比较和量化局部晚期非小细胞肺癌放疗联合不同同期化疗方案：扩展 LQ 和 TCP 模型的临床结果和理论结果。
Comparison and quantification of different concurrent chemotherapy regimens with radiotherapy in locally advanced non-small cell lung cancer: Clinical outcomes and theoretical results from an extended LQ and TCP model.
机构信息
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, PR China; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, PR China; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Lung Cancer Institute of Sun Yat-sen University, Guangzhou, PR China; Guangdong Association Study of Thoracic Oncology, Guangzhou, PR China.
出版信息
Radiother Oncol. 2022 Feb;167:34-41. doi: 10.1016/j.radonc.2021.11.033. Epub 2021 Dec 7.
PURPOSE
To develop a new radiobiological model and compare the efficacy of four concurrent chemotherapy regimens administered with radiotherapy in locally advanced non-small-cell lung cancer (LANSCLC) by in-field locoregional progression-free survival (LPFS).
MATERIALS AND METHODS
151 LANSCLC patients were reviewed and divided into 5 groups according to their concurrent chemotherapy regimens, including 24 patients treated with radiotherapy alone, 30 treated with concurrent 4-week etoposide-cisplatin (EP), 26 with 3-week pemetrexed-cisplatin (AP), 37 with weekly paclitaxel-cisplatin (TP) and 34 with weekly docetaxel-cisplatin (DP). In-field LPFS and toxicities were compared among groups. A novel tumor control probability (TCP) model, LQRGC, incorporating four "R"s of radiobiology, Gompertzian tumor growth and chemotherapeutic effect, was related to in-field LPFS. Chemo-induced biologically effective doses (BEDs) in LQRGC/TCP model were used to quantify the concurrent chemotherapeutic efficacy.
RESULTS
The median follow-up time was 54.5 months. The weekly DP and 4-week EP groups had favorable median in-field LPFS (EP:46.2 months, AP:30.3 months, TP:12.2 months, DP: not reached, radiotherapy alone: 12.2 months, p = 0.001). The 4-week EP group had a higher incidence of ≥grade 3 leukopenia (EP:76.7%, AP:15.4%, TP:24.3%, DP:14.7%, radiotherapy alone: 12.5%, p < 0.001) than the other four. The LQRGC/TCP model fitted well with the in-field LPFS with the average absolute and relative fitting errors of 6.36% and 12.12%. The chemo-induced BEDs of EP, AP, TP and DP were 5.17, 0.63, 1.89 and 2.52 Gy, respectively.
CONCLUSION
The LQRGC/TCP model achieved promising fitting accuracy for in-field LPFS. As quantified by the model, the 4-week EP and weekly DP showed higher chemo-induced BEDs when concurrently administered with radiotherapy in LANSCLC.
目的
通过瘤内局部无进展生存（LPFS），建立新的放射生物模型并比较局部晚期非小细胞肺癌（LANSCLC）患者接受四种同期放化疗方案的疗效。
材料与方法
回顾性分析 151 例 LANSCLC 患者，根据同期放化疗方案分为 5 组，单纯放疗组 24 例，4 周依托泊苷-顺铂（EP）组 30 例，3 周培美曲塞-顺铂（AP）组 26 例，每周紫杉醇-顺铂（TP）组 37 例，每周多西他赛-顺铂（DP）组 34 例。比较各组瘤内 LPFS 和毒性。建立包含放射生物学“4R”、Gompertz 肿瘤生长和化疗效果的新型肿瘤控制概率（TCP）模型 LQRGC，与瘤内 LPFS 相关。LQRGC/TCP 模型中化疗诱导的生物有效剂量（BED）用于量化同期化疗的疗效。
结果
中位随访时间为 54.5 个月。每周 DP 和 4 周 EP 组的中位瘤内 LPFS 较好（EP：46.2 个月，AP：30.3 个月，TP：12.2 个月，DP：未达到，单纯放疗组：12.2 个月，p=0.001）。4 周 EP 组白细胞减少≥3 级的发生率高于其他四组（EP：76.7%，AP：15.4%，TP：24.3%，DP：14.7%，单纯放疗组：12.5%，p<0.001）。LQRGC/TCP 模型与瘤内 LPFS 拟合较好，平均绝对和相对拟合误差分别为 6.36%和 12.12%。EP、AP、TP 和 DP 的化疗诱导 BED 分别为 5.17、0.63、1.89 和 2.52 Gy。
结论
LQRGC/TCP 模型对瘤内 LPFS 的拟合精度较高。模型量化显示，4 周 EP 和每周 DP 与放疗同期应用于 LANSCLC 时，化疗诱导的 BED 更高。
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