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Exploring Radiotherapy Targeting Strategy and Dose: A Pooled Analysis of Cooperative Group Trials of Combined Modality Therapy for Stage III Non-Small Cell Lung Cancer
Journal of Thoracic Oncology ( IF 20.4 ) Pub Date : 2018-08-01 , DOI: 10.1016/j.jtho.2018.04.011
Steven E. Schild , Herbert H. Pang , Wen Fan , Thomas E. Stinchcombe , Everett E. Vokes , Suresh S. Ramalingam , Jeffrey D. Bradley , Karen Kelly , Xiaofei Wang

Introduction: Concurrent chemoradiotherapy (CRT) is standard therapy for locally advanced NSCLC (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 from 3600 LA‐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 Gy to 74 Gy with most treatments administered once‐daily. ENI was associated with poorer survival than IF‐TRT (univariable HR = 1.37, 95% confidence interval [CI]: 1.24–1.51, p < 0.0001; multivariable HR = 1.31, 95% CI: 1.08–1.59, p = 0.002). The median survival times of the IF and ENI patients were 24 months and 16 months, respectively. Patients were divided into three dose groups: low total dose (60 Gy), medium total dose (>60 Gy to 66 Gy), and high total dose (>66 Gy to 74 Gy). With reference to the low‐dose group, the multivariable HRs were 1.08 for the medium‐dose group (95% CI: 0.93–1.25) and 1.12 for the high‐dose group (95% CI: 0.97–1.30).The univariate p = 0.054 and multivariable p = 0.17. BED was grouped as follows: low (<55.5 Gy10), 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:

探索放射治疗靶向策略和剂量:对 III 期非小细胞肺癌联合治疗的合作团体试验的汇总分析

简介:同步放化疗 (CRT) 是局部晚期 NSCLC (LA-NSCLC) 患者的标准疗法。本研究旨在检查胸部放疗 (TRT) 参数及其对患者存活率的影响。方法:我们从 3600 名 LA-NSCLC 患者中收集了个体患者数据,这些患者参与了 16 项同步 CRT 合作组试验。检查的主要 TRT 参数包括野设计策略(选择性节点照射 [ENI] 与受累野 TRT (IF-TRT) 相比)、总剂量和生物有效剂量 (BED)。使用单变量和多变量 Cox 模型计算总生存率的风险比 (HR)。结果:TRT 剂量范围为 60 Gy 至 74 Gy,大多数治疗每天一次。ENI 的生存率低于 IF-TRT(单变量 HR = 1.37,95% 置信区间 [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 患者的中位生存时间分别为 24 个月和 16 个月。患者被分为三个剂量组:低总剂量(60 Gy)、中总剂量(>60 Gy 至 66 Gy)和高总剂量(>66 Gy 至 74 Gy)。对于低剂量组,中剂量组的多变量 HR 为 1.08(95% CI:0.93-1.25),高剂量组为 1.12(95% CI:0.97-1.30)。单变量 p = 0.054 和多变量 p = 0.17。BED 分组如下:低 (<55.5 Gy10)、中 (55.5 Gy10) 或高 (>55.5 Gy10)。对于低卧床组,中卧床组的 HR 为 1.00(95% CI:0.85-1.18),高卧床组的 HR 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 与显着优于 ENI-TRT 的生存相关。TRT 总剂量和 BED 剂量水平与患者存活率没有显着相关性。未来的进展需要专注于更好的全身治疗和 TRT 的研究。
更新日期:2018-08-01
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