Saeed Nadia A, Jin Lan, Sasse Alexander W, Amini Arya, Verma Vivek, Lester-Coll Nataniel H, Chen Po-Han, Decker Roy H, Park Henry S
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
J Thorac Dis. 2022 Feb;14(2):306-320. doi: 10.21037/jtd-21-1566.
Hypofractionated radiotherapy in locally advanced limited-stage small cell lung cancer is preferred in many Western countries but not used regularly in the United States. We examined practice patterns and overall survival with definitive hypofractionated radiotherapy and chemotherapy standard radiotherapy in this setting.
We included patients in the National Cancer Database with unresected primary stage II-III small cell lung cancer in 2008-2016 who underwent chemotherapy within six months of either hypofractionated radiotherapy (40-45 Gy/15 fractions) or standard radiotherapy (45 Gy/30 fractions or 60-70 Gy/30-35 fractions) in this retrospective cohort study. Patient characteristics were assessed with univariable and multivariable logistic regression. Kaplan-Meier estimator, log-rank test, and multivariable Cox regression were used to evaluate overall survival. Propensity score matching (PSM) was performed as a sensitivity analysis. Early concurrent chemotherapy consisted of radiotherapy and chemotherapy initiated within 30 days of each other.
Seven thousand and one hundred forty-three patients were included: 97.9% received standard radiotherapy and 2.1% hypofractionated radiotherapy. Multivariable analysis on the whole cohort yielded comparable overall survival (HR for hypofractionated radiotherapy 1.09, CI: 0.90-1.32, P=0.37). On PSM (N=292), median overall survival was similar between standard radiotherapy [22.9 months (95% CI: 18.2-30.4 months)] hypofractionated radiotherapy [21.2 months (CI: 16.3-24.7 months); P=0.13]. Overall survival was shorter with hypofractionated radiotherapy in the early concurrent chemotherapy subset (15.8 22.1 months, P=0.007) and longer with hypofractionated radiotherapy in the non-early concurrent chemotherapy subset (29.5 18.5 months, P=0.027).
Overall survival with hypofractionated radiotherapy appears similar to standard radiotherapy in locally advanced limited-stage small cell lung cancer. Chemotherapy timing may modify the effect of fractionation on overall survival, though larger numbers must confirm. Hypofractionated radiotherapy may be considered in those unable to receive early concurrent chemotherapy.
在许多西方国家，局部晚期局限期小细胞肺癌的大分割放疗是首选，但在美国并未常规使用。我们在此背景下研究了大分割根治性放疗与化疗及标准放疗的实践模式和总生存期。
在这项回顾性队列研究中，我们纳入了2008年至2016年国家癌症数据库中未切除的II - III期原发性小细胞肺癌患者，这些患者在接受大分割放疗（40 - 45 Gy/15次分割）或标准放疗（45 Gy/30次分割或60 - 70 Gy/30 - 35次分割）的六个月内接受了化疗。通过单变量和多变量逻辑回归评估患者特征。使用Kaplan - Meier估计器、对数秩检验和多变量Cox回归评估总生存期。进行倾向评分匹配（PSM）作为敏感性分析。早期同步化疗包括放疗和化疗在彼此30天内开始。
纳入7143例患者：97.9%接受标准放疗，2.1%接受大分割放疗。对整个队列的多变量分析得出总生存期相当（大分割放疗的HR为1.09，CI：0.90 - 1.32，P = 0.37）。在PSM（N = 292）中，标准放疗[22.9个月（95%CI：18.2 - 30.4个月）]与大分割放疗[21.2个月（CI：16.3 - 24.7个月）；P = 0.13]的中位总生存期相似。在早期同步化疗亚组中，大分割放疗的总生存期较短（15.8对22.1个月，P = 0.007），在非早期同步化疗亚组中，大分割放疗的总生存期较长（29.5对18.5个月，P = 0.027）。
在局部晚期局限期小细胞肺癌中，大分割放疗的总生存期似乎与标准放疗相似。化疗时机可能会改变分割方式对总生存期的影响，尽管需要更多病例加以证实。对于无法接受早期同步化疗的患者，可以考虑大分割放疗。
