同期每日顺铂与高剂量放疗治疗 III 期非小细胞肺癌患者。
Concurrent Daily Cisplatin and High-Dose Radiation Therapy in Patients With Stage III Non-Small Cell Lung Cancer.
机构信息
Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands.
Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands.
出版信息
Int J Radiat Oncol Biol Phys. 2018 Nov 1;102(3):543-551. doi: 10.1016/j.ijrobp.2018.07.188. Epub 2018 Jul 25.
PURPOSE
The purpose of this study was to determine survival, local and distant control, toxicity, and prognostic factors in patients with stage III non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation therapy (CCRT).
METHODS AND MATERIALS
Consecutive patients with stage IIIA and IIIB NSCLC (N = 154) staged with F-fluorodeoxyglucose positron emission tomography/computed tomography were retrospectively selected (2005-2015). CCRT consisted of daily low-dose cisplatin (6 mg/m) combined with 24 fractions of 2.75 Gy to a total dose of 66 Gy.
RESULTS
During a median follow-up period of 22 months (range, 1-92 months) the median overall survival was 36 months. The 1-, 2-, 3-, and 5-year survival rates were 79% (95% confidence interval [CI], 73%-86%), 61% (95% CI, 54%-70%), 52% (95% CI, 43%-60%), and 40% (95% CI, 31%-51%), respectively. The local relapse-free survival at 5 years was 55% (95% CI, 44%-69%). Metastasis-free survival at 5 years was 53% (95% CI, 44%-65%). The incidence of severe gastrointestinal disorders (grade 3-5) was 11%, among which grade 3 radiation esophagitis was 8.4%. The incidence of severe respiratory, thoracic, and mediastinal disorders (grade 3-5) was 8.4%, among which grade 3 radiation pneumonitis was 1.3%. Predictors of overall survival were lymph node gross tumor volume (GTV) (hazard ratio [HR], 1.007; 95% CI, 1.000-1.012) and sex (HR, 0.500; 95% CI, 0.320-0.870) in favor of women. Although lymph node GTV was a predictor of treatment toxicity (HR, 1.010; 95% CI, 1.000-1.013), tumor GTV was the predictor for distant metastasis during follow-up (HR, 1.002; 95% CI, 1.001-1.003).
CONCLUSIONS
CCRT with daily low-dose cisplatin for locally advanced stage III NSCLC resulted in promising overall survival (3-year survival rate of 52% and 5-year survival rate of 40%) with low toxicity. Lymph node GTV, tumor GTV, and sex were predictors of overall survival, treatment toxicity, and distant metastasis.
目的
本研究旨在确定接受同期放化疗（CCRT）治疗的 III 期非小细胞肺癌（NSCLC）患者的生存率、局部和远处控制率、毒性和预后因素。
方法和材料
回顾性选择了连续的 IIIA 和 IIIB 期 NSCLC 患者（N=154），这些患者通过 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描进行分期（2005-2015 年）。CCRT 包括每天低剂量顺铂（6mg/m）与 24 个 2.75Gy 的分数相结合，总剂量为 66Gy。
结果
在中位随访 22 个月（范围 1-92 个月）期间，中位总生存期为 36 个月。1、2、3 和 5 年生存率分别为 79%（95%置信区间[CI]，73%-86%）、61%（95% CI，54%-70%）、52%（95% CI，43%-60%）和 40%（95% CI，31%-51%）。5 年局部无复发生存率为 55%（95% CI，44%-69%）。5 年无远处转移生存率为 53%（95% CI，44%-65%）。严重胃肠道疾病（3-5 级）的发生率为 11%，其中 3 级放射性食管炎为 8.4%。严重呼吸、胸部和纵隔疾病（3-5 级）的发生率为 8.4%，其中 3 级放射性肺炎为 1.3%。总生存的预测因素是淋巴结大体肿瘤体积（GTV）（风险比[HR]，1.007；95% CI，1.000-1.012）和性别（HR，0.500；95% CI，0.320-0.870）有利于女性。尽管淋巴结 GTV 是治疗毒性的预测因素（HR，1.010；95% CI，1.000-1.013），但肿瘤 GTV 是随访期间远处转移的预测因素（HR，1.002；95% CI，1.001-1.003）。
结论
局部晚期 III 期 NSCLC 患者接受每日低剂量顺铂同期放化疗，总体生存率（3 年生存率为 52%，5 年生存率为 40%）较高，毒性较低。淋巴结 GTV、肿瘤 GTV 和性别是总生存率、治疗毒性和远处转移的预测因素。
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