Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
Radiat Oncol. 2018 Nov 6;13(1):214. doi: 10.1186/s13014-018-1158-z.
Dose escalation of conventionally fractionated radiation therapy (CFRT) above 45-54 Gy has an unclear survival benefit. Prior National Cancer Database (NCDB) analyses have shown improved overall survival with induction chemotherapy (iC) prior to concurrent chemoradiation (CRT) in locally advanced pancreatic cancer. Our study compared dose-escalated CFRT with and without iC.
The NCDB was queried for primary stage III, cT4 N0-1 M0 LAPC treated with CRT with or without iC (2004-2015). CFRT was stratified by < 55 Gy and ≥ 55 Gy. Cohort iC + CRT and CRT included those with and without iC, respectively. The primary endpoint was overall survival (OS). Kaplan-Meier analysis, Cox proportional hazards method, and propensity score matching were used.
Among 2029 patients, cohort iC + CRT had 738 patients (n = 601 for 45-55 Gy and n = 137 for ≥55 Gy) and cohort CRT had 1291 patients (n = 1066 for 45-55 Gy and n = 225 for ≥55 Gy). Median follow-up was 24.3 months and 24.6 months for cohorts iC + CRT and CRT, respectively. Dose escalation showed improved survival in the multivariable analysis in cohort iC + CRT (HR 0.77, p = 0.013) but not in cohort CRT (HR 0.91, p = 0.19). Using 2:1 propensity score matching, a total of 387 patients for cohort iC + CRT and 549 patients for cohort CRT were matched. After matching, dose escalation remained significant for improved overall survival in cohort iC + CRT (median OS 16.2 vs 15.2 months; 2-yr OS 33.4% vs 25.4%; p = 0.022) but not in cohort CRT (median OS 11.8 vs 10.6 months; 2-yr OS 13.3% vs 10.1%; p = 0.16).
Patients with locally advanced pancreatic cancer who undergo iC have improved survival with radiation dose escalation above 55 Gy. For patients without iC, there is no clear association between radiation dose escalation and survival.
常规分割放疗（CFRT）剂量超过 45-54Gy 后，生存获益尚不明确。既往国家癌症数据库（NCDB）分析显示，局部晚期胰腺癌患者在同步放化疗（CRT）前接受诱导化疗（iC）可提高总体生存率。本研究比较了剂量递增 CFRT 联合和不联合 iC 的疗效。
NCDB 中检索了接受 CRT 治疗的 III 期局部晚期、cT4 N0-1 M0 LAPC 患者，治疗方案包括 iC 联合 CRT（2004-2015 年）。CFRT 按<55Gy 和≥55Gy 分层。队列 iC+CRT 和 CRT 分别包括接受和未接受 iC 的患者。主要终点是总体生存率（OS）。采用 Kaplan-Meier 分析、Cox 比例风险方法和倾向评分匹配进行分析。
在 2029 例患者中，iC+CRT 队列有 738 例患者（45-55Gy 组 n=601，55-60Gy 组 n=137），CRT 队列有 1291 例患者（45-55Gy 组 n=1066，55-60Gy 组 n=225）。iC+CRT 队列和 CRT 队列的中位随访时间分别为 24.3 个月和 24.6 个月。多变量分析显示，iC+CRT 队列中剂量递增可改善生存（HR 0.77，p=0.013），但 CRT 队列中无显著差异（HR 0.91，p=0.19）。采用 2:1 倾向评分匹配后，iC+CRT 队列共 387 例患者，CRT 队列共 549 例患者纳入分析。匹配后，iC+CRT 队列中剂量递增仍与 OS 改善显著相关（中位 OS 16.2 个月 vs 15.2 个月；2 年 OS 33.4% vs 25.4%；p=0.022），而 CRT 队列中无显著相关性（中位 OS 11.8 个月 vs 10.6 个月；2 年 OS 13.3% vs 10.1%；p=0.16）。
接受 iC 的局部晚期胰腺癌患者，放疗剂量递增至 55Gy 以上可提高生存率。未接受 iC 的患者中，放疗剂量递增与生存无明显关联。
