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.

IF 3.4 2区 医学 Q2 ONCOLOGY
Mingyu Tan, Lu Li, Bangxian Tan, Jinxin Yang
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Abstract

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 BED10 equal to or greater than 78 Gy was 62% (95% CI, 51-72%), compared to 38% (95% CI, 17-58%) for BED10 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 BED10 ≥ 78 Gy significantly impacts OS. These findings guide clinical practice and stimulate further LA-NSCLC treatment advancements.

局部晚期非小细胞肺癌现代低let放疗方案的创新:高剂量率近距离放疗、立体定向体放疗和低分割质子治疗的荟萃分析和系统综述。
背景:本研究评估了不适合手术治疗的局部晚期非小细胞肺癌(LA-NSCLC)的最新治疗方法,比较了高剂量率(HDR)近距离放疗与传统低线性能量转移(LET)低分割放疗方法。方法:从9435篇论文中筛选出符合标准的8篇,涵盖2005-2019年LA-NSCLC患者484例。分析的重点是比较结果、探索生物有效剂量(BED)和检查毒性。结果:HDR近距离治疗有较好的疗效。具体数据显示,HDR近距离放疗的中位总生存期(OS)为38个月,2年OS率为68.0% (95% CI, 58.2-79.4%)。相比之下,立体定向体放射治疗(SBRT)和质子治疗的2年总生存率分别为54% (95% CI, 36-71%)和56% (95% CI, 42-70%)。在局部控制(LC)方面,HDR近距离放疗的2年LC率为87.1% (95% CI, 79-95%),而SBRT和质子治疗的2年LC率分别为75% (95% CI, 63-86%)和84% (95% CI, 68 -100%)。BED10等于或大于78 Gy的2年OS为62% (95% CI, 51-72%),而BED10小于78 Gy的2年OS为38% (95% CI, 17-58%)。与SBRT相比,HDR近距离治疗的急性毒性更低(95% CI, 0-10%) (95% CI, 8-16%),质子治疗无3级以上事件报道。此外,SBRT 3级以上的晚期毒性事件发生率为3% (95% CI, 0-6%),质子治疗为14% (95% CI, 4-24%),而近距离放疗未观察到3级以上的晚期毒性事件。结论:低分割低LET照射治疗LA-NSCLC有效且安全,而HDR近距离治疗具有明显的OS和LC优势,且毒性小。达到BED10≥78 Gy显著影响OS。这些发现指导了临床实践并刺激了进一步的LA-NSCLC治疗进展。
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来源期刊
BMC Cancer
BMC Cancer 医学-肿瘤学
CiteScore
6.00
自引率
2.60%
发文量
1204
审稿时长
6.8 months
期刊介绍: BMC Cancer is an open access, peer-reviewed journal that considers articles on all aspects of cancer research, including the pathophysiology, prevention, diagnosis and treatment of cancers. The journal welcomes submissions concerning molecular and cellular biology, genetics, epidemiology, and clinical trials.
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