Significance of three-dimensional radical radiotherapy dose determined by organ-lesion combination for primary tumor of oligometastatic stage IV NSCLC:a reanalysis of PPRA-RTOG 003
Wang Chunlan,Su Shengfa,Ouyang Weiwei,Ma Zhu,Li Qingsong,Wang Yu,Li Huiqin,Lu Bing
Guizhou Meidical University,Guiyang 550004,China (Wang CHL);Department of Thoracic Oncology,Affiliated Hospital of Guizhou Meidical University,Guizhou Province Tumor Hospital;Guiyang 550004,China (Su SHF,Ouyang WW,Ma ZH,Li QS,Wang Y,Li HQ,Lu B)
Objective To investigate the influence of three-dimensional radiotherapy dose determined by organ-lesion combination for the primary tumor of oligometastatic stage Ⅳ non-small cell lung cancer (NSCLC) and related factors on survival. Methods Oligometastasis was defined as the metastatic lesion in only one organ or 1 metastatic lesion in each of two organs. A total of 115 patients were enrolled,and the association of dose and related factors with overall survival was investigated. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis,and the Cox regression model was used for multivariate analysis. Results Of all patients,the median survival time (MST) was 14 months,and the 1-,2-,and 3-year overall survival (OS) rates were 55.7%,18.3%,and 11.5%,respectively. All the patients,the patients benefiting from two-cycle chemotherapy,and the patients benefiting from chemoradiotherapy showed prolonged MST,and in patients receiving a primary tumor dose of ≥63 Gy or<63 Gy,the MST was 17 months and 13 months (P=0.046),17 months and 13 months (P=0.037),and 18 months and 14 months (P=0.022),respectively. Radiotherapy for metastatic lesion and effective treatment for primary tumor tended to prolong survival time,and the MST was 17 months and 13 months,respectively (P=0.055 and 0.065).The patients receiving 4-6 cycles of chemotherapy had an MST of 16 months and 13 months,respectively (P=0.165).The patients who received effective chemoradiotherapy,had a primary tumor volume of<120.1 cm3,and had improvement in Karnofsky Performance Scale (KPS) after treatment showed a prolonged MST compared with those who did not respond to chemoradiotherapy and had a large primary tumor volume and a reduction in KPS (15 months vs. 12 months,P=0.036;17 months vs. 11 months,P=0.002;14 months vs. 10 months,P=0.031).The multivariate analysis showed that primary tumor dose and volume (P=0.020 and 0.001) and the change in KPS after treatment (P=0.021) significantly affected survival. Conclusions The doses of chemotherapy and concurrent radical radiotherapy determined by organ-lesion combination for oligometastatic stage Ⅳ NSCLC can significantly prolong survival time,and primary tumor volume and KPS after treatment are the independent prognostic factors for survival.
Wang Chunlan,Su Shengfa,Ouyang Weiwei et al. Significance of three-dimensional radical radiotherapy dose determined by organ-lesion combination for primary tumor of oligometastatic stage IV NSCLC:a reanalysis of PPRA-RTOG 003[J]. Chinese Journal of Radiation Oncology, 2016, 25(6): 576-580.
[1] Siegel R,Naishadham D,Jemal A.Cancer statistics,2012[J].CA Cancer J Clin,2012,62(1):10-29.DOI:10.3322/caac.20138. [2] Morgensztern D,Ng SH,Gao F,et al. Trends in stage distribution for patients with non-small cell lung cancer:a National Cancer Database survey[J].J Thorac Oncol,2010,5(1):29-33.DOI:10.1097/JTO.0b013e3181c5920c. [3] Ouyang WW,Su SF,Ma Z,et al. Prognosis of non-small cell lung cancer patients with bone oligometastases treated concurrently with thoracic three-dimensional radiotherapy and chemotherapy[J].Radiat Oncol,2014,9(1):147.DOI:10.1186/1748-717X-9-147. [4] Scagliotti GV,Parikh P,von Pawel J,et al. Phase Ⅲ study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naⅣe patients with advanced-stage non-small-cell lung cancer[J].J Clin Oncol,2008,26(21):3543-3551.DOI:10.1200/JCO.2007.15.0375. [5] Hellman S,Weichselbaum RR.Oligometastases[J].J Clin Oncol,1995,13(1):8-10. [6] ] Mehta N,Mauer AM,Hellman S,et al. Analysis of further disease progression in metastatic non-small cell lung cancer:implications for locoregional treatment[J].Int J Oncol, 2004,25(6):1677-1683.DOI:10.3892/ijo.25.6.1677. [7] 李凤虎,卢冰,付和谊,等.546例Ⅳ期NSCLC远处转移特点的放疗意义分析[J].