SCI

8 July 2024

Long-Term Prospective Outcomes of Intensity Modulated Radiotherapy for Locally Advanced Lung Cancer

A Secondary Analysis of a Randomized Clinical Trial

（IF: JAMA Oncol., 22.5）

  • Chun SG, Hu C, Komaki RU, Timmerman RD, Schild SE, Bogart JA, Dobelbower MC, Bosch W, Kavadi VS, Narayan S, Iyengar P, Robinson C, Rothman J, Raben A, Augspurger ME, MacRae RM, Paulus R, Bradley JD. Long-Term Prospective Outcomes of Intensity Modulated Radiotherapy for Locally Advanced Lung Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol. 2024 Jun 27: e241841. 

  • Corresponding Author: Stephen G. Chun, MD, Division of Radiation Oncology, The University of Texa MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77079 (sgchun@mdanderson.org).

IMPORTANCE 重要性

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. 

对于不可切除的局晚期非小细胞肺癌（NSCLC）的最佳放疗技术存在争议，因此评估调强放疗（IMRT）的长期前瞻性结果很重要。

 

OBJECTIVE 目的

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.

比较接受IMRT与三维适形放疗（3D-CRT）同步联合卡铂/紫杉醇治疗的局晚期NSCLC患者的长期前瞻性结果。

 

DESIGN, SETTING, AND PARTICIPANTS 设计、设置与参与者

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. 

前瞻性3期随机临床试验NRG Oncology–RTOG 0617的二次分析基于分层评估了483名接受化疗放疗（3D-CRT与IMRT）的局晚期NSCLC患者。

 

MAIN OUTCOMES AND MEASURES 主要结果与方法

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).

对长期结果进行了分析，包括总生存期（OS）、无进展生存期（PFS）、局部失败时间、继发性癌症的产生以及根据《不良事件通用术语标准》第3版定义的严重等级3或更高级别的不良事件（AEs）。以Gy为单位接收指定辐射量的器官体积 (V) 的百分比报告为V（辐射剂量）。

 

RESULTS 结果

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.

在483名患者中（中位[四分位数范围]年龄，64[57-70]岁；194 [40.2%] 女性），228名（47.2%）接受了IMRT，255名（52.8%）接受了3D-CRT（中位[四分位数范围]随访时间，5.2[4.8-6.0]年）。与3D-CRT相比，IMRT与3级或更高级别的肺炎不良事件减少2倍有关（8 [3.5%] 对比 21 [8.2%]；P = .03）。在单变量分析中，心脏V20、V40和V60与较差的总生存期（OS）相关（风险比分别为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 P < .001）。与3D-CRT相比，IMRT显著降低了心脏V40（16.5% 对比 20.5%；P < .001）。心脏V40 (<20%) 的总OS优于V40 (20%)（中位[四分位数范围]，2.5[2.1-3.1]年对比1.7[1.5-2.0]年；P < .001）。在多变量分析中，心脏V40 (20%) 与较差的OS相关（风险比，1.34 [95% CI, 1.06-1.70]；P = .01），而肺V5和年龄与OS无关。在接受IMRT和3D-CRT的患者中，长期随访中罹患继发性癌症的几率相似（15 [6.6%] 对比 14 [5.5%]）。

 

CONCLUSIONS AND RELEVANCE 结论与意义

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.

这些发现支持了IMRT在局部晚期NSCLC中的标准应用。IMRT 应旨在将肺V20和心脏V20最小化至V60，而不是限制低剂量辐射浸泡。肺V5和年龄与生存率无关，不应被视为放化疗的禁忌。