Radiation Oncology Department, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
J Cancer Res Clin Oncol. 2018 Jun;144(6):1165-1171. doi: 10.1007/s00432-018-2640-6. Epub 2018 Apr 5.
PURPOSE/OBJECTIVE(S): Lung cancer tumor volume reduction is common during radiation treatment (RT). The purpose of this study was to investigate tumor volume reduction ratio (VRR) and its correlation with outcomes in a cohort of patients with stage III non-small cell lung cancer (NSCLC) who underwent image-guided radiochemotherapy (RCTx).
MATERIALS/METHODS: Fifty patients with NSCLC treated with fractionated RT at our institution between 2013 and 2017 were included. The relationship between gross tumor volume (GTV) changes during RT (week 1 vs. week 5) and outcomes were evaluated.
The median radiation dose delivered was 59.4 Gy (median fraction dose, 1.8 Gy). The median GTV before treatment was 119 cm, with a median GTV change of - 40%. Patients with more volume reduction had poorer tumor control. A VRR > 40% was associated with a poorer OS and PFS in patients with non-adenocarcinoma (non-ADC) histology. In multivariate analysis, VRR during RT, and chemotherapy (CTx) administration remained related to PFS and OS, while initial GTV remained a significant determinant for OS. In subgroup analyses, and CTx (p = 0.038) affected PFS among non-ADC patients, with initial GTV (p = 0.058) and VRR (p = 0.08) showing non-significant trends. Initial GTV (p = 0.023), VRR (p = 0.038), and CTx (p = 0.01) remained significant predictors for OS in the non-ADC group.
Worse tumor control and OS in non-ADC patients are observed with more marked RT-induced tumor shrinkage, supporting the development of response-adaptive treatment strategies, particularly in non-ADC NSCLC patients.
肺癌在放射治疗（RT）过程中肿瘤体积缩小是常见的。本研究旨在调查接受图像引导放化疗（RCTx）的 III 期非小细胞肺癌（NSCLC）患者队列中肿瘤体积缩小率（VRR）及其与结局的相关性。
材料/方法：回顾性分析了 2013 年至 2017 年在我院接受分次放疗的 50 例 NSCLC 患者的资料。评估了 RT 期间（第 1 周与第 5 周）GTV 变化与结局的关系。
中位放射剂量为 59.4Gy（中位分割剂量为 1.8Gy）。治疗前 GTV 中位数为 119cm，GTV 变化中位数为-40%。体积缩小更多的患者肿瘤控制更差。VRR＞40%与非腺癌（非 ADC）组织学患者的 OS 和 PFS 较差相关。多变量分析显示，RT 期间的 VRR 和化疗（CTx）的应用与 PFS 和 OS 相关，而初始 GTV 仍是 OS 的重要决定因素。亚组分析中，CTx（p=0.038）影响非 ADC 患者的 PFS，而初始 GTV（p=0.058）和 VRR（p=0.08）呈非显著趋势。初始 GTV（p=0.023）、VRR（p=0.038）和 CTx（p=0.01）仍是非 ADC 组 OS 的显著预测因素。
在非 ADC 患者中，观察到更明显的 RT 诱导肿瘤缩小时肿瘤控制和 OS 更差，支持开发反应适应性治疗策略，特别是在非 ADC NSCLC 患者中。
