Billiet Charlotte, Decaluwé Herbert, Peeters Stephanie, Vansteenkiste Johan, Dooms Christophe, Haustermans Karin, De Leyn Paul, De Ruysscher Dirk
Radiation Oncology.
Thoracic Surgery and Leuven Lung Cancer Group, University Hospitals Leuven/KU Leuven, Belgium.
Radiother Oncol. 2014 Jan;110(1):3-8. doi: 10.1016/j.radonc.2013.08.011. Epub 2013 Oct 4.
We hypothesized that modern postoperative radiotherapy (PORT) could decrease local recurrence (LR) and improve overall survival (OS) in patients with stage IIIA-N2 non-small-cell lung cancer (NSCLC).
To investigate the effect of modern PORT on LR and OS, we identified published phase III trials for PORT and stratified them according to use or non-use of linear accelerators. Non-individual patient data were used to model the potential benefit of modern PORT in stage IIIA-N2 NSCLC treated with induction chemotherapy and resection.
Of the PORT phase III studies, eleven trials (2387 patients) were included for OS analysis and eight (1677 patients) for LR. PORT decreased LR, whether given with cobalt, cobalt and linear accelerators, or with linear accelerators only. An increase in OS was only seen when PORT was given with linear accelerators, along with the most significant effect on LR (relative risk for LR and OS 0.31 (p=0.01) and 0.76 (p=0.02) for PORT vs. controls, respectively). Four trials (357 patients) were suitable to assess LR rates in stage III NSCLC treated with surgery, in most cases after induction chemotherapy. LR as first relapse was 30% (105/357) after 5 years. In the modeling part, PORT with linear accelerators was estimated to reduce LR rates to 10% as first relapse and to increase the absolute 5-year OS by 13%.
This modeling study generates the hypothesis that modern PORT may increase both LR and OS in stage IIIA-N2 NSCLC even in patients being treated with induction chemotherapy and surgery.
我们假设现代术后放疗（PORT）可降低IIIA-N2期非小细胞肺癌（NSCLC）患者的局部复发（LR）率并提高总生存期（OS）。
为研究现代PORT对LR和OS的影响，我们确定了已发表的PORT III期试验，并根据是否使用直线加速器进行分层。使用非个体患者数据来模拟现代PORT在接受诱导化疗和手术治疗的IIIA-N2期NSCLC中的潜在益处。
在PORT III期研究中，纳入了11项试验（2387例患者）进行OS分析，8项试验（1677例患者）进行LR分析。无论PORT是与钴、钴和直线加速器联合使用，还是仅与直线加速器使用，均可降低LR率。仅当PORT与直线加速器联合使用时，OS有所增加，同时对LR的影响最为显著（PORT组与对照组相比，LR和OS的相对风险分别为0.31（p=0.01）和0.76（p=0.02））。四项试验（357例患者）适合评估手术治疗的III期NSCLC患者的LR率，大多数情况下是在诱导化疗后。5年后，首次复发的LR率为30%（105/357）。在建模部分，估计使用直线加速器的PORT可将首次复发的LR率降低至10%，并使5年绝对OS增加13%。
这项建模研究提出了一个假设，即现代PORT可能会提高IIIA-N2期NSCLC患者的LR率和OS，即使是在接受诱导化疗和手术治疗的患者中。
