化放疗的相对剂量强度对局部晚期不可切除非小细胞肺癌疗效的影响

A. E. Glukhareva, G. V. Afonin, I. Kolobaev, L. Grivtsova, S. A. Ivanov, A. Kaprin
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The data obtained from 22 (73.3 %) patients who retained a relative dose intensity of RDI > 80 % demonstrated that given dose intensity is sufficient to achieve a stable antitumor effect. In 8 (26.7 %) cases, however, the RDI was less than 80 %, which affected the effectiveness of the treatment. The median follow-up for overall survival (OS) was 29.2 months, progression-free survival (PFS) was 15.1 months, and local control was 21.9 months. in all patients included in the analysis. The indicators of OS in the second year had an advantage in the group of patients with RDI < 80 % and amounted to 73.3 % compared with 60.5 % in patients with RDI > 80 %. PFS was higher in the group of patients with high dose intensity, in the first year of follow-up it was 75.6 % compared with the group of patients with RDI < 80 % (62.5 %), in the second year of follow-up, PFS was 27.2 % and 20.8 %, respectively. 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摘要

研究目的估算不可切除非小细胞肺癌(NSCLC)患者一线抗肿瘤治疗中保留相对剂量强度(RDI)≥80%的患者人数,并比较最佳和较低RDI组的治疗效果。研究纳入了30名局部晚期不可切除NSCLC患者(25名男性和5名女性)。中位年龄为 57 岁。纳入研究的主要标准是经形态学证实的 NSCLC IIIB-IIIC 期患者。所有患者均接受了同步放化疗。根据肿瘤的组织发生过程,鳞状细胞变异患者居多。22例(73.3%)患者的相对剂量强度(RDI)大于80%,这些数据表明,给定的剂量强度足以达到稳定的抗肿瘤效果。然而,有 8 例(26.7%)患者的相对剂量强度低于 80%,影响了治疗效果。在所有纳入分析的患者中,总生存期(OS)的中位数为 29.2 个月,无进展生存期(PFS)为 15.1 个月,局部控制为 21.9 个月。第二年的OS指标在RDI<80%的患者组中更具优势,达到73.3%,而在RDI>80%的患者中为60.5%。高剂量强度组患者的 PFS 更高,随访第一年的 PFS 为 75.6%,而 RDI < 80% 组为 62.5%,随访第二年的 PFS 分别为 27.2% 和 20.8%。在第一年的随访中,RDI > 80% 组患者的局部控制率为 90.2%,RDI < 80% 组患者的局部控制率为 62.5%。在第二年的随访中,RDI>80%的患者组在局部控制方面更具优势,分别达到48.1%和34.7%。研究结果表明,保持较高的相对剂量强度对局部晚期不可切除 NSCLC 患者的生存率和局部控制率有积极影响。然而,由于同步放化疗的高毒性,有一部分患者没有接受计划的治疗量。因此,有必要开发新的同步治疗方法,以减少联合治疗的毒性,达到最大的抗肿瘤效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The effect of the relative dose intensity of chemoradiotherapy on the effectiveness of therapy of locally advanced unresectable non-small cell lung cancer
The purpose of the study. To estimate the number of patients with the preservation of relative dose intensity (RDI) ≥ 80 % of first-line antitumor therapy in patients with unresectable non-small cell lung cancer (NSCLC), and to compare the effectiveness of therapy in groups with optimal and lower RDI.Patients and methods. The study included 30 patients (25 men and 5 women) with locally advanced unresectable NSCLC. The median age was 57 years. The main criterion for inclusion in the study was morphologically verified NSCLC with stage IIIB-IIIC of the disease. All patients underwent simultaneous chemoradiotherapy. According to the histogenesis of the tumor process, patients with a squamous cell variant prevailed.Results. The data obtained from 22 (73.3 %) patients who retained a relative dose intensity of RDI > 80 % demonstrated that given dose intensity is sufficient to achieve a stable antitumor effect. In 8 (26.7 %) cases, however, the RDI was less than 80 %, which affected the effectiveness of the treatment. The median follow-up for overall survival (OS) was 29.2 months, progression-free survival (PFS) was 15.1 months, and local control was 21.9 months. in all patients included in the analysis. The indicators of OS in the second year had an advantage in the group of patients with RDI < 80 % and amounted to 73.3 % compared with 60.5 % in patients with RDI > 80 %. PFS was higher in the group of patients with high dose intensity, in the first year of follow-up it was 75.6 % compared with the group of patients with RDI < 80 % (62.5 %), in the second year of follow-up, PFS was 27.2 % and 20.8 %, respectively. Local control was 90.2 % in the first year in the group of patients with RDI > 80 % and 62.5 % in the group of patients with RDI < 80 %. The second year of follow-up demonstrated the advantage of the group of patients with RDI >80 % in terms of local control and amounted to 48.1 % versus 34.7 %, respectively.Conclusion. The results obtained show that maintaining relative dose intensity at a high level has a positive effect on survival rates and local control of patients with locally advanced unresectable NSCLC. However, there is a cohort of patients who did not receive the planned amount of treatment, due to the high toxicity of simultaneous chemoradiotherapy. It is necessary to develop new approaches to concomitant therapy aimed at reducing the toxicity of the combined treatment and achieving maximum antitumor effect.
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