Failure patterns analysis of three-dimensional radiotherapy for stage IV non-small cell lung cancer primary tumours

IF 1.5 4区 医学 Q4 ONCOLOGY
Wei Zhang, Xin Yu Wu, Jie Liu, Wen Gang Yang, Xia Xia Chen, Bing Lu
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Abstract

Purpose

The purpose of this study was to investigate the failure patterns of three-dimensional radiotherapy of primary tumours combined with first-line systemic therapy and the influence of radiotherapy-related factors for stage IV non-small cell lung cancer.

Material and methods

Seven hundred and forty-eight cases with the initial diagnosis of stage IV non-small cell lung cancer that met the inclusion criteria were selected from 1509 cases registered from March 2003 to July 2021 for univariate analysis and failure patterns test using the chi-square test. Kaplan-Meier survival analysis was performed with the log-rank test and Cox regression model for multifactor prognostic analysis. A value of P below 0.05 indicated a statistically significant difference.

Results

The failure incidence of first-line treatment was 72.3 % in 748 cases and 33.6 % within 6 months, 38.8 % between 6 and 12 months, 19.4 % between 12 and 24 months and 8.1 % after 24 months. A significant difference was observed in the median survival time, which was 7.2, 13.4, 22.2, and 37.6 months (χ2 = 324.580, p < 0.000), respectively. The incidence of recurrent failure was 20.4 %. A decrease was observed in the recurrence rate with the increasing dose of radiotherapy to the primary tumour, and no significant difference in the incidence of recurrent failure was observed between oligometastatic and non-oligometastatic tumours. The incidence of metastatic failure was 89.4 %, with the order of incidence as follows (from highest to lowest): brain, bone, lung, liver, pleural cavity, distant lymph nodes, adrenal gland, other body parts. The incidence of additional metastases was approximately 50 %, and the progression of synchronous metastases concerned approximately one third of the cases. The metastatic status, time of treatment failure, pathology type, gender, and at least 63 Gy during the same period of four to six cycles of chemotherapy were independent factors in the prediction of prognosis.

Conclusion

The failure patterns of radiotherapy for primary tumours in stage IV non-small cell lung cancer was different from that of first-line systemic therapy alone, with significantly lower local failure, predominant metastatic failure, and the highest incidence of brain metastases. The later treatment failure occurs, the longer will be the oligometastatic status. Oligometastatic cancer, female sex, non-squamous cell carcinoma, the late occurrence of treatment failure, and at least 63 Gy concurrent four to six cycles of chemotherapy were independent prognostic factors for prolonged survival.
IV期非小细胞肺癌原发肿瘤三维放疗失败模式分析
目的探讨原发性肿瘤三维放疗联合一线全身治疗对IV期非小细胞肺癌的失败模式及放疗相关因素的影响。材料和方法从2003年3月至2021年7月登记的1509例初始诊断为IV期非小细胞肺癌的病例中选择748例符合纳入标准的病例,采用卡方检验进行单因素分析和失效模式检验。Kaplan-Meier生存分析采用log-rank检验和Cox回归模型进行多因素预后分析。P < 0.05为差异有统计学意义。结果748例患者中,一线治疗失败率为72.3%,6个月内失败率为33.6%,6 ~ 12个月失败率为38.8%,12 ~ 24个月失败率为19.4%,24个月后失败率为8.1%。中位生存时间分别为7.2、13.4、22.2、37.6个月(χ2 = 324.580, p <;分别为0.000)。复发失败率为20.4%。随着原发肿瘤放射治疗剂量的增加,复发率下降,并且在复发失败发生率方面,在少转移性和非少转移性肿瘤之间没有显著差异。转移失败发生率为89.4%,发生率从高到低依次为:脑、骨、肺、肝、胸膜腔、远处淋巴结、肾上腺、其他身体部位。附加转移的发生率约为50%,同步转移的进展约占三分之一。转移情况、治疗失败时间、病理类型、性别、4 ~ 6个化疗周期内至少63 Gy是预测预后的独立因素。结论IV期非小细胞肺癌原发肿瘤放疗的失败模式与一线全身治疗不同,局部失败明显较低,以转移性失败为主,脑转移发生率最高。治疗失败越晚,低转移状态持续时间越长。少转移癌、女性、非鳞状细胞癌、晚期治疗失败、至少63 Gy同时4 - 6个化疗周期是延长生存期的独立预后因素。
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来源期刊
Cancer Radiotherapie
Cancer Radiotherapie 医学-核医学
CiteScore
2.20
自引率
23.10%
发文量
129
审稿时长
63 days
期刊介绍: Cancer/radiothérapie se veut d''abord et avant tout un organe francophone de publication des travaux de recherche en radiothérapie. La revue a pour objectif de diffuser les informations majeures sur les travaux de recherche en cancérologie et tout ce qui touche de près ou de loin au traitement du cancer par les radiations : technologie, radiophysique, radiobiologie et radiothérapie clinique.
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