National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Thorac Cancer. 2019 Apr;10(4):799-806. doi: 10.1111/1759-7714.13001. Epub 2019 Feb 18.
The role of thoracic radiation therapy (TRT) after chemotherapy (CHT) in extensive-stage small cell lung cancer (ES-SCLC) has not been well defined. We investigated whether intensity-modulated radiotherapy (IMRT) improves outcomes in ES-SCLC after CHT compared to CHT alone.
A total of 292 patients who reached a complete response (CR), partial response (PR), or stable disease (SD) after CHT were assigned into groups: CHT + TRT and CHT alone. Propensity score matching was used to balance patient groups (n = 72 each).
The five-year overall survival (OS: 12.3% vs. 3.6%; P < 0.001) and progression-free survival (PFS: 3.2% vs. 1.7%; P = 0.006) rates were significantly higher in the CHT + TRT group. This data was confirmed in the matched samples (5-year OS: 10.5% vs. 1.6%, P < 0.001; PFS: 4.3% vs. 0.0%, P = 0.023). The overall (P = 0.002) and locoregional (P < 0.001) recurrence rates in the CHT + TRT group were significantly lower than in the CHT group. Univariate analysis showed that response evaluation after CHT and TRT were significant prognostic factors of OS. Multivariate analyses revealed that N Stage 0-1 (P = 0.02), > 6 cycles of CHT (P = 0.042), CR + PR after CHT (P < 0.001), and TRT (P < 0.001) were independently associated with longer OS compared to CHT alone.
TRT using IMRT is strongly correlated with improved OS and PFS in ES-SCLC patients reaching CR, PR or SD after CHT. A multicenter, randomized phase III clinical trial is needed to confirm these findings.
广泛期小细胞肺癌（ES-SCLC）患者在化疗（CHT）后行胸部放疗（TRT）的作用尚未明确。我们研究了与单纯 CHT 相比，调强放疗（IMRT）是否能改善 CHT 后 ES-SCLC 患者的结局。
共有 292 例在 CHT 后达到完全缓解（CR）、部分缓解（PR）或疾病稳定（SD）的患者被分配到 CHT+TRT 组和单纯 CHT 组。采用倾向评分匹配法对患者进行分组（每组 72 例）。
在 CHT+TRT 组中，5 年总生存率（OS：12.3% vs. 3.6%；P<0.001）和无进展生存率（PFS：3.2% vs. 1.7%；P=0.006）显著更高。在匹配样本中也得到了同样的结果（5 年 OS：10.5% vs. 1.6%，P<0.001；PFS：4.3% vs. 0.0%，P=0.023）。与 CHT 组相比，CHT+TRT 组的总（P=0.002）和局部区域（P<0.001）复发率显著更低。单因素分析显示，CHT 后和 TRT 后的反应评估是 OS 的显著预后因素。多因素分析显示，N 分期 0-1（P=0.02）、>6 个周期的 CHT（P=0.042）、CHT 后 CR+PR（P<0.001）和 TRT（P<0.001）与单纯 CHT 相比，与更长的 OS 相关。
在 CHT 后达到 CR、PR 或 SD 的 ES-SCLC 患者中，使用 IMRT 的 TRT 与 OS 和 PFS 的改善密切相关。需要开展多中心、随机 III 期临床试验来证实这些发现。
