Department of Radiotherapy Oncology, 485308People's Hospital of Yuxi City, Yuxi, Yunnan, China.
Department of Radiotherapy Oncology, 531840The Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province), Kunming, Yunnan, China.
Technol Cancer Res Treat. 2020 Jan-Dec;19:1533033820951802. doi: 10.1177/1533033820951802.
Concurrent chemoradiation (cCHRT) has been confirmed as the standard treatment for local advanced non-small-cell lung cancer (NSCLC). This study is to assess the appropriate timing of radiotherapy and cycles of induction chemotherapy for those patients.
227 inoperable stage III NSCLC patients were selected, we analyzed the potential prognostic factors and the influence of induction chemotherapy was evaluated.
The median survival time was 20.7 months; only 25 patients chose chemotherapy alone (11.0%), 137 patients underwent sequential chemoradiation (sCHRT, 60.4%), and 65 patients received cCHRT (28.6%). Multivariate analyses showed radiation therapy (P = 0.001), the Eastern Cooperative Oncology Group (ECOG) score (P = 0.000) and the lymph node stage (P = 0.001) were independent prognostic factors. cCHRT was not found to be superior (P = 0.330). We selected patients received 60-66 Gy and found the cCHRT groups achieved a relatively better outcome, with a median Overall Survival (OS) of 25.2 months vs 20.1 months in the sCHRT group (P = 0.019). We also found cycles of induction chemotherapy did not compromise survival; however, ≥3 cycles resulted in more grade 3-4 hematology toxicities, with a proportion of 18/99 compared with 53/103 among patients who underwent ≤3 cycles. In addition, higher grade hematology toxicities and poor ECOG were also the most common reasons for abandoning cCHRT.
For inoperable stage III NSCLC, cCHRT showed its superiority only when the radiotherapy dose was 60-66 Gy. Cycles of induction chemotherapy did not interfere with survival; however, ≥3 cycles resulted in more grade 3-4 hematology toxicities, leading to the cessation of cCHRT.
同期放化疗（cCHRT）已被确认为局部晚期非小细胞肺癌（NSCLC）的标准治疗方法。本研究旨在评估此类患者接受放疗的最佳时机和诱导化疗周期数。
选择 227 例不可手术的 III 期 NSCLC 患者，分析潜在的预后因素，并评估诱导化疗的影响。
中位生存时间为 20.7 个月；仅 25 例患者选择单纯化疗（11.0%），137 例患者接受序贯放化疗（sCHRT，60.4%），65 例患者接受 cCHRT（28.6%）。多因素分析显示，放疗（P=0.001）、东部肿瘤协作组（ECOG）评分（P=0.000）和淋巴结分期（P=0.001）是独立的预后因素。cCHRT 并未显示出优越性（P=0.330）。我们选择接受 60-66Gy 放疗的患者，发现 cCHRT 组的总体生存（OS）相对较好，中位 OS 为 25.2 个月，而 sCHRT 组为 20.1 个月（P=0.019）。我们还发现，诱导化疗周期数并不会影响生存；然而，≥3 个周期会导致更高级别的 3-4 级血液学毒性，其比例为 18/99，而接受≤3 个周期的患者为 53/103。此外，更高等级的血液学毒性和较差的 ECOG 状态也是放弃 cCHRT 的最常见原因。
对于不可手术的 III 期 NSCLC，仅当放疗剂量为 60-66Gy 时，cCHRT 才显示出其优越性。诱导化疗周期数不会影响生存；然而，≥3 个周期会导致更高级别的 3-4 级血液学毒性，从而导致 cCHRT 的终止。
