Li Xinge, Wang Jie, Chang Xu, Gao Zhenhua, Teng Feifei, Meng Xue, Yu Jinming
Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Front Oncol. 2022 Feb 10;12:793190. doi: 10.3389/fonc.2022.793190. eCollection 2022.
Local radiotherapy (LRT) is reported to be of survival benefit for advanced non-small cell lung cancer (NSCLC) in accumulating evidence, but research on the optimal initial time point remains scarce. This IRB-approved retrospective analysis identified patients diagnosed with stage IIIb-IV unresectable lung adenocarcinoma who initiated front-line LRT at our institution between 2017 and 2020. The receiver operating characteristic (ROC) curve analyses were used to cut off the initial time of LRT (before and beyond 53 days). Patients were divided into two groups: one early to initiate radiotherapy group (≤53 days, EAR group) and one deferred radiotherapy group (>53 days, DEF group). The Kaplan-Meier method was used to estimate time-to-event endpoints; the Cox proportional hazard model was used to find out predictors of progression-free survival (PFS) and overall survival (OS). A total of 265 patients with a median age of 57 were enrolled. The median follow-up time was 26.4 months (ranging from 2.2 to 69.7 months). The mOS was 38.6 months and mPFS was 12.7 months. Age >60, bone and brain metastases, multisite metastases, and EGFR 19 mutation were independent predictors associated with OS. Early initiation of local radiotherapy within 53 days after diagnosis resulted in better PFS, but not in OS. A better OS was observed in patients with bone metastasis who underwent local radiotherapy initiated within 53 days.
越来越多的证据表明，局部放疗（LRT）对晚期非小细胞肺癌（NSCLC）具有生存益处，但关于最佳初始时间点的研究仍然很少。这项经机构审查委员会（IRB）批准的回顾性分析纳入了2017年至2020年期间在我们机构开始一线LRT治疗的IIIb-IV期不可切除肺腺癌患者。采用受试者工作特征（ROC）曲线分析来确定LRT的初始时间（53天之前和之后）。患者分为两组：一组为早期开始放疗组（≤53天，EAR组）和一组延迟放疗组（>53天，DEF组）。采用Kaplan-Meier方法估计事件发生时间终点；采用Cox比例风险模型找出无进展生存期（PFS）和总生存期（OS）的预测因素。共纳入265例患者，中位年龄为57岁。中位随访时间为26.4个月（范围为2.2至69.7个月）。mOS为38.6个月，mPFS为12.7个月。年龄>60岁、骨和脑转移、多部位转移以及EGFR 19突变是与OS相关的独立预测因素。诊断后53天内尽早开始局部放疗可带来更好的PFS，但对OS无影响。在诊断后53天内开始局部放疗的骨转移患者中观察到更好的OS。
