Woody Neil M, Stephans Kevin L, Andrews Martin, Zhuang Tingliang, Gopal Priyanka, Xia Ping, Farver Carol F, Raymond Daniel P, Peacock Craig D, Cicenia Joseph, Reddy Chandana A, Videtic Gregory M M, Abazeed Mohamed E
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Department of Translational Hematology Oncology Research, Cleveland Clinic, Cleveland, Ohio.
J Thorac Oncol. 2017 Mar;12(3):510-519. doi: 10.1016/j.jtho.2016.11.002. Epub 2016 Dec 22.
Stereotactic body radiation therapy (SBRT) is the standard of care for medically inoperable patients with early-stage NSCLC. However, NSCLC is composed of several histological subtypes and the impact of this heterogeneity on SBRT treatments has yet to be established.
We analyzed 740 patients with early-stage NSCLC treated definitively with SBRT from 2003 through 2015. We calculated cumulative incidence curves using the competing risk method and identified predictors of local failure using Fine and Gray regression.
Overall, 72 patients had a local failure, with a cumulative incidence of local failure at 3 years of 11.8%. On univariate analysis, squamous histological subtype, younger age, fewer medical comorbidities, higher body mass index, higher positron emission tomography standardized uptake value, central tumors, and lower radiation dose were associated with an increased risk for local failure. On multivariable analysis, squamous histological subtype (hazard ratio = 2.4 p = 0.008) was the strongest predictor of local failure. Patients with squamous cancers fail SBRT at a significantly higher rate than do those with adenocarcinomas or NSCLC not otherwise specified, with 3-year cumulative rates of local failure of 18.9% (95% confidence interval [CI]: 12.7-25.1), 8.7% (95% CI: 4.6-12.8), and 4.1% (95% CI: 0-9.6), respectively.
Our results demonstrate an increased rate of local failure in patients with squamous cell carcinoma. Standard approaches for radiotherapy that demonstrate efficacy for a population may not achieve optimal results for individual patients. Establishing the differential dose effect of SBRT across histological groups is likely to improve efficacy and inform ongoing and future studies that aim to expand indications for SBRT.
立体定向体部放射治疗（SBRT）是早期非小细胞肺癌（NSCLC）医学上无法手术患者的标准治疗方法。然而，NSCLC由几种组织学亚型组成，这种异质性对SBRT治疗的影响尚未确定。
我们分析了2003年至2015年期间接受SBRT根治性治疗的740例早期NSCLC患者。我们使用竞争风险法计算累积发病率曲线，并使用Fine和Gray回归确定局部失败的预测因素。
总体而言，72例患者出现局部失败，3年局部失败累积发病率为11.8%。单因素分析显示，鳞状组织学亚型、年龄较小、合并症较少、体重指数较高、正电子发射断层扫描标准化摄取值较高、中央型肿瘤以及较低的放射剂量与局部失败风险增加相关。多因素分析显示，鳞状组织学亚型（风险比=2.4，p=0.008）是局部失败的最强预测因素。鳞状细胞癌患者SBRT失败率明显高于腺癌或未另行指定的NSCLC患者，3年局部失败累积率分别为18.9%（95%置信区间[CI]：12.7-25.1）、8.7%（95%CI：4.6-12.8）和4.1%（95%CI：0-9.6）。
我们的结果表明鳞状细胞癌患者局部失败率增加。对总体人群显示有效的标准放疗方法可能无法使个体患者获得最佳结果。确定SBRT在不同组织学组中的剂量差异效应可能会提高疗效，并为旨在扩大SBRT适应症的正在进行和未来研究提供参考。
