Division of General Internal Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029, USA.
Eur Respir J. 2012 Oct;40(4):957-64. doi: 10.1183/09031936.00176911. Epub 2012 Jan 12.
Radiotherapy (RT) is the standard therapy for unresected stage I-II nonsmall cell lung cancer (NSCLC). Using population-based data, we compared survival and toxicity among unresected elderly patients treated with combined chemoradiotherapy (CRT) or RT alone. Using the Surveillance, Epidemiology and End Results (SEER) registry (National Cancer Institute, Bethesda, MD, USA) we identified 3,006 cases of unresected stage I-II NSCLC. We used propensity score methods to compare survival and rates of toxicity of patients treated with RT versus CRT. Overall, 844 (28%) patients received CRT. Adjusted analyses showed that CRT was associated with improved survival (hazard ratio 0.85, 95% CI 0.78-0.94). Combination therapy was also associated with better survival among stage I patients treated with intermediate complexity RT (HR 0.80, 95% CI 0.70-0.90); however, no difference in survival was observed among patients treated with complex RT. In stage II patients, CRT was associated with improved survival regardless of the RT technique (HR 0.61-0.72). CRT was associated with increased odds of toxicity. Despite increased toxicity, CRT may improve survival of elderly unresected patients with stage II disease as well as stage I NSCLC treated with intermediate RT complexity. Randomised trials are needed to clarify the balance of benefits and risk of CRT in unresected patients.
放疗（RT）是未切除的 I-II 期非小细胞肺癌（NSCLC）的标准治疗方法。本研究利用基于人群的数据，比较了接受联合放化疗（CRT）或单纯 RT 治疗的未切除老年患者的生存和毒性。本研究利用监测、流行病学和最终结果（SEER）数据库（美国国立癌症研究所，贝塞斯达，MD），确定了 3006 例未切除的 I-II 期 NSCLC 病例。本研究使用倾向评分方法比较了接受 RT 与 CRT 治疗的患者的生存和毒性发生率。共有 844 例（28%）患者接受 CRT。调整后的分析表明，CRT 可改善生存（风险比 0.85，95%CI 0.78-0.94）。在接受中等复杂 RT 治疗的 I 期患者中，联合治疗也与更好的生存相关（HR 0.80，95%CI 0.70-0.90）；然而，在接受复杂 RT 治疗的患者中，生存无差异。在 II 期患者中，无论 RT 技术如何，CRT 均可改善生存（HR 0.61-0.72）。CRT 与毒性增加相关。尽管毒性增加，但 CRT 可能改善 II 期疾病以及接受中等 RT 复杂性治疗的 I 期 NSCLC 未切除患者的生存。需要进行随机试验以明确 CRT 在未切除患者中的获益和风险的平衡。
