Department of Radiation Oncology, Washington University School of Medicine and Alvin J. Siteman Comprehensive Cancer Center, St. Louis, MO 63110, USA.
Cooperative Studies Program Epidemiology Center, HSR&D/DVAHCS, Durham, NC 27705, USA.
Int J Environ Res Public Health. 2021 Mar 21;18(6):3241. doi: 10.3390/ijerph18063241.
There has been growing interest in utilizing information from cone-beam computed tomography (CBCT) to help guide both treatment delivery and prognosis. In this assessment of locally advanced unresectable stage III non-small cell lung cancer (NSCLC) treated with definitive chemoradiation, we aimed to determine the survival advantage associated with using CBCT to measure tumor regression. Patient, tumor, and treatment characteristics were collected. The serial tumor shrinkage for each patient was determined from tumor volume contours on weekly CBCTs. Survival analysis was performed using the Kaplan-Meier technique and a Cox proportional hazards model. At least two-thirds of patients had a tumor volume reduction of at least 5% after each week of chemoradiation. A weekly reduction in tumor volume of 5% or greater seen on the CBCT images during radiation therapy was significantly associated with improved overall survival, which remained significant when adjusted for age, histology, grade, and T- and N-stages ( 0.0036). Additionally, the presence of N3 disease was associated with a five-fold increased risk of recurrence ( 0.0006) and a nearly three-fold increased risk of death ( 0.053) compared with N0-N2 disease. Tumor volume shrinkage observed in the CBCT images during definitive chemoradiation holds promise as a prognostic indicator of stage III NSCLC, especially given its affordability, availability, and applicability. Further evaluation in a prospective fashion is warranted to validate the tumor volume shrinkage and its clinical utility.
利用锥形束 CT（CBCT）信息来帮助指导治疗和预后已经引起了越来越多的关注。在这项对接受根治性放化疗的局部晚期不可切除 III 期非小细胞肺癌（NSCLC）的评估中，我们旨在确定使用 CBCT 测量肿瘤退缩与生存优势相关。收集了患者、肿瘤和治疗特征。通过每周 CBCT 上的肿瘤体积轮廓来确定每位患者的肿瘤退缩情况。采用 Kaplan-Meier 技术和 Cox 比例风险模型进行生存分析。至少三分之二的患者在每周放化疗后肿瘤体积减少至少 5%。在放射治疗期间 CBCT 图像上观察到的肿瘤体积每周减少 5%或更多与总生存显著相关，当调整年龄、组织学、分级以及 T 和 N 期时仍然显著（0.0036）。此外，与 N0-N2 疾病相比，N3 疾病的存在与复发风险增加五倍（0.0006）和死亡风险增加近三倍（0.053）相关。在根治性放化疗期间 CBCT 图像中观察到的肿瘤体积退缩有望成为 III 期 NSCLC 的预后指标，尤其是考虑到其可负担性、可用性和适用性。需要前瞻性评估进一步验证肿瘤体积退缩及其临床应用。
