Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China; Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.
Radiother Oncol. 2022 Jul;172:140-146. doi: 10.1016/j.radonc.2022.01.022. Epub 2022 Jan 29.
Concurrent chemoradiotherapy is the standard treatment for limited-stage small-cell lung cancer patients (SCLC). However, the optimal dose and schedule of thoracic radiotherapy (TRT) has not been established.
We retrospectively reviewed the clinical records of limited-stage SCLC patients treated with twice-daily TRT and concurrent chemotherapy between December 2009 and December 2017. Patients were divided into two groups according to radiotherapy dose: the intensity modulated radiotherapy (IMRT) group [45 Gy to the planning target volume (PTV)] and the simultaneous integrated boost IMRT (SIB-IMRT) group (57 Gy to the gross tumour volume, 51 Gy to the clinical target volume, and 45 Gy to PTV). A 1:1 propensity score matching (PSM) was applied to balance the observable potential confounding factors between the two groups. Primary endpoint was progression-free survival (PFS).
A total of 112 patients were enrolled in our study, including 71 patients in the IMRT group and 41 patients in the SIB-IMRT group. After PSM, the clinical features were well balanced between the groups, including 37 patients each. The median PFS was 17.54 months in the IMRT group versus 34.92 months in the SIB-IMRT group (P = 0.047). The median overall survival (OS) was 38.52 months in the IMRT group versus 63.41 months in the SIB-IMRT group (P = 0.261).
Compared with IMRT, a high dose of twice-daily TRT by the SIB-IMRT approach with concurrent chemotherapy for limited-stage SCLC patients may improve PFS without increasing toxicities. However, PFS improvement failed to result in significant advantages in OS.
同期放化疗是局限期小细胞肺癌（SCLC）患者的标准治疗方法。然而，胸部放疗（TRT）的最佳剂量和方案尚未确定。
我们回顾性分析了 2009 年 12 月至 2017 年 12 月接受每日两次 TRT 联合同期化疗的局限期 SCLC 患者的临床资料。根据放疗剂量将患者分为两组：调强放疗（IMRT）组[45 Gy 至计划靶区（PTV）]和同步整合增敏调强放疗（SIB-IMRT）组（57 Gy 至大体肿瘤体积，51 Gy 至临床靶区，45 Gy 至 PTV）。采用 1:1 倾向评分匹配（PSM）平衡两组间可观察到的潜在混杂因素。主要终点是无进展生存期（PFS）。
共纳入 112 例患者，其中 IMRT 组 71 例，SIB-IMRT 组 41 例。PSM 后，两组的临床特征均衡，每组各有 37 例患者。IMRT 组中位 PFS 为 17.54 个月，SIB-IMRT 组为 34.92 个月（P=0.047）。IMRT 组中位总生存期（OS）为 38.52 个月，SIB-IMRT 组为 63.41 个月（P=0.261）。
与 IMRT 相比，SIB-IMRT 同步化疗治疗局限期 SCLC 患者的每日两次高剂量 TRT 可能会提高 PFS，而不增加毒性。然而，PFS 的改善并未导致 OS 的显著优势。
