调强放射治疗与三维适形放射治疗在局部晚期肺癌中的疗效比较：病理及临床结果
Comparative effectiveness of intensity modulated radiation therapy to 3-dimensional conformal radiation in locally advanced lung cancer: pathological and clinical outcomes.
作者信息
Appel Sarit, Bar Jair, Ben-Nun Alon, Perelman Marina, Alezra Dror, Urban Damien, Ben-Ayun Maoz, Honig Nir, Ofek Efrat, Katzman Tamar, Onn Amir, Chatterji Sumit, Dubinski Sergey, Tsvang Lev, Felder Shira, Kraitman Judith, Haisraely Ory, Rabin Alezra Tatiana, Lieberman Sivan, Marom Edith M, Golan Nir, Simansky David, Symon Zvi, Lawrence Yaacov Richard
机构信息
1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel.
2 Department of Medical Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel.
出版信息
Br J Radiol. 2019 May;92(1097):20180960. doi: 10.1259/bjr.20180960. Epub 2019 Apr 1.
OBJECTIVE
Intensity-modulated radiotherapy (IMRT) has better normal-tissue sparing compared with 3-dimensional conformal radiation (3DCRT). We sought to assess the impact of radiation technique on pathological and clinical outcomes in locally advanced non-small cell lung cancer (LANSCLC) treated with a trimodality strategy.
METHODS
Retrospective review of LANSCLC patients treated from August 2012 to August 2018 at Sheba Medical Center, Israel. The trimodality strategy consisted of concomitant chemoradiation to 60 Gray (Gy) followed by completion surgery. The planning target volume (PTV) was defined by co-registered PET/CT. Here we compare the pathological regression, surgical margin status, local control rates (LC), disease free (DFS) and overall survival (OS) between 3DCRT and IMRT.
RESULTS
Our cohort consisted of 74 patients with mean age 62.9 years, male in 51/74 (69%), adenocarcinoma in 46/74 (62.1%), stage 3 in 59/74 (79.7%) and chemotherapy in 72/74 (97.3%). Radiation mean dose: 59.2 Gy (SD ± 3.8). Radiation technique : 3DCRT in 51/74 (68.9%), IMRT in 23/74 (31%). Other variables were similar between groups.Major pathological response (including pathological complete response or less than 10% residual tumor cells) was similar: 32/51 (62.7%) in 3DCRT and 15/23 (65.2%) in IMRT, p=0.83. Pathological complete response (pCR) rates were similar: 17/51 (33.3%) in 3DCRT and 8/23 (34.8%) in IMRT, p=0.9. Surgical margins were negative in 46/51 (90.1%) in 3DCRT vs. 17/19 (89.4%) in IMRT (p=1.0).The 2-year LC rates were 81.6% (95% CI 69-89.4%); DFS 58.3% (95% CI 45.5-69%) and 3-year OS 70% (95% CI57-80%). Comparing radiation techniques, there were no significant differences in LC (p=0.94), DFS (p=0.33) and OS (p=0.72).
CONCLUSION
When used to treat LANSCLC in the neoadjuvant setting, both IMRT and 3DCRT produce comparable pathological and clinical outcomes.
ADVANCES IN KNOWLEDGE
This study validates the real-world effectiveness of IMRT compared to 3DCRT.
目的
与三维适形放疗（3DCRT）相比，调强放疗（IMRT）对正常组织的保护更好。我们试图评估放疗技术对采用三联疗法治疗的局部晚期非小细胞肺癌（LANSCLC）的病理和临床结果的影响。
方法
回顾性分析2012年8月至2018年8月在以色列谢巴医疗中心接受治疗的LANSCLC患者。三联疗法包括同步放化疗至60格雷（Gy），随后进行根治性手术。计划靶区（PTV）通过PET/CT融合图像定义。在此，我们比较3DCRT和IMRT之间的病理退缩、手术切缘状态、局部控制率（LC）、无病生存期（DFS）和总生存期（OS）。
结果
我们的队列包括74例患者，平均年龄62.9岁，男性51/74（69%），腺癌46/74（62.1%），Ⅲ期59/74（79.7%），72/74（97.3%）接受过化疗。放疗平均剂量：59.2 Gy（标准差±3.8）。放疗技术：3DCRT 51/74（68.9%），IMRT 23/74（31%）。两组间其他变量相似。主要病理反应（包括病理完全缓解或残留肿瘤细胞少于10%）相似：3DCRT组32/51（62.7%），IMRT组15/23（65.2%），p = 0.83。病理完全缓解（pCR）率相似：3DCRT组17/51（33.3%），IMRT组8/23（34.8%），p = 0.9。3DCRT组46/51（90.1%）手术切缘阴性，IMRT组17/19（89.4%）手术切缘阴性（p = 1.0）。2年LC率为81.6%（95%CI 69 - 89.4%）；DFS为58.3%（95%CI 45.5 - 69%），3年OS为70%（95%CI 57 - 80%）。比较放疗技术，LC（p = 0.94）、DFS（p = 0.33）和OS（p = 0.72）无显著差异。
结论
在新辅助治疗LANSCLC时，IMRT和3DCRT产生的病理和临床结果相当。
知识进展
本研究验证了IMRT与3DCRT相比在现实世界中的有效性。
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