Prognosis and it related factors in patients of stage Ⅲ non-smallcell lung cancer after three-dimensional conformal radiotherapy
Tian Xiuming, Qiu Rong, Wang Yuxiang, Ge Hui, Li Jing, Zhu Shuhai, Qiao Xueying
Department of Radiatio Oncology (Tian XM, Qiu Rg, Wang YX, Li J, Zhu SH, Qiao XY), Department of Respiratory (Ge H), Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China;Department of Internal Medicine, Hebei Chest Cancer Hospital,Shijiazhuang 050011,China (Tian XM)
Abstract：Objective To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) and prognostic factors for stage Ⅲ non-small cell lung cancer (NSCLC). Methods From 2000 to 2010, 474 patients with stage Ⅲ NSCLC undergoing 3DCRT were enrolled as subjects. Those patients, consisting of 382 males and 92 females, had a median age of 63 years. In those patients, 211 had stage ⅢA NSCLC and 263 had stage ⅢB NSCLC;165 were treated with radiotherapy alone and 309 with chemoradiotherapy;55 were treated with conventional radiotherapy plus 3DCRT, 340 with 3DCRT, and 79 with intensity-modulated radiotherapy;the median equivalent dose was 60 Gy (44-77 Gy).The Kaplan-Meier method, log-rank test, and Cox model were used for survival rate calculation, univariate analysis, and multivariate analysis, respectively. Results The follow-up rate was 96.6%.In all patients, the 1-, 3-, and 5-year overall survival rates were 63.0%, 24.9%, and 17.8%, respectively;the median survival time was 18 months. The univariate analysis showed that sex, age, immediate response, radiotherapy method, fractionation scheme, chemotherapy, and radiation pneumonitis (RP) were prognostic factors (P=0.004,0.001,0.000,0.007,0.004,0.009,0.049).The multivariate analysis showed that sex, age, immediate response, radiotherapy method, and RP were independent prognostic factors (P=0.006,0.000,0.000,0.003,0.048).Patients with radiation doses of 60-66 Gy had the best prognosis of all. Conclusions In patients with stage Ⅲ NSCLC undergoing 3DCRT, female patients, patients at a young age, patients with satisfactory immediate response, patients treated with full-course 3DCRT, and patients with grade 0-1 RP have better prognosis than others.3DCRT combined with chemotherapy improves survival in patients. A radiation dose of 60-66 Gy is recommended.
Tian Xiuming,Qiu Rong,Wang Yuxiang et al. Prognosis and it related factors in patients of stage Ⅲ non-smallcell lung cancer after three-dimensional conformal radiotherapy[J]. Chinese Journal of Radiation Oncology, 2016, 25(7): 681-685.
[1]阿依古丽·卡力,张瑾熔,王巨武,等.肺癌CT及X线模拟定位放疗计划的剂量学比较研究[J].中华放射肿瘤学杂志,2007,16(3):197-200.DOI:10.3760/j.issn:1004-4221.2007.03.008 Kali A, Zhang JR, Wang JW, et al. Dosimetric comparison between CT and X-ray semulation of radiotherapy for lung cancer[J].Chin J Radiat Oncol,2007,16(3):197-200.DOI:10.3760/j.issn:1004-4221.2007.03.008 [2]梁军,冯勤付,张可,等.肺癌三维适形放疗与常规放疗剂量学优势的比较[J].临床肿瘤学杂志,2006,11(11):814-821.DOI:10.3969/j.issn.1009-0460.2006.11.004 Liang J, Feng QF, Zhang K, et al. To compare the dosiology of three-dimensional cnformal radiotherapy (3D-CRT) with that of conventionalradiotherapy in lung cancer[J].Chin Clinic Oncol, 2006,11(11):814-821.DOI:10.3969/j.issn.1009-0460.2006.11.004 [3]Sher DJ, Koshy M, Liptay MJ, et al. Influence of conformal radiotherapy technique on survival after chemoradiotherapy for patients with stage Ⅲ non-small cell lung cancer in the National Cancer Data Base[J]. Cancer,2014,20(13):2060-2068.DOI:10.1002/cncr.28677 [4]Harris JP, Murphy JD, Hanlon AL, et al. A population-based comparative effectiveness study of radiation therapy techniques in stage Ⅲ non-small cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2014,88(4):872-884.DOI:10.1016/j.ijrobp.2013.12.010 [5]曹建忠,欧广飞,梁军,等.