Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
Radiother Oncol. 2019 Feb;131:145-149. doi: 10.1016/j.radonc.2018.12.006. Epub 2018 Dec 31.
The National Comprehensive Cancer Network (NCCN) recently revised recommendations for inoperable stage I small cell lung cancer (SCLC), having added stereotactic ablative radiotherapy (SABR)/chemotherapy to the historical paradigm of concurrent conventionally-fractionated radiation therapy (CFRT)/chemotherapy. Despite the conformality, convenience, and cost-effectiveness of SABR, the NCCN continues to recommend both CFRT/chemotherapy and SABR/chemotherapy primarily because these approaches have not been comparatively analyzed to date.
The National Cancer Database was queried for histologically-confirmed T1-2N0M0 SCLC; all patients received chemotherapy. Multivariable logistic regression ascertained factors associated with SABR/chemotherapy. Kaplan-Meier analysis assessed overall survival (OS); multivariable Cox proportional hazards modeling examined factors associated with OS. Survival was also calculated following propensity matching.
Of 2,107 patients, 7.1% underwent SABR/chemotherapy, and 92.9% received CFRT/chemotherapy. The median (interquartile range) dose of SABR was 50 (48-54) Gy in 4 (3-5) fractions, and 55.8 (45-60) Gy in 30 (30-33) fractions for CFRT. Patients receiving SABR/chemotherapy were more often older, had T1 disease, treated at academic/integrated network facilities, and managed in more recent years (p < 0.05 for all). Respective median survival figures were 29.2 versus 31.2 months (p = 0.77), which persisted following propensity matching (25.4 versus 34.3 months, p = 0.85). On multivariable analysis, radiotherapeutic technique was not associated with OS (p = 0.95).
For stage I SCLC, SABR/chemotherapy affords statistically equivalent outcomes to CFRT/chemotherapy. Because randomized studies addressing this uncommon scenario would almost certainly suffer from inadequate accrual, these retrospective data should be strongly considered in efforts to institute SABR/chemotherapy as the preferred option for this population.
美国国家综合癌症网络（NCCN）最近修订了无法手术的 I 期小细胞肺癌（SCLC）的治疗建议，将立体定向消融放疗（SABR）/化疗添加到传统分割放疗（CFRT）/化疗的历史范例中。尽管 SABR 具有适形性、便利性和成本效益，但 NCCN 仍然主要推荐 CFRT/化疗和 SABR/化疗，因为迄今为止尚未对这些方法进行比较分析。
从国家癌症数据库中检索经组织学证实的 T1-2N0M0 SCLC；所有患者均接受化疗。多变量逻辑回归确定与 SABR/化疗相关的因素。采用 Kaplan-Meier 分析评估总生存期（OS）；多变量 Cox 比例风险模型分析与 OS 相关的因素。在进行倾向匹配后也计算了生存率。
在 2107 名患者中，7.1%接受了 SABR/化疗，92.9%接受了 CFRT/化疗。SABR 的中位（四分位距）剂量为 50（48-54）Gy，分 4（3-5）次；CFRT 的中位剂量为 55.8（45-60）Gy，分 30（30-33）次。接受 SABR/化疗的患者年龄较大，多为 T1 期疾病，在学术/综合网络设施接受治疗，且治疗时间较晚（所有 p 值均<0.05）。相应的中位生存数据分别为 29.2 个月和 31.2 个月（p=0.77），在进行倾向匹配后仍保持不变（25.4 个月和 34.3 个月，p=0.85）。多变量分析显示，放疗技术与 OS 无关（p=0.95）。
对于 I 期 SCLC，SABR/化疗与 CFRT/化疗提供了统计学上等效的结果。由于针对这种罕见情况的随机研究几乎肯定会因入组不足而受到影响，因此在努力将 SABR/化疗作为该人群的首选方案时，应充分考虑这些回顾性数据。
