Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois.
Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois.
Int J Radiat Oncol Biol Phys. 2015 Feb 1;91(2):344-50. doi: 10.1016/j.ijrobp.2014.10.002.
To determine the comparative effectiveness of different stereotactic body radiation therapy (SBRT) dosing regimens for early-stage non-small-cell lung cancer, using a large national database, focusing on the relative impact of dose as a function of tumor stage.
The study included patients in the National Cancer Database from 2003 to 2006 with T1-T2N0M0 inoperable lung cancer (n=498). The biologically effective dose (BED) was calculated according to the linear quadratic formula using an α/β ratio of 10. High versus lower-dose (HD vs LD) SBRT was defined as a calculated BED above or below 150 Gy. Overall survival was estimated using Kaplan-Meier methods and Cox proportional hazard regression.
The 5 most common dose fractionation schemes (percentage of cohort) used were 20 Gy × 3 (34%), 12 Gy × 4 (16%), 18 Gy × 3 (10%), 15 Gy × 3 (10%), and 16 Gy × 3 (4%). The median calculated BED was 150 Gy (interquartile range 106-166 Gy). The 3-year overall survival (OS) for patients who received HD versus LD was 55% versus 46% (log-rank P=.03). On subset analysis of the T1 cohort there was no association between calculated BED and 3-year OS (61% vs 60% with HD vs LD, P=.9). Among the T2 cohort, patients receiving HD experienced superior 3-year OS (37% vs 24%, P=.01). On multivariable analysis, factors independently prognostic for mortality were female gender (hazard ratio [HR] 0.76, P=.01), T2 tumor (HR 1.99, P=.0001), and HD (HR 0.68, P=.001).
This comparative effectiveness analysis of SBRT dose for patients with stage I non-small-cell lung cancer suggests that higher doses (>150 Gy BED) are associated with a significant survival benefit in patients with T2 tumors.
利用大型国家数据库，确定不同立体定向体放射治疗（SBRT）剂量方案治疗早期非小细胞肺癌的比较疗效，重点关注肿瘤分期作为剂量函数的相对影响。
本研究纳入了 2003 年至 2006 年 National Cancer Database 中无法手术的 T1-T2N0M0 期非小细胞肺癌患者（n=498）。采用α/β比为 10 的线性二次公式计算生物有效剂量（BED）。高剂量（HD）与低剂量（LD）SBRT 的定义是计算出的 BED 高于或低于 150Gy。采用 Kaplan-Meier 方法和 Cox 比例风险回归估计总生存率。
使用最常见的 5 种剂量分割方案（队列百分比）分别为 20Gy×3（34%）、12Gy×4（16%）、18Gy×3（10%）、15Gy×3（10%）和 16Gy×3（4%）。中位计算 BED 为 150Gy（四分位距 106-166Gy）。接受 HD 与 LD 的患者 3 年总生存率（OS）分别为 55%和 46%（对数秩 P=.03）。在 T1 队列的亚组分析中，计算的 BED 与 3 年 OS 之间没有关联（HD 与 LD 的 3 年 OS 分别为 61%和 60%，P=.9）。在 T2 队列中，接受 HD 的患者 3 年 OS 更优（37%比 24%，P=.01）。多变量分析显示，女性（HR 0.76，P=.01）、T2 肿瘤（HR 1.99，P=.0001）和 HD（HR 0.68，P=.001）是独立的死亡预后因素。
这项针对 I 期非小细胞肺癌患者 SBRT 剂量的比较疗效分析表明，T2 肿瘤患者较高剂量（>150GyBED）与生存获益显著相关。