中华放射肿瘤学杂志,2012,21(2):122-125.DOI:10.3760/cma.j.issn.1004-4221.2012.02.008. Li FH,Lu B,Fu HY,et al. Metastasis features of 546 patients with stage Ⅳ non-small cell lung cancer at first visit and the significance in radiotherapy[J].Chin J Radiat Oncol,2012,21(2):122-125.DOI:10.3760/cma.j.issn.1004-4221.2012.02.008. [8] 付和谊,卢冰,欧阳伟炜,等.Ⅳ期NSCLC同期化放疗的临床结果分析[J].中华放射肿瘤学杂志,2009,18(1):52-56.DOI:10.3760/cma.j.issn.1004-4221.2009.01.052. Fu HY,Lu B,Ouyang WW,et al. Clinical outcome of concurrent chemo-radiotherapy for patients with stage Ⅳ non-small cell lung cancer[J].Chin J Radiat Oncol,2009,18(1):52-56.DOI:10.3760/cma.j.issn.1004-4221.2009.01.052. [9] De Ruysscher D,Wanders R,van Baardwijk A,et al. Radical Treatment of non–small-cell lung cancer patients with synchronous oligometastases:long-term results of a prospectⅣe phase Ⅱ trial (Nct01282450)[J].J Thorac Oncol,2012,7(10):1547-1555.DOI:10.1097/JTO.0b013e318262caf6. [10] Downey RJ.The management of non-small cell lung cancer with oligometastases[J].Thorac Surg Clin,2014,24(4):391-397.DOI:10.1016/j.thorsurg.2014.07.003. [11] Flannery TW,Suntharalingam M,Regine WF,et al. Long-term survⅣal in patients with synchronous,solitary brain metastasis from non-small-cell lung cancer treated with radiosurgery[J].Int J Radiat Oncol Biol Phys,2008,72(1):19-23.DOI:10.1016/j.ijrobp.2007.12.031. [12] Modi A,Vohra HA,Weeden DF.Does surgery for primary non-small cell lung cancer and cerebral metastasis have any impact on survⅣal?[J].Interact Cardiovasc Thorac Surg,2009,8(4):467-473.DOI:10.1510/icvts.2008.195776. [13] 欧阳伟炜,卢冰,胡银祥,等.Ⅳ期NSCLC同期放化疗单中心前瞻性生存分析[J].中华肿瘤防治杂志,2013,20(16):1262-1266. Ouyang WW,Lu B,Hu YX,et al. ProspectⅣe survⅣal analysis from a single center for stage Ⅳ NSCLC patients treated with chemotherapy and radiotherapy[J].Chin J Cancer Prev Treat,2013,20(16):1262-1266. [14] Arrieta O,Villarreal-Garza C,Zamora J,et al. Long-term survⅣal in patients with non-small cell lung cancer and synchronous brain metastasis treated with whole-brain radiotherapy and thoracic chemoradiation[J].Radiat Oncol,2011,6(1):166.DOI:10.1186/1748-717X-6-166. [15] 田军,施瑞浩,江涛,等.45例肺癌脑转移放疗后生存期的影响因素[J].中国癌症杂志,2006,16(4):310-312.DOI:10.3969/j.issn.1007-3639.2006.04.017. Tian J,Shi RH,Jiang T,et al. Influential factor for the survⅣal after radiotherapy for brain metastases from the pulmonary tumor in the 45 patients[J].China Oncol,2006,16(4):310-312.DOI:10.3969/j.issn.1007-3639.2006.04.017. [16] Welzel G,Fleckenstein K,Schaefer J,et al. Memory function before and after whole brain radiotherapy in patients with and without brain metastases[J].Int J Radiat Oncol Biol Phys,2008,72(5):1311-1318.DOI:10.1016/j.ijrobp.2008.03.009. [17] Lara PN Jr,Redman MW,Kelly K,et al. Disease control rate at 8 weeks predicts clinical benefit in advanced non-small-cell lung cancer:results from Southwest Oncology Group randomized trials[J].J Clin Oncol, 2008,26(3):463-467.DOI:10.1200/JCO.2007.13.0344. [18] CIG Media Group. Phase Ⅱ and Ⅲ trials:comparison of four chemotherapy regimens in advanced non–small-cell lung cancer (ECOG 1594)[J].Clin Lung Cancer,2000,2(1):21-22.DOI:10.1016/S1525-7304(11)70620-9. [19] Lopez GJL,Gomez D,Zhuang Y,et al. Prognostic impact of radiation therapy to the primary tumor in patients with non-small cell lung cancer and oligometastasis at diagnosis[J].Int J Radiat Oncol Biol Phys,2012,84(1):e61-e67.DOI:10.1016/j.ijrobp.2012.02.054.
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