Rieber Juliane, Deeg Alexander, Ullrich Elena, Foerster Robert, Bischof Marc, Warth Arne, Schnabel Philipp A, Muley Thomas, Kappes Jutta, Heussel Claus Peter, Welzel Thomas, Thomas Michael, Steins Martin, Dienemann Hendrik, Debus Jürgen, Hoffmann Hans, Rieken Stefan
Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany.
Translational Research Unit, Thoraxklinik, Heidelberg University, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany; Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany.
Lung Cancer. 2016 Jan;91:41-7. doi: 10.1016/j.lungcan.2015.11.014. Epub 2015 Nov 25.
Current guidelines recommend postoperative radiation therapy (PORT) for incompletely resected non-small cell lung cancer (NSCLC). However, there is still a paucity of evidence for this approach. Hence, we analyzed survival in 78 patients following radiotherapy for incompletely resected NSCLC (R1) and investigated prognostic factors.
All 78 patients with incompletely resected NSCLC (R1) received PORT between December 2001 and September 2014. The median total dose for PORT was 60 Gy (range 44-68 Gy). The majority of patients had locally advanced tumor stages (stage IIA (2.6%), stage IIB (19.2%), stage IIIA (57.7%) and stage IIIB (20.5%)). 21 patients (25%) received postoperative chemotherapy.
Median follow-up after radiotherapy was 17.7 months. Three-year overall (OS), progression-free (PFS), local (LPFS) and distant progression-free survival (DPFS) rates were 34.1, 29.1, 44.9 and 51.9%, respectively. OS was significantly prolonged at lower nodal status (pN0/1) and following dose-escalated PORT with total radiation doses >54 Gy (p=0.012, p=0.013). Furthermore, radiation doses >54 Gy significantly improved PFS, LPFS and DPFS (p=0.005; p=0.050, p=0.022). Interestingly, survival was neither significantly influenced by R1 localization nor by extent (localized vs. diffuse). Multivariate analyses revealed lower nodal status and radiation doses >54.0 Gy as the only independent prognostic factors for OS (p=0.021, p=0.036).
For incompletely resected NSCLC, PORT is used for improving local tumor control. Local progression is still the major pattern of failure. Radiation doses >54 Gy seem to support improved local control and were associated with better OS in this retrospective study.
当前指南推荐对不完全切除的非小细胞肺癌（NSCLC）进行术后放疗（PORT）。然而，这种方法的证据仍然不足。因此，我们分析了78例不完全切除的NSCLC（R1）患者放疗后的生存情况，并研究了预后因素。
2001年12月至2014年9月期间，所有78例不完全切除的NSCLC（R1）患者均接受了PORT。PORT的中位总剂量为60 Gy（范围44 - 68 Gy）。大多数患者为局部晚期肿瘤分期（IIA期（2.6%）、IIB期（19.2%）、IIIA期（57.7%）和IIIB期（20.5%））。21例患者（25%）接受了术后化疗。
放疗后的中位随访时间为17.7个月。三年总生存（OS）率、无进展生存（PFS）率、局部无进展生存（LPFS）率和远处无进展生存（DPFS）率分别为34.1%、29.1%、44.9%和51.9%。在较低的淋巴结状态（pN0/1）以及总放射剂量>54 Gy的剂量递增PORT后，OS显著延长（p = 0.012，p = 0.013）。此外，放射剂量>54 Gy显著改善了PFS、LPFS和DPFS（p = 0.005；p = 0.050，p = 0.022）。有趣的是，生存情况既未受到R1定位的显著影响，也未受到范围（局限性与弥漫性）的显著影响。多因素分析显示，较低的淋巴结状态和放射剂量>54.0 Gy是OS的唯一独立预后因素（p = 0.021，p = 0.036）。
对于不完全切除的NSCLC，PORT用于改善局部肿瘤控制。局部进展仍然是主要的失败模式。在这项回顾性研究中，放射剂量>54 Gy似乎有助于改善局部控制，并与更好的OS相关。
