Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan.
Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan.
Int J Radiat Oncol Biol Phys. 2021 Sep 1;111(1):143-151. doi: 10.1016/j.ijrobp.2021.04.014. Epub 2021 Apr 21.
We investigated whether delivery of a high biologically effective dose (BED) to primary tumors affects systemic outcomes of cancer-specific death (CSD) and overall survival (OS) rates after stereotactic body radiation therapy (SBRT) in patients with early-stage non-small cell lung cancer (ES-NSCLC).
Among consecutive ES-NSCLC patients treated with SBRT between 2005 and 2019, we retrospectively identified patients who received a prescription of 50 to 60 Gy in 5 fractions with maximum doses of 62.5 to 100 Gy. Patients were categorized by maximum BED within the planning target volume with a threshold dose of 200 Gy. Outcomes were analyzed in all and matched patients.
Overall, 433 patients were eligible, and 262 and 171 patients were categorized into HighBED and LowBED groups, respectively. After propensity score matching, pairs of 154 patients were selected. Median follow-up times for the HighBED and LowBED groups were 52.3 months (range, 0.8-107.2 months) and 121.6 months (range, 3.0-162.8 months), respectively. The local recurrence rate in the HighBED group was significantly lower than that in the LowBED group (5-year rate, 1.3% and 7.2%; hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.03-0.65; P = .011). Rates of any recurrence and CSD in the HighBED group were significantly lower (5-year any recurrence: 18.1% and 32.1%; HR, 0.52; 95% CI, 0.33-0.83; P = .0058; 5-year CSD: 9.5% and 21.8%; HR, 0.38; 95% CI, 0.20-0.70; P = .002), and OS in the HighBED group was significantly better compared with the LowBED group (5-year rate: 61.7% and 51.8%; HR, 0.71; 95% CI, 0.50-1.00; P = .047).
In patients with peripheral ES-NSCLC, SBRT with a high maximum dose may improve not only local control, but also any recurrence, CSD, and OS rates without increased toxicity. Further trials designed to evaluate whether higher intensity SBRT increases local control rates and contributes to improved CSD and OS outcomes are anticipated.
我们研究了立体定向体部放射治疗（SBRT）后，原发性肿瘤接受高生物有效剂量（BED）是否会影响早期非小细胞肺癌（ES-NSCLC）患者的癌症特异性死亡（CSD）和总生存率（OS）。
在 2005 年至 2019 年间接受 SBRT 治疗的连续 ES-NSCLC 患者中，我们回顾性地确定了接受 5 次分割，每次 50-60 Gy，最大剂量为 62.5-100 Gy 的处方剂量的患者。通过在计划靶区（PTV）内的最大 BED 进行分类，以 200 Gy 为阈值剂量。分析了所有和匹配患者的结果。
共有 433 名患者符合条件，262 名和 171 名患者分别分为 HighBED 和 LowBED 组。经过倾向评分匹配后，选择了 154 对患者。HighBED 和 LowBED 组的中位随访时间分别为 52.3 个月（范围，0.8-107.2 个月）和 121.6 个月（范围，3.0-162.8 个月）。HighBED 组的局部复发率明显低于 LowBED 组（5 年率，1.3%和 7.2%；风险比[HR]，0.15；95%置信区间[CI]，0.03-0.65；P=0.011）。HighBED 组的任何复发和 CSD 发生率明显较低（5 年任何复发：18.1%和 32.1%；HR，0.52；95%CI，0.33-0.83；P=0.0058；5 年 CSD：9.5%和 21.8%；HR，0.38；95%CI，0.20-0.70；P=0.002），与 LowBED 组相比，HighBED 组的 OS 明显更好（5 年率：61.7%和 51.8%；HR，0.71；95%CI，0.50-1.00；P=0.047）。
对于外周性 ES-NSCLC 患者，SBRT 采用高最大剂量不仅可以提高局部控制率，还可以降低任何复发、CSD 和 OS 率，而不会增加毒性。预计将进行进一步的试验，以评估更高强度的 SBRT 是否会增加局部控制率，并有助于提高 CSD 和 OS 结局。
