Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, 1 Beijing Road West, Guiyang, 550004, China.
Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, 1 Beijing Road West, Guiyang, 550004, China.
BMC Cancer. 2024 Aug 26;24(1):1053. doi: 10.1186/s12885-024-12826-1.
The most appropriate time of primary tumor radiotherapy in non-small cell lung cancer(NSCLC) with EGFR-TKIs remains unclear. The aim of this study was to investigate the effect of the time factor of primary tumor radiotherapy on long-term overall survival(OS)and provide a theoretical basis for further clinical research.
In total, 238 patients with EGFR-TKIs and OS ≥ 12 months were statistically analysed. Patients were grouped: the D group without primary tumor radiotherapy and the R group with it.The R group were divided into three groups according to the interval between the start of EGFR-TKIs and the start of primary tumor radiotherapy: R(<30 days), R(≥ 30 days and disease stable), and R(radiotherapy after disease progression). The Kaplan-Meier method and log-rank test were used for survival analyses. Exploratory landmark analyses were investigated.
The OS rates at 1, 2, 3, 5 years for the R group and D group were 96.8%, 62.9%, 38.3%, 17.1%, and 95.6%, 37.7%, 21.8%, 2.9%, respectively; the corresponding MST was 29 months(95% CI: 24.3-33.7) for the R group and 22 months(95% CI: 20.4-23.6) for the D group (χ = 13.480, p<0.001). Multivariate analysis revealed that primary tumor radiotherapy was independent predictors of prolonged OS.Among the four groups, The R appeared to have the best OS (D, χ = 19.307, p<0.001;R, χ = 11.687, p = 0.01; R, χ = 4.086, p = 0.043). Landmark analyses(22 months) showed the R group had a significant long-term OS.The incidence of radiation pneumonitis ≥ grade 2 was17.3%(n = 19)and radiation esophagitis ≥ grade 2 was observed in 32 patients(29.1%).
Our results showed that primary tumour radiotherapy may prolong long-term OS with acceptable toxicities. Appropriate delay(R)of primary tumour radiotherapy may be the best choice.Premature radiotherapy(R) and radiotherapy after disease progression (R)may not be reasonable for long-term OS.
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）治疗的非小细胞肺癌（NSCLC）患者中，原发肿瘤放疗的最佳时机仍不清楚。本研究旨在探讨原发肿瘤放疗时间因素对长期总生存（OS）的影响，并为进一步的临床研究提供理论依据。
共对 238 例 EGFR-TKIs 治疗后 OS≥12 个月的患者进行统计学分析。患者分为无原发肿瘤放疗的 D 组和有放疗的 R 组。R 组根据 EGFR-TKIs 开始至原发肿瘤放疗开始的间隔时间分为三组：R（<30 天）、R（≥30 天且疾病稳定）和 R（疾病进展后放疗）。采用 Kaplan-Meier 法和对数秩检验进行生存分析。进行探索性 landmark 分析。
R 组和 D 组的 OS 率在 1、2、3、5 年时分别为 96.8%、62.9%、38.3%、17.1%和 95.6%、37.7%、21.8%、2.9%；相应的 MST 为 R 组 29 个月（95%CI：24.3-33.7），D 组 22 个月（95%CI：20.4-23.6）（χ²=13.480，p<0.001）。多因素分析显示，原发肿瘤放疗是延长 OS 的独立预测因素。在这四组中，R 组的 OS 似乎最好（D，χ²=19.307，p<0.001；R，χ²=11.687，p=0.01；R，χ²=4.086，p=0.043）。landmark 分析（22 个月）显示 R 组有显著的长期 OS。≥2 级放射性肺炎的发生率为 17.3%（n=19），32 例（29.1%）发生≥2 级放射性食管炎。
我们的结果表明，原发肿瘤放疗可能延长长期 OS，且毒性可接受。适当延迟（R）原发肿瘤放疗可能是最佳选择。过早放疗（R）和疾病进展后放疗（R）可能不利于长期 OS。
