A prospective,multicenter,phase Ⅱclinical study of three-dimensionalradiotherapy with concurrent chemotherapy for stage IV non-small-cell lung cancer-The impact of different pathological types on survival (PPRA-RTOG003)
Teaching and Research Section of Oncology,Guizhou Medical University,Guiyang 550004,China (Deng R);Department of Radiation Oncology,Sichuan Cancer Hospital (Li T);Department of Radiation Oncology,Fujian Cancer Hospital (Li JCH);Department of Radiation Oncology,Gansu Cancer Hospital (Wang XH);Department of Radiation Oncology,West China Hospital of Sichuan University (Lu Y);Department of Radiation Oncology,Zhejiang Cancer Hospital (Chen M);Department of Thoracic Oncology,Affiliated Cancer Hospital and Affiliated Hospital of Zunyi Medical College (Bai YJ);Department of Oncology,Guizhou Cancer Hospital,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China (Su SHF,Ouyang WW,Li QS,Ma ZH,Hu YX,Li HQ,Lu B);Stem Cell and Tissue Engineering Research Center,Guizhou Medical University (He ZHX)
Abstract： Objective To evaluate the survival of different pathological types with concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT) for stage Ⅳ non-small-cell lung cancer (NSCLC). Methods Two hundred and three patients of stage Ⅳ NSCLC were enrolled from 2008 to 2012.Of the 174 patients eligible for analysis,The patients of squamous carcinoma and non-squamous carcinoma were 51 and 123,respectively. Patients were treated by platinum-based chemotherapy,the median number of cycle was 4.The median dose of primary tumor was 63 Gy. Survival was calculated by Kaplan-Meier method and compared using the Logrank. Cox regression model were used to examine the effect of response on overall survival. Results Of 174 patients,the 1-,2-,and 3-year overall survival (OS) rates and median survival time (MST) were 56%,16%,9% and 13 months,respectively. For patients under the same cycles of chemotherapy,the same dose of primary tumor,the same metastasis states,the same N staging,and when two cycles of chemotherapy and the recent curative effect are effective,no matter whether squamous carcinoma or non-squamous carcinoma,the 1-,2-,and 3-year OS rates and MST were not statistically significant (all P>0.05).At the same of T staging (T1-T2),the 1-,2-,and 3-year OS rates and MST for the patients of non-squamous carcinoma were better than squamous carcinoma (P=0.000).Multivariate analysis showed that different pathological types,gender,age and the cycles of chemotherapy were not independent factors for survival (all P>0.05),but those treated with DTPTV≥63 Gy can prolong survival time. Conclusions CCTTRT had no effect on different pathological types of survival. The survival of non-squamous carcinoma may be extended when the T staging was T1-T2.Clinical Trial Registry ClinicalTrials.gov,registration number:ChiCTRTNC10001026.
. A prospective,multicenter,phase Ⅱclinical study of three-dimensionalradiotherapy with concurrent chemotherapy for stage IV non-small-cell lung cancer-The impact of different pathological types on survival (PPRA-RTOG003)[J]. Chinese Journal of Radiation Oncology, 2016, 25(10): 1051-1056.
[1] 雷源源,吴一龙.微转移在非小细胞肺癌的预后价值[J].中国肺癌杂志,2013,16(9):492-498.DOI:10.3779/j.issn.1009-3419.2013.09.10. Lei YY,Wu YL.The prognostic value of micrometastasis in non-small cell lung cancer[J].Chin J Lung Cancer,2013,16(9):492-498.DOI:10.3779/j.issn.1009-3419.2013.09.10. [2] Jemal A,Siegel R,Ward E,et al. Cancer statistics,2007[J].CA Cancer J Clin,2007,57(1):43-66.DOI:10.3322/canjclin.57.1.43. [3] Bray F,Ferlay J,Parkin DM,et al. GLOBOCAN 2000:cancer incidence,mortality and prevalence worldwide[OB/OL].Lyon,France:IARC Press,2001. [4] Govindan R,Page N,Morgensztern D,et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years:analysis of the surveillance,epidemiologic,and end results database[J].J Clin Oncol,2006,24(28):4539-4544.DOI:10.1200/JCO.2005.04.4859. [5] Ramalingam S,Belani CP.State-of-the-art chemotherapy for advanced non-small cell lung cancer[J].Semin Oncol,2004,31(S1):68-74.DOI:10.1053/j.seminoncol.2003.12.017. [6] Su SF,Li T,Lu B,et al. Three-dimensional radiation therapy to the primary tumor with concurrent chemotherapy in patients with stage Ⅳ non-small cell lung cancer:results of a multicenter phase Ⅱstudy from PPRA-RTOG,China[J].Int J Radiat Oncol Biol Phys,2015,93(4):769-777.DOI:10.1016/j.ijrobp.2015.08.012. [7] Nakamura H,Kawasaki N,Taguchi M,et al. Association of HER-2 overexpression with prognosis in nonsmall cell lung carcinoma:a metaanalysis[J].Cancer,2005,103(9):1865-1873.DOI:10.1002/cncr.20957. [8] Potente G,Macori F,Caimi M,et al. Noncalcified pulmonary hamartomas:computed tomography enhancement patterns with histologic correlation[J].J Thorac Imaging,1999,14(2):101-104. [9] Shimada Y,Saji H,Kakihana M,et al. Retrospective analysis of nodal spread patterns according to tumor location in pathological N2 non-small cell lung cancer[J].World J Surg,2012,36(12):2865-2871.DOI:10.1007/s00268-012-1743-5. [10] Strauss GM,Jemal A,McKenna MB,et al. Creation of an epidemic:the tobacco industry (TI) and smoking-related adenocarcinoma (AD) of the lung[J].J Clin Oncol,2007,25(Suppl 18):7583. [11] 李峻岭,石远凯.