Stephen G Chun, Chen Hu, Ritsuko U Komaki, Robert D Timmerman, Steven E Schild, Jeffrey A Bogart, Michael C Dobelbower, Walter Bosch, Vivek S Kavadi, Samir Narayan, Puneeth Iyengar, Clifford Robinson, Jan Rothman, Adam Raben, Mark E Augspurger, Robert M MacRae, Rebecca Paulus, Jeffrey D Bradley
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引用次数: 0
摘要
重要性：不可切除的局部晚期非小细胞肺癌（NSCLC）的最佳放疗技术尚存争议，因此评估调强放疗（IMRT）的长期前瞻性疗效非常重要：比较接受IMRT和三维适形放疗（3D-CRT）并同时接受卡铂/紫杉醇治疗的局部晚期NSCLC患者的长期前瞻性疗效：前瞻性3期随机临床试验NRG Oncology-RTOG 0617的二次分析，根据分层评估了483名接受化放疗（3D-CRT vs IMRT）治疗局部晚期NSCLC的患者：主要结果：对长期结果进行了分析，包括总生存期（OS）、无进展生存期（PFS）、局部衰竭时间、第二种癌症的发生，以及根据《不良事件通用术语标准》（Common Terminology Criteria for Adverse Events）第3版出现的3级或3级以上严重不良事件（AEs）。器官体积（V）接受以Gy为单位的特定辐射量的百分比报告为V（辐射剂量）：483名患者（中位数[IQR]年龄为64[57-70]岁；女性194[40.2%]）中，228人（47.2%）接受了IMRT，255人（52.8%）接受了3D-CRT（中位数[IQR]随访时间为5.2[4.8-6.0]年）。与 3D-CRT 相比，IMRT 的 3 级或以上肺炎 AEs 减少了 2 倍（8 [3.5%] vs 21 [8.2%]; P = .03）。单变量分析显示，心脏 V20、V40 和 V60 与较差的 OS 相关（危险比分别为 1.06 [95% CI, 1.04-1.09]；1.09 [95% CI, 1.05-1.13]；1.16 [95% CI, 1.09-1.24]；均为 P 结论和相关性：这些研究结果支持对局部晚期 NSCLC 标准使用 IMRT。IMRT的目标应该是尽量减少肺V20和心脏V20至V60，而不是限制低剂量放射浴。肺V5和年龄与生存率无关，不应被视为化放疗的禁忌症：试验注册：ClinicalTrials.gov Identifier：试验注册：ClinicalTrials.gov Identifier：NCT00533949。
Long-Term Prospective Outcomes of Intensity Modulated Radiotherapy for Locally Advanced Lung Cancer: A Secondary Analysis of a Randomized Clinical Trial.
Importance: The optimal radiotherapy technique for unresectable locally advanced non-small cell lung cancer (NSCLC) is controversial, so evaluating long-term prospective outcomes of intensity-modulated radiotherapy (IMRT) is important.
Objective: To compare long-term prospective outcomes of patients receiving IMRT and 3-dimensional conformal radiotherapy (3D-CRT) with concurrent carboplatin/paclitaxel for locally advanced NSCLC.
Design, setting, and participants: A secondary analysis of a prospective phase 3 randomized clinical trial NRG Oncology-RTOG 0617 assessed 483 patients receiving chemoradiotherapy (3D-CRT vs IMRT) for locally advanced NSCLC based on stratification.
Main outcomes and measures: Long-term outcomes were analyzed, including overall survival (OS), progression-free survival (PFS), time to local failure, development of second cancers, and severe grade 3 or higher adverse events (AEs) per Common Terminology Criteria for Adverse Events, version 3. The percentage of an organ volume (V) receiving a specified amount of radiation in units of Gy is reported as V(radiation dose).
Results: Of 483 patients (median [IQR] age, 64 [57-70] years; 194 [40.2%] female), 228 (47.2%) received IMRT, and 255 (52.8%) received 3D-CRT (median [IQR] follow-up, 5.2 [4.8-6.0] years). IMRT was associated with a 2-fold reduction in grade 3 or higher pneumonitis AEs compared with 3D-CRT (8 [3.5%] vs 21 [8.2%]; P = .03). On univariate analysis, heart V20, V40, and V60 were associated with worse OS (hazard ratios, 1.06 [95% CI, 1.04-1.09]; 1.09 [95% CI, 1.05-1.13]; 1.16 [95% CI, 1.09-1.24], respectively; all P < .001). IMRT significantly reduced heart V40 compared to 3D-CRT (16.5% vs 20.5%; P < .001). Heart V40 (<20%) had better OS than V40 (≥20%) (median [IQR], 2.5 [2.1-3.1] years vs 1.7 [1.5-2.0] years; P < .001). On multivariable analysis, heart V40 (≥20%), was associated with worse OS (hazard ratio, 1.34 [95% CI, 1.06-1.70]; P = .01), whereas lung V5 and age had no association with OS. Patients receiving IMRT and 3D-CRT had similar rates of developing secondary cancers (15 [6.6%] vs 14 [5.5%]) with long-term follow-up.
Conclusions and relevance: These findings support the standard use of IMRT for locally advanced NSCLC. IMRT should aim to minimize lung V20 and heart V20 to V60, rather than constraining low-dose radiation bath. Lung V5 and age were not associated with survival and should not be considered a contraindication for chemoradiotherapy.
期刊介绍：
At JAMA Oncology, our primary goal is to contribute to the advancement of oncology research and enhance patient care. As a leading journal in the field, we strive to publish influential original research, opinions, and reviews that push the boundaries of oncology science.
Our mission is to serve as the definitive resource for scientists, clinicians, and trainees in oncology globally. Through our innovative and timely scientific and educational content, we aim to provide a comprehensive understanding of cancer pathogenesis and the latest treatment advancements to our readers.
We are dedicated to effectively disseminating the findings of significant clinical research, major scientific breakthroughs, actionable discoveries, and state-of-the-art treatment pathways to the oncology community. Our ultimate objective is to facilitate the translation of new knowledge into tangible clinical benefits for individuals living with and surviving cancer.
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