SCI

20 August 2024

Real-world acute toxicity and 90-day mortality in patients with stage I non-small cell lung cancer treated with stereotactic body radiotherapy

(Journal of Thoracic Oncology; IF:21.0)

  • van Rossum PSN, Wolfhagen N, van Bockel LW, Coremans IEM, van Es CA, van der Geest AM, De Jaeger KEA, Wachters B, Knol HP, Koppe FLA, Pomp J, Reymen BJT, Schinagl DAX, Spoelstra FOB, Tissing-Tan CJA, Peters M, van der Voort van Zijp NCMG, van der Wel AM, Wiegman EM, Wijsman R, Damhuis RAM, Belderbos JSA, Real-world acute toxicity and 90-day mortality in patients with stage I non-small cell lung cancer treated with stereotactic body radiotherapy., Journal of Thoracic Oncology (2024), doi: https://doi.org/10.1016/j.jtho.2024.07.016.

  • Correspondence to: p.s.n.vanrossum@amsterdamumc.nl

Introduction: 介绍

Stereotactic body radiotherapy (SBRT) has firmly established its role in stage I non-small cell lung cancer (NSCLC). Clinical trial results may not fully apply to real-world scenarios. This study aimed to uncover the real-world incidence of acute toxicity and 90-day mortality in SBRT-treated stage I NSCLC patients and develop prediction models for these outcomes.

立体定向放疗（SBRT）已在Ⅰ期非小细胞肺癌（NSCLC）中确立了其地位。但是临床试验结果可能无法完全适用于真实世界场景。本研究旨在揭示SBRT治疗的Ⅰ期NSCLC患者的急性毒性和90天死亡的实际发生率，并寻找这些结果的预测模型。

 

Methods:方法

Prospective data from the Dutch Lung Cancer Audit for Radiotherapy (DLCA-R) were collected nationally. Patients with stage I NSCLC (cT1-2aN0M0) treated with SBRT in 2017-2021 were included. Acute toxicity was assessed, defined as grade ≥2 radiation-pneumonitis or grade ≥3 non-hematologic toxicity ≤90 days after SBRT. Prediction models for acute toxicity and 90-day mortality were developed and internally validated.

在全国范围内收集了荷兰放疗肺癌审计(Dutch Lung Cancer Audit for Radiotherapy, DLCA-R)的前瞻性数据。纳入2017—2021年接受SBRT的I期(cT1 ~ 2aN0M0) NSCLC患者。急性不良反应定义为放疗后≤90 天时≥2级放射性肺炎或≥3级非血液学不良反应。我们设计了急性毒性和90天死亡率的预测模型，并进行了内部验证。

 

Results:结果

Among 7,279 patients, the mean age was 72.5 years, with 21.6% being >80 years. Most were female (50.7%), had WHO scores 0-1 (73.3%), and cT1a-b tumors (64.6%), predominantly in upper lobes (65.2%). Acute toxicity was observed in 280 (3.8%) of patients and 90-day mortality in 122 (1.7%). Predictors for acute toxicity included WHO ≥2, lower FEV1 and DLCO, no pathology confirmation, middle/lower lobe tumor location, cT1c-cT2a stage, and higher mean lung dose (c-statistic 0.68). Female gender, WHO ≥2, and acute toxicity predicted higher 90-day mortality (c-statistic 0.73).

7 279例患者中，平均年龄72.5岁，21.6%为>80岁。大多数患者为女性(50.7%)，WHO评分为0 ~ 1分(73.3%)，cT1a-b期肿瘤(64.6%)，主要位于上叶(65.2%)。急性毒性反应280例(3.8%)，90天死亡122例(1.7%)。预测急性毒性的因素包括WHO≥2分、FEV1和DLCO较低、无病理证实、肿瘤位于中下叶、cT1c ~ cT2a期和较高的平均肺剂量(c-statistic 0.68)。女性、WHO评分≥2分和急性毒性可预测更高的90 天病死率(c-statistic 0.73)。

 

Conclusions:结论

This nationwide study revealed a low rate of acute toxicity and an acceptable 90-day mortality rate in SBRT-treated stage I NSCLC patients. Notably, advanced age did not increase acute toxicity or mortality risk. Our predictive models, with satisfactory performance, offer valuable tools for identifying high-risk patients.

这项全国性研究显示，SBRT治疗的I期NSCLC患者急性毒性发生率低，90天死亡率可接受。值得注意的是，高龄并未增加急性毒性或死亡风险。我们的预测模型具有良好的性能，为识别高危患者提供了有价值的工具。