老年及多病的II/III期非小细胞肺癌患者适度低分割胸部放疗的真实世界见解：一项回顾性研究
Real-world insights into moderately hypofractionated thoracic radiotherapy in elderly and multimorbid patients with stage II/III NSCLC: a retrospective study.
作者信息
Kravutske Helene, Mansoorian Sina, Käsmann Lukas, Lehmann Janina, Richlitzki Cedric, Kauffmann-Guerrero Diego, Schmidt-Hegemann Nina-Sophie, Reinmuth Niels, Tufman Amanda, Dinkel Julien, Gaus Richard, Manapov Farkhad, Belka Claus, Eze Chukwuka
机构信息
Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
出版信息
Acta Oncol. 2025 Jul 25;64:957-965. doi: 10.2340/1651-226X.2025.43496.
PURPOSE
Investigating real-world outcomes of moderately hypofractionated radiotherapy (hypoRT) in elderly and multimorbid stage IIB-IIIC non-small-cell lung cancer (NSCLC) patients ineligible for concurrent chemoradiation.
METHODS
We retrospectively analysed 70 patients with primary or recurrent stage IIB-IIIC NSCLC (TNM, 8th edition). HypoRT was administered to a total dose of 38-56 Gy in 10-17 fractions (2.5-3.8 Gy/fraction). Patterns of recurrence, survival outcome, and toxicity were assessed.
RESULTS
Seventy patients, with a median age of 76.4 years (range: 51.6-88.2 years), who received hypoRT between August 2015 and September 2022, were reviewed. At baseline, the median Charlson Comorbidity Index (CCI) with oncological diagnosis was 8 (range: 3-13). With a median follow-up post-radiotherapy of 63.9 months (95% Confidence Interval [CI]: 34.8-93.1 months), median progression-free survival (PFS) was 7.6 months (95% CI 6.0-11.0 months), and the median overall survival (OS) was 20.7 months (95% CI 16.7-30.7 months). Competing risk analysis revealed 12-month cumulative incidences of locoregional and distant failure in 41% (95% CI 30-53%) and 14% (95% CI 6-23%) of patients, respectively. Following disease progression, 45 patients received subsequent therapy: 25 underwent additional radiotherapy, 22 received systemic treatment (including immunotherapy), and 19 were referred for best supportive care. Treatment was well tolerated; only 3 patients (4%) developed grade 3 pneumonitis. No adverse events of grade > 3 were reported.
INTERPRETATION
Moderately hypoRT is a safe, feasible, and effective treatment option for elderly and multimorbid patients with stage IIB-IIIC NSCLC, offering encouraging survival outcomes and low toxicity rates. Future prospective studies are needed to validate these findings and optimise treatment strategies for this high-risk population.
目的
研究在不符合同步放化疗条件的老年及多病态IIB-IIIC期非小细胞肺癌（NSCLC）患者中，适度低分割放疗（hypoRT）的真实世界疗效。
方法
我们回顾性分析了70例原发性或复发性IIB-IIIC期NSCLC患者（TNM，第8版）。HypoRT的总剂量为38-56 Gy，分10-17次给予（每次2.5-3.8 Gy）。评估复发模式、生存结局和毒性。
结果
回顾了2015年8月至2022年9月期间接受hypoRT的70例患者，中位年龄为76.4岁（范围：51.6-88.2岁）。基线时，合并肿瘤诊断的中位Charlson合并症指数（CCI）为8（范围：3-13）。放疗后中位随访63.9个月（95%置信区间[CI]：34.8-93.1个月），中位无进展生存期（PFS）为7.6个月（95% CI 6.0-11.0个月），中位总生存期（OS）为20.7个月（95% CI 16.7-30.7个月）。竞争风险分析显示，患者局部区域和远处失败的12个月累积发生率分别为41%（95% CI 30-53%）和14%（95% CI 6-23%）。疾病进展后，45例患者接受了后续治疗：25例接受了额外放疗，22例接受了全身治疗（包括免疫治疗），19例接受了最佳支持治疗。治疗耐受性良好；仅3例患者（4%）发生3级肺炎。未报告>3级不良事件。
解读
适度低分割放疗对于老年及多病态的IIB-IIIC期NSCLC患者是一种安全、可行且有效的治疗选择，具有令人鼓舞的生存结局和低毒性率。未来需要进行前瞻性研究以验证这些发现，并优化针对这一高危人群的治疗策略。
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