Introduction

Concurrent chemoradiotherapy(CRT) is standard therapy for locally-advanced non–small-cell lung cancer(LA-NSCLC)patients. This study was performed to examine thoracic radiotherapy(TRT) parameters and their impact on patient survival.

Methods

We collected Individual patient data(IPD) from 3600LA-NSCLC patients participating in 16 cooperative group trials of concurrent CRT. The primary TRT parameters examined included field design strategy(elective nodal irradiation(ENI) compared to involved field TRT(IF-TRT)), total dose, and biologically effective dose(BED). Hazard ratios(HRs) for overall survival were calculated with univariable and multivariable Cox models.

Results

TRT doses ranged from 60 to 74 Gy with most treatments administered once-daily. ENI was associated with poorer survival than IF-TRT(univariable HR,1.37;95%CI,1.24-1.51,p<0.0001;multivariable HR,1.31;95%CI,1.08-1.59,p=0.002). The median survival of the IF and ENI patients were 24 and 16 months, respectively. Patients were divided into 3 dose groups: low total dose(60 Gy), medium total dose(>60Gy-66Gy) and high total dose(>66Gy-74 Gy). With reference to the low dose group, the multivariable HR’s were 1.08 for the medium dose group(95%CI=0.93-1.25) and 1.12 for the high dose group(CI=0.97-1.30).The univariate p=0.054 and multivariable p=0.17. BED was grouped as follows: low(<55.5Gy₁₀), medium(=55.5 Gy₁₀₎, or high(>55.5 Gy₁₀). With reference to the low BED group, the HR was 1.00(95%CI=0.85-1.18) for the medium BED group and 1.10(95%CI=0.93-1.31) for the high BED group. The univariable p=0.076 and multivariable p=0.16.

Conclusions

For LA-NSCLC patients treated with concurrent CRT, IF-TRT was associated with significantly better survival than ENI-TRT. TRT total and BED dose levels were not significantly associated with patient survival. Future progress will require research focusing on better systemic therapy and TRT.

中文翻译：

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探索放射疗法的靶向策略和剂量：联合治疗III期非小细胞肺癌的联合模式联合试验研究

介绍

并行放化疗是局部晚期非小细胞肺癌（LA-NSCLC）患者的标准治疗方法。进行这项研究以检查胸腔放疗（TRT）参数及其对患者生存的影响。

方法

我们从参加16项同时进行的CRT协作组试验的3600LA-NSCLC患者中收集了个体患者数据（IPD）。检查的主要TRT参数包括现场设计策略（与所涉及的现场TRT（IF-TRT）相比的电性节点照射（ENI）），总剂量和生物学有效剂量（BED）。使用单变量和多变量Cox模型计算总体生存的危险比（HRs）。

结果

TRT剂量范围为60至74 Gy，大多数治疗每天一次。ENI的生存率较IF-TRT低（单变量HR，1.37; 95％CI，1.24-1.51，p <0.0001;多变量HR，1.31; 95％CI，1.08-1.59，p = 0.002）。IF和ENI患者的中位生存期分别为24和16个月。将患者分为3个剂量组：低总剂量（60 Gy），中总剂量（> 60Gy-66Gy）和高总剂量（> 66Gy-74 Gy）。参考低剂量组，中剂量组（95％CI = 0.93-1.25）的多变量HR为1.08，高剂量组（CI = 0.97-1.30）的多变量HR为1.12。单变量p = 0.054和多变量p = 0.17。床分组如下：低（<55.5Gy ₁₀），中（55.5 =戈瑞_10） ，或高（> 55.5戈瑞₁₀）。相对于低BED组，HR为中BED组为1.00（95％CI = 0.85-1.18），高BED组为1.10（95％CI = 0.93-1.31）。单变量p = 0.076和多变量p = 0.16。

结论

对于同时接受CRT治疗的LA-NSCLC患者，IF-TRT的生存期明显优于ENI-TRT。TRT总量和BED剂量水平与患者生存率无显着相关。未来的进展将需要专注于更好的全身治疗和TRT的研究。