连续超分割加速放疗（CHART）治疗非小细胞肺癌（NSCLC）：9 个英国中心 7 年经验。

Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres.

机构信息

Weston Park Hospital, Sheffield, UK.

Weston Park Hospital, Sheffield, UK; Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK.

出版信息

Clin Oncol (R Coll Radiol). 2018 Mar;30(3):144-150. doi: 10.1016/j.clon.2017.12.019. Epub 2018 Jan 12.

DOI:10.1016/j.clon.2017.12.019

PMID:29336865

Abstract

AIM

Continuous hyperfractionated accelerated radiotherapy (CHART) remains an option to treat non-small cell lung cancer (NSCLC; NICE, 2011). We have previously published treatment outcomes from 1998-2003 across five UK centres. Here we update the UK CHART experience, reporting outcomes and toxicities for patients treated between 2003 and 2009.

MATERIALS AND METHODS

UK CHART centres were invited to participate in a retrospective data analysis of NSCLC patients treated with CHART from 2003 to 2009. Nine (of 14) centres were able to submit their data into a standard database. The Kaplan-Meier method estimated survival and the Log-rank test analysed the significance.

RESULTS

In total, 849 patients had CHART treatment, with a median age of 71 years (range 31-91), 534 (63%) were men, 55% had undergone positron emission tomography-computed tomography (PET-CT) and 26% had prior chemotherapy; 839 (99%) patients received all the prescribed treatment. The median overall survival was 22 months with 2 and 3 year survival of 47% and 32%, respectively. Statistically significant differences in survival were noted for stage IA versus IB (33.2 months versus 25 months; P = 0.032) and IIIA versus IIIB (20 months versus 16 months; P = 0.018). Response at 3 months and outcomes were significantly linked; complete response showing survival of 34 months against 19 months, 15 months and 8 months for partial response, stable and progressive disease, respectively (P < 0.001). Age, gender, performance status, prior chemotherapy and PET-CT did not affect the survival outcomes. Treatment was well tolerated with <5% reporting ≥grade 3 toxicity.

CONCLUSION

In routine practice, CHART results for NSCLC remain encouraging and we have been able to show an improvement in survival compared with the original trial cohort. We have confirmed that CHART remains deliverable with low toxicity rates and we are taking a dose-escalated CHART regimen forward in a randomised phase II study of sequential chemoradiotherapy against other accelerated dose-escalated schedules.

摘要

目的

连续超分割加速放疗（CHART）仍然是治疗非小细胞肺癌（NSCLC；NICE，2011）的一种选择。我们之前发表了 1998 年至 2003 年间在五个英国中心的治疗结果。在这里，我们更新了英国 CHART 的经验，报告了 2003 年至 2009 年间治疗的患者的结果和毒性。

材料和方法

邀请英国 CHART 中心参与对 2003 年至 2009 年间接受 CHART 治疗的 NSCLC 患者进行回顾性数据分析。14 个中心中有 9 个（9 个）能够将其数据输入标准数据库。采用 Kaplan-Meier 法估计生存率，采用 Log-rank 检验分析生存率的差异。

结果

共有 849 例患者接受 CHART 治疗，中位年龄为 71 岁（范围 31-91），534 例（63%）为男性，55%接受了正电子发射断层扫描-计算机断层扫描（PET-CT）检查，26%接受了化疗；839 例（99%）患者接受了所有规定的治疗。中位总生存期为 22 个月，2 年和 3 年生存率分别为 47%和 32%。IA 期与 IB 期（33.2 个月与 25 个月；P=0.032）和 IIIA 期与 IIIB 期（20 个月与 16 个月；P=0.018）的生存差异有统计学意义。3 个月时的反应和结果有显著的相关性；完全缓解的生存时间为 34 个月，部分缓解、稳定和进展性疾病的生存时间分别为 19 个月、15 个月和 8 个月（P<0.001）。年龄、性别、表现状态、既往化疗和 PET-CT 对生存结果没有影响。治疗耐受性良好，<5%的患者报告有≥3 级毒性。