腔内近距离放疗对不可切除胆道癌放疗生存结局的影响：倾向评分匹配分析。

Impact of intraluminal brachytherapy on survival outcome for radiation therapy for unresectable biliary tract cancer: a propensity-score matched-pair analysis.

机构信息

Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.

出版信息

Int J Radiat Oncol Biol Phys. 2014 Jul 15;89(4):822-9. doi: 10.1016/j.ijrobp.2014.04.020.

DOI:10.1016/j.ijrobp.2014.04.020

PMID:24969796

Abstract

PURPOSE

To determine whether adding intraluminal brachytherapy (ILBT) to definitive radiation therapy (RT) for unresectable biliary tract cancer has a positive impact on survival outcome.

METHODS AND MATERIALS

The original cohort comprised 209 patients, including 153 who underwent external beam RT (EBRT) alone and 56 who received both ILBT and EBRT. By matching propensity scores, 56 pairs (112 patients) consisting of 1 patient with and 1 patient without ILBT were selected. They were well balanced in terms of sex, age, performance status, clinical stage, jaundice, and addition of chemotherapy. The impact of ILBT on overall survival (OS), disease-specific survival (DSS), and local control (LC) was investigated.

RESULTS

The 2-year OS rates were 31% for the ILBT+ group and 40% for theILBT- group (P=.862). The 2-year DSS rates were 42% for the ILBT+ group and 41% for the ILBT- group (P=.288). The 2-year LC rates were 65% for the ILBT+ group and 35% for the ILBT- group (P=.094). Three of the 4 sensitivity analyses showed a significantly better LC for the ILBT+ group (P=.010, .025, .049), and another showed a marginally better LC (P=.068), and none of the sensitivity analyses showed any statistically significant differences in OS or DSS.

CONCLUSIONS

In the treatment for unresectable biliary tract cancer, the addition of ILBT to RT has no impact on OS or DSS but is associated with better LC. Therefore, the role of ILBT should be addressed by other measures than survival benefit, for example, by less toxicity, prolonged biliary tract patency decreasing the need for further palliative interventions, or patient quality of life.

摘要

目的

确定不可切除的胆道癌患者接受腔内近距离放射治疗（ILBT）联合根治性放射治疗（RT）是否对生存结果有积极影响。

方法和材料

原始队列包括 209 例患者，其中 153 例接受单纯外照射放疗（EBRT），56 例接受 ILBT 联合 EBRT。通过匹配倾向评分，选择了 56 对（112 例）患者，其中 1 例接受了 ILBT，另 1 例未接受 ILBT。两组患者在性别、年龄、体力状况、临床分期、黄疸和化疗的应用方面均具有良好的可比性。研究了 ILBT 对总生存（OS）、疾病特异性生存（DSS）和局部控制（LC）的影响。

结果

ILBT+组的 2 年 OS 率为 31%，ILBT-组为 40%（P=.862）。ILBT+组的 2 年 DSS 率为 42%，ILBT-组为 41%（P=.288）。ILBT+组的 2 年 LC 率为 65%，ILBT-组为 35%（P=.094）。四项敏感性分析中的三项表明 ILBT+组的 LC 显著更好（P=.010、.025、.049），另一项显示 LC 略有改善（P=.068），但敏感性分析均未显示 OS 或 DSS 有统计学差异。