Department of Radiation Oncology, Paracelsus Medical University, Salzburg, Australia.
Institute for Research and Development on Advanced Radiation Technologies (radART), Paracelsus Medical University, Salzburg, Australia.
Thorac Cancer. 2020 Jun;11(6):1375-1385. doi: 10.1111/1759-7714.13451. Epub 2020 Apr 22.
Concomitant chemo-radiotherapy (cCRT) with 60 Gy in 30 fractions is the standard of care for stage 111 non-small cell lung cancer (NSCLC). With a median overall survival of 28.7 months at best and maximum locoregional control rates of 70% at two years, the prognosis for these patients is still dismal. This systematic review summarizes data on dose escalation by alternative fractionation, which has been explored as a primary strategy to improve both local control and overall survival over the past three decades. A Pubmed literature search was performed according to the PRISMA guidelines. Because of the large variety of radiation regimens total doses were converted to EQD . Only studies using an EQD of at least 49.5 Gy, which corresponds to the conventional 60 Gy in six weeks, were included. In a total of 3256 patients, the median OS was 17 months (range 7.4-30 months). While OS was better for patients treated after the year 2000 (P = 0.003) or with a mandatory F-FDG-PET-CT in the diagnostic work-up (P = 0.001), treatment sequence did not make a difference (P = 0.106). The most commonly reported toxicity was acute esophagitis (AE) with a median rate of 24% (range 0%-84%). AE increased at a rate of 0.5% per Gy increment in EQD (P = 0.016). Dose escalation above the conventional 60 Gy using modified radiation fractionation schedules and shortened OTT yield similar mOS and LRC regardless of treatment sequence with a significant EQD dependent increase in AE. KEY POINTS: Significant findings Modified radiation dose escalation sequentially combined with chemotherapy yields similar outcome as concomitant treatment. OS is better with the mandatory inclusion of FDG-PET-CT in the diagnostic work-up. The risk of acute esophagitis increases with higher EQD . What this study adds Chemo-radiotherapy (CRT) with modified dose escalation regimens yields OS and LC rates in the range of standard therapy regardless of treatment sequence. This broadens the database of curative options in patients who are not eligible concomitant CRT.
同期放化疗（cCRT）联合 60Gy/30f 是 ⅠB-ⅢA 期非小细胞肺癌（NSCLC）的标准治疗方案。最佳中位总生存期为 28.7 个月，2 年局部区域控制率最高为 70%，这些患者的预后仍然很差。本系统综述总结了过去 30 年来通过改变分割剂量进行剂量递增的数据，这已被探索作为提高局部控制和总生存的主要策略。根据 PRISMA 指南进行了 Pubmed 文献检索。由于放射治疗方案种类繁多，总剂量转换为 EQD 。仅纳入使用至少 49.5Gy EQD 的研究，这相当于常规 6 周 60Gy 。在总共 3256 例患者中，中位 OS 为 17 个月（7.4-30 个月）。虽然接受治疗的患者在 2000 年后（P=0.003）或在诊断工作中强制性使用 F-FDG-PET-CT（P=0.001）的 OS 更好，但治疗顺序没有差异（P=0.106）。最常报告的毒性是急性食管炎（AE），中位数为 24%（0%-84%）。AE 以 EQD 每增加 0.5Gy 增加 0.5%的速度增加（P=0.016）。使用改良放射分割方案和缩短 OTT 进行常规 60Gy 以上的剂量递增，无论治疗顺序如何，mOS 和 LRC 相似，AE 呈剂量依赖性增加。要点：重要发现 序贯联合化疗的改良放射剂量递增与同期治疗具有相似的疗效。在诊断工作中强制性纳入 FDG-PET-CT 可改善 OS。AE 风险随 EQD 增加而增加。本研究的新发现 改良剂量递增方案的放化疗序贯治疗可产生与标准治疗相当的 OS 和 LC 率，无论治疗顺序如何。这拓宽了不符合同期放化疗条件的患者的治愈选择范围。
