Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Radiation Oncology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Radiother Oncol. 2024 Sep;198:110383. doi: 10.1016/j.radonc.2024.110383. Epub 2024 Jun 13.
No established early biomarkers currently exist to predict responses during concurrent chemoradiotherapy (CCRT) in patients with unresectable non-small cell lung cancer (NSCLC). This study investigated the potential of gross tumor volume (GTV) and its changes during CCRT as predictors of survival outcomes.
We identified 227 patients with unresectable stage III NSCLC who underwent definitive CCRT followed by durvalumab between November 2018 and December 2022. GTV was defined as the volume of the primary tumor, assessed at two time points: before starting CCRT for initial planning (GTV1), and at the fourth week of CCRT for adaptive planning (GTV2). Both relative and absolute regressions between GTV1 and GTV2 were calculated.
The median GTV1 volume was 90 mL (range, 5-840 mL), and the median GTV2 volume was 64 mL (range, 1-520 mL), resulting in median absolute and relative regressions of 18.6 mL and 25.0 %, respectively. Among the GTV parameters, relative GTV regression exhibited the strongest predictive value, with an area under the curve (AUC) of 0.804 for in-field progression and 0.711 for overall progression. The 1-year progression-free survival rates for the high (>30 %), intermediate (0-30 %), and low (≤0%) relative regression groups were 88.0 %, 62.6 %, and 14.3 %, respectively (p = 0.006 for high vs. intermediate; p < 0.001 for intermediate vs. low). Additionally, GTV2 volume demonstrated stronger associations with survival outcomes than GTV1 volume.
Relative GTV regression was identified as a promising early predictor for patients with unresectable stage III NSCLC. Further development of a multi-parametric predictive model is warranted to guide patient-tailored therapeutic approaches.
目前尚无既定的早期生物标志物可预测不可切除非小细胞肺癌（NSCLC）患者同步放化疗（CCRT）期间的反应。本研究探讨了大体肿瘤体积（GTV）及其在 CCRT 期间的变化作为预测生存结局的潜力。
我们纳入了 2018 年 11 月至 2022 年 12 月期间接受根治性 CCRT 后序贯度伐利尤单抗治疗的 227 例不可切除 III 期 NSCLC 患者。GTV 定义为原发肿瘤的体积，在两个时间点进行评估：开始 CCRT 进行初始计划时（GTV1）和 CCRT 进行第 4 周时进行适应性计划时（GTV2）。计算了 GTV1 与 GTV2 之间的相对和绝对回归。
中位 GTV1 体积为 90mL（范围，5-840mL），中位 GTV2 体积为 64mL（范围，1-520mL），导致中位绝对和相对回归分别为 18.6mL 和 25.0%。在 GTV 参数中，相对 GTV 回归具有最强的预测价值，对于场内进展的曲线下面积（AUC）为 0.804，对于总进展的 AUC 为 0.711。高（>30%）、中（0-30%）和低（≤0%）相对回归组的 1 年无进展生存率分别为 88.0%、62.6%和 14.3%（高与中比较，p=0.006；中与低比较，p<0.001）。此外，GTV2 体积与生存结局的相关性强于 GTV1 体积。
相对 GTV 回归被确定为不可切除 III 期 NSCLC 患者有前途的早期预测指标。进一步开发多参数预测模型以指导患者个体化治疗方法是必要的。
