Li-Ming Xu, Zhao Lu-Jun, Simone Charles B, Cheng Chingyun, Kang Minglei, Wang Xin, Gong Lin-Lin, Pang Qing-Song, Wang Jun, Yuan Zhi-Yong, Wang Ping
Departments of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China.
Departments of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China.
Radiother Oncol. 2017 Nov;125(2):331-337. doi: 10.1016/j.radonc.2017.10.005. Epub 2017 Oct 24.
The importance of the thoracic radiation therapy (TRT) dose has not been clearly defined in extensive stage small-cell lung cancer (ES-SCLC) and it is unclear whether improved TRT dose translates into a survival benefit.
306 patients with ES-SCLC were retrospectively reviewed, of which 170 received IMRT/CRT fractionation RT after ChT, and 136 received chemotherapy (ChT) alone. We adopted the time-adjusted BED (tBED) for effective dose fractionation calculation. Due to the nonrandomized nature of this study, we compared the ChT+RT with ChT groups that matched on possible confounding variables.
Patients achieved 2-year OS, PFS and LC rates of 19.7%, 10.7% and 28.4%, respectively. After propensity score matching, (113 cases for each group), the rates of OS, PFS and LC at 2 years were 21.4%, 7.7% and 34.5% for ChT+TRT, and 10.3% (p<0.001), 4.6% (p<0.001) and 6.3% for ChT only (p<0.001), respectively. Among propensity score matching patients, 56 cases for each group received the high dose (tBED>50 Gy) TRT and received low dose (tBED≤50 Gy) TRT. Two-year OS, PFS and LC rates were 32.3%, 15.3% and 47.1% for the high dose compared with 17.0% (p<0.001), 12.9% (p=0.097) and 34.7% (p=0.029) for low dose radiotherapy.
TRT added to ChT improved ES-SCLC patient OS. High dose TRT improved OS over lower doses. Our results suggest that high-dose thoracic radiation therapy may be a reasonable consideration in select patients with ES-SCLC.
在广泛期小细胞肺癌（ES-SCLC）中，胸段放疗（TRT）剂量的重要性尚未明确界定，且提高TRT剂量是否能转化为生存获益尚不清楚。
回顾性分析306例ES-SCLC患者，其中170例在化疗后接受调强放疗/同步放化疗，136例仅接受化疗（ChT）。我们采用时间调整生物等效剂量（tBED）计算有效剂量分割。由于本研究的非随机性质，我们将ChT+RT组与在可能的混杂变量上匹配的ChT组进行比较。
患者的2年总生存期（OS）、无进展生存期（PFS）和局部控制率（LC）分别为19.7%、10.7%和28.4%。倾向评分匹配后（每组113例），ChT+TRT组2年的OS、PFS和LC率分别为21.4%、7.7%和34.5%，单纯ChT组分别为10.3%（p<0.001）、4.6%（p<0.001）和6.3%（p<0.001）。在倾向评分匹配的患者中，每组56例接受高剂量（tBED>50 Gy）TRT，56例接受低剂量（tBED≤50 Gy）TRT。高剂量组的2年OS、PFS和LC率分别为32.3%、15.3%和47.1%，低剂量放疗组分别为17.0%（p<0.001）、12.9%（p=0.097）和34.7%（p=0.029）。
ChT联合TRT可改善ES-SCLC患者的OS。高剂量TRT比低剂量TRT更能改善OS。我们的结果表明，对于部分ES-SCLC患者，高剂量胸段放疗可能是一个合理的选择。
