Xu Liming, Zhang Kunning, Han Haonan, Sun Han, Yuan Yajing, Wang Jun, Zhao Lujun, Wang Ping
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Hubei Key Laboratory of Tumor Microenvironment and Immunotherapy, College of Basic Medical Sciences, China Three Gorges University, Yichang, China.
Front Oncol. 2023 Sep 15;13:1245506. doi: 10.3389/fonc.2023.1245506. eCollection 2023.
This study was designed to evaluate the suitable radiotherapy dose in SCLC patients with BM.
A retrospective analysis was performed among 121 patients on the prognosis of BM of SCLC who were admitted to our hospital from 2013 to 2023. They all received first line chemotherapy. 80 patients of them received TRT after chemotherapy. The Chi square method was used to compare the categorical data. Univariate survival analysis was estimated by Kaplan Meier method and the logrank was used to compare survival curves between groups. A multivariate prognostic analysis was made by the Cox proportional hazard model. The iOS and iLC of two groups of low dose and high dose were analyzed after propensity score matching (PSM).
In all the patients, the median follow-up time was 18.6 months (range 6.30~85.7), the 2-year iOS and iLC rates were 15.4% and 70.3%, respectively, and cerebral necrosis occurred in 2 patients. In univariate analysis related to iOS, extracranial disease control (p=0.023), higher DS-GPA (≥2) (p=0.016), immunotherapy (p=0.049), low-dose(p=0.030), and WBRT+SIB (p=0.009) were significantly associated with an increase in survival rate. After PSM, the 2-year iOS of low dose (n=49) was significantly higher than that of high dose (n=49) (P=0.025), while the 2-year iLC was not significantly improved (P=0.267). In DS-GPA < 2 subgroup, the iOS of low dose group was significantly higher than that of high dose group (p=0.019). In the DS-GPA ≥ 2 subgroup, the 2-year iLC of the low dose group was significantly inferior than that of the high dose group (p=0.044).
The iLC was improved along with increasing radiotherapy dose, but high dose had inferior iOS compared to low dose, while there were not significantly improving iLC when radiotherapy BED >56Gy. But in patients with DS-GPA≥2 subgroup, high dose brought better iLC benefits.
本研究旨在评估小细胞肺癌脑转移（SCLC-BM）患者合适的放疗剂量。
对2013年至2023年我院收治的121例SCLC-BM患者的预后进行回顾性分析。他们均接受一线化疗。其中80例患者化疗后接受立体定向放疗（TRT）。采用卡方检验比较分类数据。采用Kaplan-Meier法进行单因素生存分析，用logrank检验比较组间生存曲线。采用Cox比例风险模型进行多因素预后分析。倾向评分匹配（PSM）后分析两组低剂量和高剂量的颅内无进展生存期（iOS）和颅内局部控制率（iLC）。
所有患者中位随访时间为18.6个月（范围6.30~85.7个月），2年iOS率和iLC率分别为15.4%和70.3%，2例发生脑坏死。在与iOS相关的单因素分析中，颅外疾病控制（p=0.023）、较高的诊断特异性GPA（≥2）（p=0.016）、免疫治疗（p=0.049）、低剂量（p=0.030）和全脑放疗+立体定向体部放疗（WBRT+SIB）（p=0.009）与生存率提高显著相关。PSM后，低剂量组（n=49）的2年iOS显著高于高剂量组（n=49）（P=0.025），而2年iLC无显著改善（P=0.267）。在诊断特异性GPA<2亚组中，低剂量组的iOS显著高于高剂量组（p=0.019）。在诊断特异性GPA≥2亚组中，低剂量组的2年iLC显著低于高剂量组（p=0.044）。
iLC随放疗剂量增加而改善，但高剂量组的iOS低于低剂量组，当放疗生物等效剂量（BED）>56Gy时，iLC无显著改善。但在诊断特异性GPA≥2亚组患者中，高剂量带来更好的iLC获益。