三维适形放疗治疗局部晚期非小细胞肺癌的疗效[J].中华肿瘤杂志,2011,33(7):529-534.DOI:10.3760/cma.j.issn.0253-3766.2011.07.013 Cao JZ, Ou GF,Liang J, et al. Therapeutic efficacy of three-dimensional conformal radiation therapy for patients with locally advanced non-small cell lung cancer[J].Chin J Oncol,2011,33(7):529-534.DOI:10.3760/cma.j.issn.0253-3766.2011.07.013 [6]Wao H,Mhaskar R,Kumar A, et al.Survival of patients with non-small cell lung cancer without treatment:a systematic review and meta-analysis[J].Systematic Reviews,2013,2:10.DOI:10.1186/2046-4053-2-10 [7]Wang L,Correa CR,Zhao L,et al. The Effect of Radiation Dose and Chemotherapy on Overall Survival in 237 Patients with Stage Ⅲ Non-Small Cell Lung Cancer[J].Int J Radiat Oncol Biol Phys,2009,73(5):1383-1390.DOI:10.1016/j.ijrobp.2008.06.1935 [8]欧广飞,王绿化,张红星,等.289例局部晚期非小细胞肺癌放疗和放化综合治疗结果[J].中华放射肿瘤学杂志,2007,16(2):86-90.DOI:10.3760/j.issn:1004-4221.2007.02.002 Ou GF, Wang LH, Zhang HX, et al. Outcome of 289 local advanced non-small cell lung cancer treated with radiotheapy alone or radiotherapy combined with chemotherapy[J].Chin J Radiat Oncol, 2007,16(2):86-90.DOI:10.3760/j.issn:1004-4221.2007.02.002 [9]朱向帜,王绿化,欧广飞,等.三维适形放射治疗局部晚期非小细胞肺癌预后因素分析[J].中华肿瘤杂志,2007,29(10):748-753.DOI:10.3760/j.issn:0253-3766.2007.10.007 Zhu XZ, Wang LH, Ou GF,et al. Prognosis of local advanced non small cell lung cancer treated with three demensional conformal radiotherapy[J].Chin J Oncol, 2007,29(10):748-753.DOI:10.3760/j.issn:0253-3766.2007.10.007 [10]沈文斌,祝淑钗,苏景伟,等.三维适形放射治疗局部晚期非小细胞肺癌长期生存分析[J].中华放射医学与防护杂志,2010,(30):180-184.DOI:10.3760/cma.j.issn.0254-5098.2010.02.019 Shen WB,Zhu SC,Su JW,et al. Analysis of long·term survival in patients treated with three-dimensional conformal radiotherapy for locaHy advanced non-small cell lung cancer. Chin J Radiol Med Prot,2010,(30):180-184.DOI:10.3760/cma.j.issn.0254-5098.2010.02.019 [11]湛永滋,黄昌杰,黄剑峰.159例不宜手术的Ⅲ期非小细胞肺癌同步放化疗临床分析[J].中国肿瘤临床,2009,36(22):1274-1276.10.3969/j.issn.1000-8179.2009.22.004 Zhan YZ,Huang MJ,Huang JF. Clinical analysis of the effect of concurrent adiochemotherapy on 159 unresectable cases of stage Ⅲnon-small cell lung cancer[J].Clin Oncol Chin,2009,36(22):1274-1276 [12]刘飞,李光,党军,等.三维适形放疗非小细胞肺癌预后因素分析[J].中华放射肿瘤学杂志,2007,16(5):344-347.DOI:10.3760/j.issn:1004-4221.2007.05.006 Liu F, Li G, Dang J, et al. Prognostic factors of three demensional conformal radiation therapy in treating non-small cell lung cancer[J].Chin J Radiat Oncol, 2007,16(5):344-347.DOI:10.3760/j.issn:1004-4221.2007.05.006 [13]Basaki k, Abe y, Aoki m, et al. Prognostic factors for survival in stage Ⅲ non-small-cell lung cancer treated with definitive radiation therapy:impact of tumor volume[J].Int J Radiat Oncol Biol Phys,2006,64(2):449-454 [14]McGovern SL,Liao Z,Bucci MK,et al. Is sex associated with the outcome of patients treated with radiation for nonsmall cell lung cancer?