Liu Zhiyan, Wang Jing, Yuan Zhiyong, Zhang Baozhong, Gong Linlin, Zhao Lujun, Wang Ping
Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, and Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P.R. China.
-first Author: Jing Wang.
J Cancer. 2018 Jun 23;9(15):2625-2630. doi: 10.7150/jca.24976. eCollection 2018.
To evaluate the clinical outcomes of simultaneous dose reduction of elective nodal area with intensity-modulated radiotherapy (SIR-IMRT) versus conventional IMRT (C-IMRT) in patients with limited-stage small-cell lung cancer (LS-SCLC), patients with LS-SCLC who received definitive SIR-IMRT or C-IMRT were retrospectively analyzed. In SIR-IMRT group, the prescribed dose was 60Gy to the planning gross target volume (PTV), and 54Gy to the planning target volume (PTV). In the C-IMRT group, the prescribed dose was 60Gy to the whole PTV. Radiation-related toxicities were estimated according to Common Terminology Criteria for Adverse Events (version 3.0). The primary endpoint was loco-regional recurrence-free survival (LRFS), and the secondary endpoints include overall survival (OS) and toxicities. LRFS and OS were estimated with Kaplan-Meier method. After propensity score matching, 84 patients were included in this study, with 42 patients in each group. Fifty-eight patients experienced treatment failure. Grade 3 and above radiation-induced lung toxicity developed in 2 patients in SIR-IMRT group and 5 patients in C-IMRT group, respectively. Grade 3 and above radiation-related esophagitis was observed in 3 patients and 5 patients, respectively. The 1-, 3-year LRFS rates of the SIR-IMRT group and C-IMRT group were 90.4%, 73.3% and 87.1%, 45.0%(=0.025), respectively. Reducing the irradiation dose to the elective nodal region may reduce radiation-induced toxicities without compromising local-regional control and overall survival.
为评估局限期小细胞肺癌（LS-SCLC）患者中，选择性淋巴结区域同步剂量降低的调强放疗（SIR-IMRT）与传统调强放疗（C-IMRT）的临床疗效，对接受根治性SIR-IMRT或C-IMRT的LS-SCLC患者进行回顾性分析。在SIR-IMRT组中，计划大体肿瘤靶区（PTV）的处方剂量为60Gy，计划靶区（PTV）的处方剂量为54Gy。在C-IMRT组中，整个PTV的处方剂量为60Gy。根据不良事件通用术语标准（第3.0版）评估放疗相关毒性。主要终点是局部区域无复发生存期（LRFS），次要终点包括总生存期（OS）和毒性。采用Kaplan-Meier法估计LRFS和OS。倾向评分匹配后，本研究纳入84例患者，每组42例。58例患者出现治疗失败。SIR-IMRT组和C-IMRT组分别有2例和5例患者发生3级及以上放射性肺毒性。分别有3例和5例患者观察到3级及以上放射性食管炎。SIR-IMRT组和C-IMRT组的1年、3年LRFS率分别为90.4%、73.3%和87.1%、45.0%（P=0.025）。降低选择性淋巴结区域的照射剂量可减少放疗引起的毒性，而不影响局部区域控制和总生存期。
