校正因子进行了校正。患者分为低 BED 组（n = 70）和高 BED 组（n = 135），BED 截断值为 57 Gy（相当于 40 天内 30 次分割的 60 Gy）。比较两组患者的结局。
所有可分析患者的中位随访时间为 20.7 个月，生存患者的中位随访时间为 50.8 个月。考虑到所有患者，中位生存时间为 22.9 个月（95%置信区间，20.6-25.2 个月）；2 年和 5 年生存率分别为 47.2%和 22.3%。高 BED 组患者的局部控制（p = 0.024）、无进展生存（p = 0.006）和总生存（p = 0.005）显著改善，远处转移无进展生存有改善趋势（p = 0.196）。多变量 Cox 回归表明，年龄（p = 0.003）、KPS（p = 0.009）、体重减轻（p = 0.023）和 BED（p = 0.004）是总生存的显著预测因素。
我们的数据表明，高 BED 与中国 LS-SCLC 人群的良好结局显著相关，表明即使在较高的放射剂量范围内，仍存在阳性的 BED 反应关系。
