同步整合推量强度调控放射治疗与常规强度调控放射治疗局部晚期非小细胞肺癌的疗效与安全性比较：一项回顾性研究。

Comparison of efficacy and safety between simultaneous integrated boost intensity-modulated radiotherapy and conventional intensity-modulated radiotherapy in locally advanced non-small-cell lung cancer: a retrospective study.

机构信息

Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Radiat Oncol. 2019 Jun 13;14(1):106. doi: 10.1186/s13014-019-1259-3.

DOI:10.1186/s13014-019-1259-3

PMID:31196118

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6567443/

Abstract

BACKGROUND

Consistent results are lacking as regards the comparative effectiveness of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) versus conventional intensity-modulated radiotherapy in patients with locally advanced non-small-cell lung cancer (LA-NSCLC). Therefore, we conducted a retrospective analysis to demonstrate the role of SIB-IMRT for patients.

METHODS

Patients who had histologically confirmed NSCLC, stage III disease and received thoracic IMRT between 2014 and 2016 were retrospectively reviewed. The survival, toxicities and dose to organs at risk (OAR) were compared among patients irradiated with different techniques. The SIB-IMRT plans were designed to deliver 45-59.4Gy (median: 50.4Gy) to PTV while simultaneously delivering 50-70Gy (median: 59.92Gy) to PGTV. As for conventional IMRT plans, a total dose of 50-70Gy (median: 60Gy) was delivered to PTV.

RESULTS

426 patients with stage III NSCLC were eligible for analysis, including 128 with SIB-IMRT and 298 with conventional IMRT. The SIB-IMRT group had more stage IIIB disease (69.5% vs. 53%, P = 0.002), larger planning treatment volumes (median: 504 ml vs. 402 ml, P<0.001), and a larger planning treatment volume/volume of lung ratio (median, 0.18 vs. 0.12, P<0.001). The median OS of the SIB-IMRT and conventional IMRT groups were 34.5 and 31.7 months, with the 2-year rate of 60.4 and 59%, respectively (P = 0.797). No difference in PFS, LRFS or DMFS was observed between the two techniques. Patients treated with SIB-IMRT got similar lung and esophageal toxicities versus those with conventional IMRT.

CONCLUSIONS

SIB-IMRT may be an effective and safe option for patients with locally advanced NSCLC, especially for those with large mass or wide lymph node metastasis.

摘要

背景

在局部晚期非小细胞肺癌（LA-NSCLC）患者中，同步整合推量强度调制放疗（SIB-IMRT）与常规强度调制放疗的比较疗效结果并不一致。因此，我们进行了一项回顾性分析，以展示 SIB-IMRT 对患者的作用。

方法

回顾性分析了 2014 年至 2016 年间接受胸部调强放疗的组织学证实为 NSCLC、III 期疾病的患者。比较了采用不同技术放疗的患者的生存情况、毒性和危及器官（OAR）剂量。SIB-IMRT 计划旨在将 45-59.4Gy（中位数：50.4Gy）传递至 PTV，同时将 50-70Gy（中位数：59.92Gy）传递至 PGTV。对于常规 IMRT 计划，将 50-70Gy（中位数：60Gy）的总剂量传递至 PTV。

结果

426 例 III 期 NSCLC 患者符合分析条件，其中 128 例接受 SIB-IMRT，298 例接受常规 IMRT。SIB-IMRT 组有更多的 IIIB 期疾病（69.5%比 53%，P=0.002）、更大的计划治疗体积（中位数：504ml 比 402ml，P<0.001）和更大的计划治疗体积/肺体积比（中位数，0.18 比 0.12，P<0.001）。SIB-IMRT 和常规 IMRT 组的中位 OS 分别为 34.5 和 31.7 个月，2 年生存率分别为 60.4%和 59%（P=0.797）。两种技术之间无 PFS、LRFS 或 DMFS 差异。与常规 IMRT 相比，接受 SIB-IMRT 治疗的患者肺部和食管毒性相似。