Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e291-7. doi: 10.1016/j.ijrobp.2011.03.052. Epub 2011 Jun 2.
To investigate survival and local recurrence after stereotactic ablative radiotherapy (SABR) or three-dimensional conformal radiotherapy (3D-CRT) administered for early-stage primary lung cancer and to investigate longitudinal changes of health-related quality of life (HRQOL) parameters after either treatment.
Two prospective cohorts of inoperable patients with T1-2N0M0 primary lung tumors were analyzed. Patients received 70 Gy in 35 fractions with 3D-CRT or 60 Gy in three to eight fractions with SABR. Global quality of life (GQOL), physical functioning (PF), and patient-rated dyspnea were assessed using the respective dimensions of European Organization for Research and Treatment of Cancer Core Questionnaire-C30 and LC13. HRQOL was analyzed using multivariate linear mixed-effects modeling, survival and local control (LC) using the Kaplan-Meier method, Cox proportional hazards analysis, and Fine and Gray multivariate competing risk analysis as appropriate.
Overall survival (OS) was better after SABR compared with 3D-CRT with a HR of 2.6 (95% confidence interval [CI]: 1.5-4.8; p < 0.01). 3D-CRT conferred a subhazard ratio for LC of 5.0 (95% CI: 1.7-14.7; p < 0.01) compared with SABR. GQOL and PF were stable after SABR (p = 0.21 and p = 0.62, respectively). Dyspnea increased after SABR by 3.2 out of 100 points (95% CI: 1.0-5.3; p < 0.01), which is clinically insignificant. At 1 year, PF decreased by an excess of 8.7 out of 100 points (95% CI: 2.8-14.7; p < 0.01) after 3D-CRT compared with SABR.
In this nonrandomized comparison of two prospective cohorts of medically inoperable patients with Stage I lung cancer, OS and LC were better after SABR. GQOL, PF, and patient-rated dyspnea were stable after SABR, whereas PF decreased after 3D-CRT approaching clinical significance already at 1 year.
研究立体定向消融放疗（SABR）或三维适形放疗（3D-CRT）治疗早期原发性肺癌的生存和局部复发情况，并研究两种治疗方法后健康相关生活质量（HRQOL）参数的纵向变化。
对 2 个不能手术的 T1-2N0M0 期原发性肺肿瘤患者的前瞻性队列进行了分析。患者接受 3D-CRT 下 70Gy/35 次或 SABR 下 60Gy/3-8 次分割。使用欧洲癌症研究与治疗组织核心问卷 C30 和 LC13 的相应维度评估全球健康状况（GQOL）、身体功能（PF）和患者报告的呼吸困难。使用多变量线性混合效应模型分析 HRQOL，使用 Kaplan-Meier 方法、Cox 比例风险分析和 Fine 和 Gray 多变量竞争风险分析评估生存和局部控制（LC），适当时进行分析。
SABR 后的总生存（OS）优于 3D-CRT，风险比为 2.6（95%置信区间[CI]：1.5-4.8；p < 0.01）。3D-CRT 与 SABR 相比，LC 的亚风险比为 5.0（95%CI：1.7-14.7；p < 0.01）。SABR 后 GQOL 和 PF 稳定（p = 0.21 和 p = 0.62）。SABR 后呼吸困难增加了 3.2 分（100 分）（95%CI：1.0-5.3；p < 0.01），无临床意义。与 SABR 相比，3D-CRT 后 1 年 PF 下降超过 8.7 分（100 分）（95%CI：2.8-14.7；p < 0.01）。
在不能手术的 I 期肺癌患者的 2 个前瞻性队列的非随机比较中，SABR 后的 OS 和 LC 更好。SABR 后 GQOL、PF 和患者报告的呼吸困难稳定，而 3D-CRT 后 PF 在 1 年内下降，接近临床意义。
