Boston Medical Center, One Boston Medical Center Pl., Boston, MA 02118, USA.
Department of Radiation Oncology, Boston Medical Center, 830 Harrison Ave. Moakley LL, Boston, MA 02118, USA; Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA.
Lung Cancer. 2019 May;131:147-153. doi: 10.1016/j.lungcan.2019.03.031. Epub 2019 Apr 1.
The role of stereotactic body radiation therapy (SBRT) in treating stage II non-small cell lung cancer (NSCLC) remains unclear. This study evaluates SBRT dose prescription patterns and survival outcomes in Stage II NSCLC using the National Cancer Database (NCDB).
Patients diagnosed with Stage II NSCLC and treated with SBRT between 2004-2013 were identified in NCDB. The biologically effective dose with α/β = 10 Gy (BED) was calculated. Overall survival (OS) was analyzed using the Kaplan-Meier method and Cox regression models.
Of 56,543 patients with Stage II NSCLC, 451 (0.8%) received SBRT. There were 360 patients (79.8%) with node-negative and 91 patients (20.2%) with node-positive disease. The most common prescriptions were 10 Gy x 5 (35.9%) and 12 Gy x 4 (19.3%). The mean and median BED were 114.9 Gy and 105.6 Gy, respectively. With median follow-up of 19.3 months, overall median survival was 23.7 months. Median survival was 22.4 months for those treated with BED < 114.9 Gy versus 31.5 months for BED ≥ 114.9 Gy (p = 0.036). On multivariate analysis, BED as a continuous variable (hazard ratio [HR] 0.991, p = 0.009) and ≥ 114.9 Gy (HR 0.63, p = 0.015) were associated with improved survival in node-negative patients. BED as a continuous variable (HR 0.997, p = 0.465) and ≥ 114.9 Gy (HR 0.81, p = 0.546) were not significant factors for predicting survival in node-positive patients.
SBRT is infrequently utilized to treat Stage II NSCLC in the United States. Treatment with higher BED was associated with improved survival, and the benefit was limited to patients with node-negative disease.
立体定向体部放射治疗（SBRT）在治疗 II 期非小细胞肺癌（NSCLC）中的作用仍不清楚。本研究使用国家癌症数据库（NCDB）评估 II 期 NSCLC 中 SBRT 的剂量处方模式和生存结果。
在 NCDB 中确定了 2004-2013 年间接受 SBRT 治疗的 II 期 NSCLC 患者。计算了生物有效剂量（BED）与 α/β=10 Gy 的比值。使用 Kaplan-Meier 方法和 Cox 回归模型分析总生存期（OS）。
在 56543 例 II 期 NSCLC 患者中，有 451 例（0.8%）接受了 SBRT。其中 360 例（79.8%）为淋巴结阴性，91 例（20.2%）为淋巴结阳性。最常见的处方为 10 Gy x 5（35.9%）和 12 Gy x 4（19.3%）。平均和中位 BED 分别为 114.9 Gy 和 105.6 Gy。中位随访时间为 19.3 个月，总体中位生存期为 23.7 个月。BED＜114.9 Gy 的患者中位生存期为 22.4 个月，BED≥114.9 Gy 的患者中位生存期为 31.5 个月（p=0.036）。多变量分析显示，BED 为连续变量（风险比[HR]0.991，p=0.009）和≥114.9 Gy（HR 0.63，p=0.015）与淋巴结阴性患者的生存改善相关。BED 为连续变量（HR 0.997，p=0.465）和≥114.9 Gy（HR 0.81，p=0.546）均不是淋巴结阳性患者预测生存的显著因素。
SBRT 在美国很少用于治疗 II 期 NSCLC。较高的 BED 治疗与生存改善相关，且获益仅限于淋巴结阴性疾病患者。