[J].Cancer,2009,115(14):3233-3242.DOI:10.1002/cncr.24361 [15]Nakamura H,Ando K, Shinmyo T,et al. Female Gender Is an Independent Prognostic Factor in Non-small-cell Lung Cancer:a Meta-analysis[J].Ann Thorac Cardiovasc Surg,2011,17(5):469-480 [16]Holgersson G,Hoye E,Bergqvist M,et al. Swedish Lung Cancer Radiation Study Group:predictive value of age at diagnosis for radiotherapy response in patients with non-small cell lung cancer[J].Acta Oncol,2012,51(6):759-767. DOI:10.3109/0284186X.2012.681064 [17]Koumarianou A,Fountzilas G,Kosmidis P,et al. Non small cell lung cancer in the elderly:clinico-pathologic, management and outcome characteristics in comparison to younger patients[J].J Chemother,2009,21(5):573-583 [18]Asmis TR,Ding K,Seymour L,et al. Age and comorbidity as independent prognostic factors in the treatment of non small-cell lung cancer:a review of National Cancer Institute of Canada Clinical Trials Group trials[J].Clin Oncol. 2008,26(1):54-59 [19]Marnitz S,Stuschke M,Bohsung J,et al. Intraindividual comparison of conventional three-dimensional radiotherapy and intensity modulated radiotherapy in the therapy of locally advanced non-small cell lung cancer a planning study[J].Strahlenther Onkol,2002,178(11):651-658 [20]Murshed H,Liu HH,Liao Z, et al. Dose and volume reduction for normal lung using intensity-modulated radiotherapy for advanced-stage non-small-cell lung cancer[J].Int J Radiat Oncol Biol Phys,2004,58(4):1258-1267 [21]Harris JP, Murphy JD, Hanlon AL, et al. A population-based comparative effectiveness study of radiation therapy techniques in stage Ⅲ non-small cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2014,88(4):872-884.DOI:10.1016/j.ijrobp.2013.12.010 [22]Liao ZX, Komaki RR, Thames HD Jr, et al. Influence of technologic advances on outcomes in patients with unresectable, locally advanced non-small-cell lung cancer receiving concomitant chemoradiotherapy[J].Int J Radiat Oncol Biol Phys,2010,76(3):775-781.DOI:10.1016/j.ijrobp.2009.02.032 [23]Alexander BM,Othus M,Caglar HB,et al. Tumor volume is a prognostic factor in non-small-cell lung cancer treated with chemoradiotherapy[J].Int J Radiat Oncol Biol Phys,2011,79(5):1381-1387. DOI:10.1016/j.ijrobp.2009.12.060 [24]Lee DS, Kim YS, Kang JH, et al. Clinical responses and prognostic indicators of concurrent chemoradiation for non-small cell lung cancer[J].Cancer Res Treat,2011,43(1):32-41.doi:10.4143/crt.2011.43.1.32 [25]张彬,乔田奎.Ⅲ期非小细胞肺癌放化同期治疗临床观察与预后分析[J].中国癌症杂志,2010,20(9):703-706.DOI:10.3969/j.issn.1007-3639.2010.09.013 Zhang B,Qiao TK.Analysis of three dimensional conformal radiotherapy combined with chemotherapy in the treatment of stage 18 non-small cell lung cancer and analysis of prognostic factors and its prognostic factors[J].Chin Oncol, 2010,20(9):703-706.DOI:10.3969/j.issn.1007-3639.2010.09.013 [26]Bradley JD, Paulus R, Komaki R, et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage ⅢA or ⅢB non-small-cell lung cancer (RTOG 0617):a randomised, two-by-two factorial phase 3 study[J].Lancet Oncol,2015,16(2):187-199.DOI:10.1016/S1470-2045(14)71207-0 [27]Kim TY,Yang SH,Lee SH,et al.A phase Ⅲ randomized trial of combined chemoradiotherapy versus radiotherapy alone in locally advanced non-small-cell lung cancer[J].Am J Clin Oncol,2002,25(3):238-243 [28]Curran WJ,Jr., Paulus R,Langer CJ,et al. Sequential vs. Concurrent Chemoradiation for Stage Ⅲ Non–Small Cell Lung Cancer:Randomized Phase Ⅲ Trial RTOG 9410[J].J Natl Cancer Inst,2011,103(19):1452-1460.DOI:10.1093/jnci/djr325 [29]Auperin A,Le Pechoux C,Rolland E,et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer[J].J Clin Oncol,2010,28(13):2181-2190.DOI:10.1200/JCO.2009.26.2543.
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