Zhou Wei, Wang Pang, Ti Xinyu, Yin Yutian, Huang Shigao, Yang Zhi, Li Jie, Chai Guangjin, Lyu Bo, Li Zhaohui, Zhou Yan, Xiao Feng, Xu Lin, Shi Mei, Zhao Lina
Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an 710032, China.
Out-Patient Department, Xijing Hospital, Air Force Medical University, Xi'an 710032, China.
Cancers (Basel). 2022 Aug 13;14(16):3920. doi: 10.3390/cancers14163920.
Background: As there are no randomized trials comparing twice-daily with sequential hypofractionated (sequential hypo) radiotherapy regimens for limited-stage small-cell lung cancer (LS-SCLC). This study aimed to compare these two regimens for LS-SCLC by propensity score-matched analysis (PSM). Methods: We retrospectively analyzed 108 LS-SCLC patients between January 2015 and July 2019. All patients received concurrent twice-daily or sequential hypo radiotherapy. The survival, failure patterns, and toxicities were evaluated before and after PSM. Results: Before PSM, multivariate analysis showed that patients treated with sequential hypo had a significantly better overall survival (OS) and distant metastasis-free survival (DMFS) (HR = 0.353, p = 0.009; HR = 0.483, p = 0.039, respectively). Total radiotherapy time ≥ 24 days and stage III (HR = 2.454, p = 0.004; HR = 2.310, p = 0.004, respectively) were poor prognostic indicators for OS. Patients with a total radiotherapy time ≥ 24 days and N2−3 were more likely to recur than others (HR = 1.774, p = 0.048; HR = 2.369, p = 0.047, respectively). N2−3 (HR = 3.032, p = 0.011) was a poor prognostic indicator for DMFS. After PSM, being aged ≥65 years was associated with poorer OS, relapse-free survival (RFS) and DMFS (p < 0.05). A total radiotherapy time of ≥24 days was a poor prognostic indicator for OS and RFS (HR = 2.671, p = 0.046; HR = 2.370, p = 0.054, respectively). Although there was no significant difference, the patients in the sequential hypo group had a trend towards a better OS. The failure pattern between the two groups showed no difference. More patients had grade 1−2 esophagitis in the twice-daily group (p = 0.001). Conclusions: After propensity matching, no difference was shown in survival and failure. The sequential hypo schedule was associated with comparable survival and less toxicity and may be used as an alternative to concurrent twice-daily regimens.
由于尚无随机试验比较局限期小细胞肺癌（LS-SCLC）每日两次放疗方案与序贯低分割放疗方案。本研究旨在通过倾向评分匹配分析（PSM）比较这两种LS-SCLC放疗方案。方法：我们回顾性分析了2015年1月至2019年7月期间的108例LS-SCLC患者。所有患者均接受了同步每日两次或序贯低分割放疗。在PSM前后评估生存情况、失败模式和毒性。结果：在PSM前，多因素分析显示接受序贯低分割放疗的患者总生存期（OS）和无远处转移生存期（DMFS）显著更好（HR = 0.353，p = 0.009；HR = 0.483，p = 0.039）。总放疗时间≥24天和Ⅲ期（HR = 2.454，p = 0.004；HR = 2.310，p = 0.004）分别是OS的不良预后指标。总放疗时间≥24天且N2-3期的患者比其他患者更易复发（HR = 1.774，p = 0.048；HR = 2.369，p = 0.047）。N2-3期（HR = 3.032，p = 0.011）是DMFS的不良预后指标。PSM后，年龄≥65岁与较差的OS、无复发生存期（RFS）和DMFS相关（p < 0.05）。总放疗时间≥24天是OS和RFS的不良预后指标（HR = 2.671，p = 0.046；HR = 2.370，p = 0.054）。尽管无显著差异，但序贯低分割组患者的OS有更好的趋势。两组间失败模式无差异。每日两次放疗组更多患者出现1-2级食管炎（p = 0.001）。结论：倾向匹配后，生存和失败方面未显示差异。序贯低分割方案与相当的生存率和更低的毒性相关，可作为同步每日两次放疗方案的替代方案。
