局部晚期非小细胞肺癌现代低线性能量传递放疗方案的创新：高剂量率近距离放疗、立体定向体部放疗和大分割质子治疗的荟萃分析与系统评价
Innovations in modern low-LET radiotherapy regimens for locally advanced non-small cell lung cancer: a meta-analysis and systematic review of high-dose-rate brachytherapy, stereotactic body radiotherapy, and hypofractionated proton therapy.
作者信息
Tan Mingyu, Li Lu, Tan Bangxian, Yang Jinxin
机构信息
Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China.
出版信息
BMC Cancer. 2025 May 26;25(1):942. doi: 10.1186/s12885-025-14328-0.
BACKGROUND
This study assesses recent treatments for locally advanced non-small cell lung cancer (LA-NSCLC) ineligible for surgery, comparing high-dose-rate (HDR) brachytherapy with conventional low linear energy transfer (LET) hypofractionated radiotherapy methods.
METHODS
From 9435 papers, 8 meeting criteria were selected, covering 484 LA-NSCLC patients (2005-2019). Analysis focused on comparing outcomes, exploring biologically effective doses (BED), and examining toxicities.
RESULTS
HDR brachytherapy had better effectiveness. Specific data revealed that the median overall survival (OS) with HDR brachytherapy was 38 months, with a significant 2-year OS rate of 68.0% (95% CI, 58.2-79.4%). In comparison, stereotactic body radiation (SBRT) and proton treatment had 2-year OS rates of 54% (95% CI, 36-71%), and 56% (95% CI, 42-70%), respectively. In terms of local control (LC), the 2-year LC rate for HDR brachytherapy stood at 87.1% (95% CI, 79-95%), whereas the 2-year LC rates for SBRT and proton therapy were 75% (95% CI, 63-86%) and 84% (95% CI, 68 -100%), respectively. The 2-year OS for BED equal to or greater than 78 Gy was 62% (95% CI, 51-72%), compared to 38% (95% CI, 17-58%) for BED less than 78 Gy. Acute toxicity was lower with HDR brachytherapy (95% CI, 0-10%) versus SBRT (95% CI, 8-16%), with no grade 3 + events reported for proton therapy. Furthermore, the rate of late toxicity events above grade 3 was 3% (95% CI, 0-6%) for SBRT and 14% (95% CI, 4-24%) for proton therapy, while no late toxicities above grade 3 were observed with brachytherapy.
CONCLUSIONS
Hypofractionated low LET irradiation is efficacious and safe for LA-NSCLC, while HDR brachytherapy provides significant OS and LC advantages with few toxicities. Achieving BED ≥ 78 Gy significantly impacts OS. These findings guide clinical practice and stimulate further LA-NSCLC treatment advancements.
背景
本研究评估了不适用于手术的局部晚期非小细胞肺癌（LA-NSCLC）的近期治疗方法，比较了高剂量率（HDR）近距离放射治疗与传统低线性能量传递（LET）低分割放射治疗方法。
方法
从9435篇论文中筛选出8篇符合标准的论文，涵盖484例LA-NSCLC患者（2005 - 2019年）。分析重点在于比较疗效、探索生物等效剂量（BED）以及检查毒性。
结果
HDR近距离放射治疗具有更好的疗效。具体数据显示，HDR近距离放射治疗的中位总生存期（OS）为38个月，2年总生存率显著为68.0%（95%置信区间，58.2 - 79.4%）。相比之下，立体定向体部放疗（SBRT）和质子治疗的2年总生存率分别为54%（95%置信区间，36 - 71%）和56%（95%置信区间，42 - 70%）。在局部控制（LC）方面，HDR近距离放射治疗的2年局部控制率为87.1%（95%置信区间，79 - 95%），而SBRT和质子治疗的2年局部控制率分别为75%（95%置信区间，63 - 86%）和84%（95%置信区间，68 - 100%）。生物等效剂量等于或大于78 Gy时的2年总生存率为62%（95%置信区间，51 - 72%），而生物等效剂量小于78 Gy时为38%（95%置信区间，17 - 58%）。HDR近距离放射治疗的急性毒性低于SBRT（95%置信区间，0 - 10%对95%置信区间，8 - 16%），质子治疗未报告3级及以上事件。此外，SBRT的3级以上晚期毒性事件发生率为3%（95%置信区间，0 - 6%），质子治疗为14%（95%置信区间，4 - 24%），而近距离放射治疗未观察到3级以上晚期毒性。
结论
低分割低LET照射对LA-NSCLC有效且安全，而HDR近距离放射治疗在总生存期和局部控制方面具有显著优势且毒性较小。实现生物等效剂量≥78 Gy对总生存期有显著影响。这些发现指导临床实践并推动LA-NSCLC治疗的进一步发展。
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