Introduction: It remains unclear if histology should be independently considered when choosing stereotactic ablative body radiotherapy dose prescriptions for NSCLC. Methods: The study population included 508 patients with 561 lesions between 2000 and 2016, of which 442 patients with 482 lesions had complete dosimetric information. Eligible patients had histologically or clinically diagnosed early‐stage NSCLC and were treated with 3 to 5 fractions. The primary endpoint was in‐field tumor control censored by either death or progression. Involved lobe control was also assessed. Results: At 6.7 years median follow‐up, 3‐year in‐field control, involved lobe control, overall survival, and progression‐free survival rates were 88.1%, 80.0%, 49.4%, and 37.2%, respectively. Gross tumor volume (GTV) (hazard ratio [HR] = 1.01 per mL, p = 0.0044) and histology (p = 0.0225) were independently associated with involved lobe failure. GTV (HR = 1.013, p = 0.001) and GTV dose (cutoff of 110 Gy, biologically effective dose with &agr;/&bgr; = 10 [BED10], HR = 2.380, p = 0.0084) were independently associated with in‐field failure. For squamous cell carcinomas, lower prescription doses were associated with worse in‐field control (12 Gy × 4 or 10 Gy × 5 versus 18 Gy or 20 Gy × 3: HR = 3.530, p = 0.0447, confirmed by propensity score matching) and was independent of GTV (HR = 1.014 per mL, 95% confidence interval: 1.005–1.022, p = 0.0012). For adenocarcinomas, there were no differences in in‐field control observed using the above dose groupings (p = 0.12 and p = 0.31, respectively). Conclusions: In the absence of level I data, GTV and histology should be considered to personalize radiation dose for stereotactic ablative body radiotherapy. We suggest lower prescription doses (i.e., 12 Gy × 4 or 10 G × 5) should be avoided for squamous cell carcinomas if normal tissue tolerances are met.

中文翻译：

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组织学、肿瘤体积和辐射剂量预测非小细胞肺癌患者立体定向消融放疗后的结果

简介：目前尚不清楚在选择非小细胞肺癌立体定向消融体放疗剂量处方时是否应独立考虑组织学。方法：研究人群包括2000年至2016年间508名患者，561个病灶，其中442名患者，482个病灶拥有完整的剂量信息。符合条件的患者经组织学或临床诊断为早期 NSCLC，并接受 3 至 5 次分次治疗。主要终点是现场肿瘤控制，根据死亡或进展进行审查。还评估了涉及的肺叶控制。结果：中位随访 6.7 年时，3 年现场控制、受累肺叶控制、总生存率和无进展生存率分别为 88.1%、80.0%、49.4% 和 37.2%。肿瘤大体积 (GTV)（风险比 [HR] = 1.01/mL，p = 0.0044）和组织学（p = 0.0225）与受累肺叶衰竭独立相关。GTV（HR = 1.013，p = 0.001）和 GTV 剂量（截止值 110 Gy，生物有效剂量 &agr;/&bgr; = 10 [BED10]，HR = 2.380，p = 0.0084）与现场失败独立相关。对于鳞状细胞癌，较低的处方剂量与较差的现场控制相关（12 Gy × 4 或 10 Gy × 5 对比 18 Gy 或 20 Gy × 3：HR = 3.530，p = 0.0447，通过倾向评分匹配证实）与 GTV 无关（HR = 1.014/mL，95% 置信区间：1.005–1.022，p = 0.0012）。对于腺癌，使用上述剂量组观察到的现场控制没有差异（分别为 p = 0.12 和 p = 0.31）。结论：在缺乏 I 级数据的情况下，应考虑 GTV 和组织学来个性化立体定向消融体放疗的辐射剂量。我们建议，如果满足正常组织的耐受性，则应避免对鳞状细胞癌使用较低的处方剂量（即 12 Gy × 4 或 10 G × 5）。