Rulach Robert, Harrow Stephen, Chalmers Anthony J, Fenwick John
University of Oxford, Department of Oncology, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK.
School of Cancer Sciences, University of Glasgow, Glasgow G61 1QH, UK.
Clin Transl Radiat Oncol. 2025 Aug 21;55:101036. doi: 10.1016/j.ctro.2025.101036. eCollection 2025 Nov.
Loco-regional recurrence is seen in up to 50 % of patients with non-small cell lung cancer (NSCLC) by 2 years after curative intent radiotherapy (RT). For these patients, radical re-irradiation (re-RT) is possible, but data is lacking regarding efficacy and radiation dose response, especially about conventionally fractionated re-irradiation. We analysed associations between survival following re-irradiation and RT dose, to guide clinicians regarding target re-RT dose, and predict re-treatment efficacy.
We performed a literature search for studies primarily comprised of NSCLC patients that detailed 2-year overall survival (OS) rates and delivered doses. These data were collated with intervals between treatments, PTV sizes and use of concurrent chemotherapy where this information was available. Logistic regression analyses of associations between OS and treatment and patient factors were carried out. Doses required for 30% and 50% OS were calculated.
We identified 20 suitable studies (675 patients). In univariable models, OS was significantly associated with the initial RT dose, re-RT dose and chemotherapy use but not the interval. The best multivariable OS model according to the Akaike Information Criterion included only the re-RT dose (p < 0.05) and described the data well (Hosmer-Lemeshow p-value = 0.385). This model predicted OS rates of 30 % and 50 % at re-RT equivalent doses in 2 Gy fractions (EQD2s) of 49.8 Gy (95 % CI 36.4, 58.0 Gy) and 76.5 Gy (95 % CI 70.8, 82.7 Gy) respectively.
OS following re-RT of recurrent NSCLC is significantly associated with retreatment dose. A reasonable target dose for re-RT is EQD2s > 50 Gy with survival rates continuing to increase to 85 Gy.
在接受根治性放疗（RT）的非小细胞肺癌（NSCLC）患者中，高达50%的患者在2年内会出现局部区域复发。对于这些患者，根治性再放疗（re-RT）是可行的，但关于疗效和放射剂量反应的数据尚缺乏，尤其是关于常规分割再放疗的数据。我们分析了再放疗后的生存率与放疗剂量之间的关联，以指导临床医生确定靶区再放疗剂量，并预测再治疗疗效。
我们对主要由NSCLC患者组成的研究进行了文献检索，这些研究详细列出了2年总生存率（OS）和给予的剂量。这些数据与治疗间隔、计划靶区体积大小以及在可获得此信息时同步化疗的使用情况进行了整理。对OS与治疗及患者因素之间的关联进行了逻辑回归分析。计算了30%和50% OS所需的剂量。
我们确定了20项合适的研究（675例患者）。在单变量模型中，OS与初始放疗剂量、再放疗剂量和化疗使用显著相关，但与间隔无关。根据赤池信息准则，最佳多变量OS模型仅包括再放疗剂量（p < 0.05），并且对数据拟合良好（Hosmer-Lemeshow p值 = 0.385）。该模型预测，在以2 Gy分割的再放疗等效剂量（EQD2s）分别为49.8 Gy（95% CI 36.4, 58.0 Gy）和76.5 Gy（95% CI 70.8, 82.7 Gy）时，OS率分别为30%和50%。
复发性NSCLC再放疗后的OS与再治疗剂量显著相关。再放疗的合理靶剂量为EQD2s > 50 Gy，生存率持续上升至85 Gy。
