Koshy Matthew, Malik Renu, Sher David J, Spiotto Michael, Mahmood Usama, Aydogan Bulent, Weichselbaum Ralph R
Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL.
Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL.
Clin Lung Cancer. 2014 Sep;15(5):365-71. doi: 10.1016/j.cllc.2014.05.004. Epub 2014 Jun 2.
In this study, we examined trends in the radiotherapy dose prescribed and the effect of dose escalation on survival in patients with stage III lung cancer.
Radiation dose prescription patterns were analyzed for 38,848 patients in the National Cancer Database with clinical stage III disease who underwent concurrent chemoradiation between 2004 and 2011 to a dose between 57 and 80 Gy. Survival information was available for patients diagnosed from 2004 to 2006 (n = 12,024). Overall survival (OS) was estimated using Kaplan-Meier methods. Cox proportional hazard regression was used to estimate hazard ratios (HRs).
The percentage of patients treated to ≥ 64 Gy increased from 50% in 2004 to 62% in 2011 (P < .001). The 5-year OS was 12% for patients treated between 57 and 59.3 Gy, 14% for patients treated at 59.4 to 62.9 Gy, 16% for patients treated at 63 to 66 Gy and 66.1 to 73.9 Gy, and 13% for patients treated at 74 to 80 Gy (P < .0001). In multivariate analysis, the estimated HR (95% confidence interval) was 1.3 (1.1-1.6) for 57 to 59.3 Gy, 1.0 (0.9-1.2) for 59.4 to 62.9 Gy, 0.9 (0.9-1.2) for 63 to 66 Gy, 0.9 (0.8-1.1) for 66.1 to 73.9 Gy, and 1.0 (referent) for the 74 to 80 Gy cohort. There was no significant difference in the HR for the dose groups > 59.4 Gy compared with the 74 to 80 Gy cohort.
There was no improvement in OS with radiotherapy dose escalation beyond 59.4 Gy for patients with unresectable clinical stage III lung cancer treated with chemoradiation.
在本研究中，我们调查了III期肺癌患者的放疗处方剂量趋势以及剂量递增对生存的影响。
对国家癌症数据库中38848例临床III期疾病且在2004年至2011年间接受同步放化疗、剂量在57至80 Gy之间的患者的放射剂量处方模式进行分析。有2004年至2006年确诊患者（n = 12024）的生存信息。采用Kaplan-Meier方法估计总生存期（OS）。使用Cox比例风险回归估计风险比（HRs）。
接受≥64 Gy治疗的患者百分比从2004年的50%增至2011年的62%（P <.001）。57至59.3 Gy治疗的患者5年OS为12%，59.4至62.9 Gy治疗的患者为14%，63至66 Gy以及66.1至73.9 Gy治疗的患者为16%，74至80 Gy治疗的患者为13%（P <.0001）。多因素分析中，57至59.3 Gy的估计HR（95%置信区间）为1.3（1.1 - 1.6），59.4至62.9 Gy为1.0（