肺鳞癌治疗进展[J].癌症进展,2012,10(2):120-123.DOI:10.3969/j.issn.1672-1535.2012.02.004. Li JL,Shi YK.Advances in the treatment of lung squamous cell carcinoma[J].Oncol Prog,2012,10(2):120-123.DOI:10.3969/j.issn.1672-1535.2012.02.004. [12] Gabrielson E.Worldwide trends in lung cancer pathology[J].Respirology,2006,11(5):533-538.DOI:10.1111/j.1440-1843.2006.00909.x. [13] Schiller JH,Harrington D,Belani CP,et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer[J].N Engl J Med,2002,346(2):92-98.DOI:10.1056/NEJMoa011954. [14] Mok TS,Wu YL,Thongprasert S,et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinomar[J].N Engl J Med,2009,361(10):947-957.DOI:10.1056/NEJMoa0810699. [15] 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. [16] Hanna N,Shepherd FA,Fossella FV,et al. Randomized phase Ⅲ trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy[J].J Clin Oncol,2004,22(9):1589-1597.DOI:10.1200/JCO.2004.08.163. [17] Le Chevalier T,Scagliotti G,Natale R,et al. Gemcitabine in the treatment of NSCLC:meta analysis of survival and progression free survival data[J].Lung Cancer,2005,47(1):69-80. [18] Heighway J,Betticher DC.Lung:non-small cell carcinoma[R].Atlas Genet Cytogenet Oncol Haematol,2004.DOI:10.4267/2042/38084. [19] Netikova I,Bursikova E,Vesely P,et al. A simple non-destructive test of cellular activity (NTCA) for in vitro assessment of cancer cell chemosensitivity/resistance[J].Anticancer Res,2007,27(4B):2331-2337. [20] Bunn Jr PA,Kelly K.New chemotherapeutic agents prolong survival and improve quality of life in non-small cell lung cancer:a review of the literature and future directions[J].Clin Cancer Res,1998,4(5):1087-1100. [21] Hoang T,Suzanne D,Joan HS,et al. Does histology predict survival of advanced non-small cell lung cancer (NSCLC) treated with standard platin-based chemotherapy? Retrospective analysis of E1594[C]//Proceedings of the 13th World Conference on Lung Cancer. Moscone West,San Francisco,USA:WCLC,2009. [22] Scagliotti GV,De Marinis F,Rinaldi M,et al. Phase Ⅲ randomized trial comparing three platinum-based doublets in advanced non-small-cell lung cancer[J].J Clin Oncol,2002,20(21):4285-4291.DOI:10.1200/JCO.2002.02.068. [23] Kelly K,Crowley J,Bunn Jr PA,et al. Randomized phase Ⅲ trial of paclitaxel plus carboplatin versus vinorelbine plus cisplatin in the treatment of patients with advanced non-small-cell lung cancer:a southwest oncology group trial[J].J Clin Oncol,2001,19(13):3210-3218. [24] Kawabe S,Munshi A,Zumstein LA,et al. Adenovirus-mediated wild-type p53 gene expression radiosensitizes non-small cell lung cancer cells but not normal lung fibroblasts[J].Int J Radiat Biol,2001,77(2):185-194.DOI:10.1080/09553000010008540. [25] Kasid U,Pirollo K,Dritschilo A,et al. Oncogenic basis of radiation resistance[J].Adv Cancer Res,1993,61:195-233. [26] Choi EJ,Ryu YK,Kim SY,et al. Targeting epidermal growth factor receptor-associated signaling pathways in non-small cell lung cancer cells:implication in radiation response[J].Mol Cancer Res,2010,8(7):1027-1036.DOI:10.1158/1541-7786.MCR-09-0507. [27] Xu YP,Zhang YP,Ma SL.EGFR inhibitors with concurrent thoracic radiation therapy for locally advanced non-small cell lung cancer[J].Lung Cancer,2001,73(3):249-255.DOI:10.1016/j.lungcan.2011.04.017. [28] Ciardiello F,Tortora G.EGFR antagonists in cancer treatment[J].N Eng J Med,2008,358(11):1160-1174.DOI:10.1056/NEJMra0707704. [29] Dacic S,Flanagan M,Cieply K,et al. Significance of EGFR protein expression and gene amplification in non-small cell lung carcinoma[J].Am J Clin Pathol,2006,125(6):860-865.DOI:10.1309/H5UW6CPCWWC92241. [30] 龙金华,卢冰,欧阳伟炜,等.Ⅳ期非小细胞肺癌化疗同期胸部三维放疗的前瞻性临床研究(三)—不同放疗剂量对生存的影响[J].中华放射肿瘤学杂志,2011,21(1):23-27.DOI:10.3760/cma.j.issn.1004-4221.2012.01.008. Long JH,Lu B,Ouyang WW,et al. A prospective study on concurrent chemotherapy and thoracic three-dimensional radiotherapy for stage Ⅳ non-small cell lung cancer (3)-the impact of radiation dose to thoracic primary tumor on survival[J].Chin J Radiat Oncol,2012,21(1):23-27.DOI:10.3760/cma.j.issn.1004-4221.2012.01.008.
2016, Vol. 25 
