Ⅳ期NSCLC原发肿瘤三维放射治疗失败模式分析

doi:10.3760/cma.j.cn113030-20211207-00502

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Abstract Objective To explore the characteristics of failure patterns of three‐dimensional radiotherapy combined with first‐line drug therapy for primary tumors of stage Ⅳ non‐small cell lung cancer(NSCLC)and investigate the influence of radiotherapy‐related factors. Methods 708 patients newly‐diagnosed with stage Ⅳ NSCLC from March 2003 to July 2020 were selected. Chi‐square test was used for univariate analysis of failure patterns. Kaplan‐Meier method, Log‐rank test and Cox regression model were employed for multivariate analysis. Results The incidence of first‐line treatment failure in 708 cases was 71.2%, and the incidence of treatment failure was 22.7%, 28.8%, 13.3%, and 6.4% for ≤6 months, >6-12 months, >12-24 months, and>24 months, respectively, and the median survival time was 7.2, 13.4, 22.2, and 37.6 months, which was significantly different(χ²=226.013,P<0.001). The incidence of recurrence failure(RF)was 21.3%.There was no significant difference in the incidence of RF between oligometastasis(OM)and non‐oligometastasis(NOM). The incidence of DF was 66.3% and the order of incidence was brain>bone>lung>pleural cavity>liver>distant lymph nodes>adrenal gland>other sites, occurring in approximately 1/2 of AM and 1/3 of PSM cases. Metastatic status, time to treatment failure, pathological type, gender, combined treatment intensity were the independent influencing factors for predicting prognosis. Conclusions The failure pattern of radiotherapy for primary tumors of stage Ⅳ NSCLC is different from that of first‐line drug therapy, with significantly lower local failure and predominantly metastatic failure. The incidence of brain metastasis is the highest. The later time to treatment failure, the longer the overall survival(OS). OM, female, non‐squamous cell carcinoma, late treatment failure, 4-6 cycles of chemotherapy over the same period ≥63 Gy are the independent prognostic factors for prolonging survival.

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	Articles by authors
	Wu Xinyu
	Su Shengfa
	Ouyang Weiwei
	Li Qingsong
	Ma Zhu
	Yang Wengang
	Chen Xiaxia
	Geng Yichao
	Lu Bing

Key words： Carcinoma,non‐small cell lung,stage Ⅵ Radiation therapy Primary tumor Pattern of failure Survival

Received: 07 December 2021

Fund:Guizhou Science and Technology Plan Support Project[Qian Sci Co‐support(2019)2795]

Corresponding Authors: Lu Bing, Email: lbgymaaa@163.com

Cite this article:

Wu Xinyu,Su Shengfa,Ouyang Weiwei et al. The patterns of failure with three‐dimensional radiation therapy for primary tumors of stage Ⅳ NSCLC[J]. Chinese Journal of Radiation Oncology, 2022, 31(8): 691-697.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20211207-00502 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2022/V31/I8/691

[1] Chen VW, Ruiz BA, Hsieh MC, et al.Analysis of stage and clinical/prognostic factors for lung cancer from SEER registries: AJCC staging and collaborative stage data collection system[J]. Cancer,2014,120(Suppl23):3781‐3792.DOI:10.1002/cncr.29045.
[2] Arbour KC, Riely GJ.Systemic Therapy for Locally Advanced and Metastatic Non‐Small Cell Lung Cancer: A Review[J]. JAMA, 2019,322(8): 764‐774.DOI: 10.1001/jama.2019.11058.
[3] Schwer AL, Gaspar LE.Update in the treatment of brain metastases from lung cancer[J]. Clin Lung Cancer, 2006,8(3): 180‐186.DOI: 10.3816/CLC.2006.n.045.
[4] Pao W, Miller VA, Politi KA, et al.Acquired resistance of lung adenocarcinomas to gefitinib or erlotinib is associated with a second mutation in the EGFR kinase domain[J]. PLoS Med, 2005,2(3): e73.DOI: 10.1371/journal.pmed.0020073.
[5] Pao W, Wang TY, Riely GJ, et al.KRAS mutations and primary resistance of lung adenocarcinomas to gefitinib or erlotinib[J]. PLoS Med, 2005,2(1):e17.DOI:10.1371/journal.pmed.0020017.
[6] Rusthoven KE, Hammerman SF, Kavanagh BD, et al.Is there a role for consolidative stereotactic body radiation therapy following first‐line systemic therapy for metastatic lung cancer?A patterns‐of‐failure analysis[J]. Acta Oncol, 2009,48(4): 578‐583.DOI: 10.1080/02841860802662722.
[7] Higginson D, Chen R, Tracton G, et al.The impact of local and regional disease extent on overall survival in patients with advanced stage ⅢB/Ⅳ non‐small cell lung carcinoma[J]. Int J Radiat Oncol Biol Phys, 2012,84(3): e385‐392.
[8] 胡小龙,李宏奇,徐向升,等.43例寡转移NSCLC立体定向放疗结果分析[J]. 中华放射肿瘤学杂志,2017,26(10): 1141‐1146.DOI: 10.3760/cma.j.issn.1004‐4221.2017.10.007.
Hu XL, Li HQ, Xu XS, et al.Result of stereotactic radiotherapy of oligometastasis non‐small cell lung cancer[J]. Chin J Radiat Oncol, 2017,26(10): 1141‐1146.DOI: 10.3760/cma.j.issn.1004‐4221.2017.10.007.
[9] Chen X, Chen H, Poon I, et al.Late metastatic presentation is associated with improved survival and delayed wide‐spread progression after ablative stereotactic body radiotherapy for oligometastasis[J]. Cancer Med, 2021,10(18): 6189‐6198.DOI: 10.1002/cam4.4133.
[10] Su S, Hu Y, Ouyang W, et al.Might radiation therapy in addition to chemotherapy improve overall survival of patients with non‐oligometastatic stage Ⅳ non‐small cell lung cancer?:secondary analysis of two prospective studies[J]. BMC Cancer, 2016,16(1): 908.DOI: 10.1186/s12885‐016‐2952‐3.
[11] Su S, 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 2 study from PPRA‐RTOG, China[J]. Int J Radiat Oncol Biol Phys, 2015,93(4): 769‐777.
[12] Petrelli F, Ghidini A, Cabiddu M, et al.Addition of radiotherapy to the primary tumour in oligometastatic NSCLC: a systematic review and meta‐analysis[J]. Lung Cancer, 2018,126:194‐200.DOI: 10.1016/j.lungcan.2018.11.017.
[13] De Ruysscher D, Wanders R, Hendriks LE, et al.Progression‐free survival and overall survival beyond 5 years of NSCLC patients with synchronous oligometastases treated in a prospective phase II trial(NCT 01282450)[J]. J Thorac Oncol, 2018,13(12): 1958‐1961.DOI: 10.1016/j.jtho.2018.07.098.
[14] Eisenhauer EA, Therasse P, Bogaerts J, et al.New response evaluation criteria in solid tumours: revised RECIST guideline(version 1.1)[J]. Eur J Cancer, 2009,45(2): 228‐247.
[15] Su SF, Hu YX, Ouyang WW, et al.Overall survival and toxicities regarding thoracic three‐dimensional radiotherapy with concurrent chemotherapy for stage Ⅳ non‐small cell lung cancer: results of a prospective single‐center study[J]. BMC Cancer, 2013,13:474.DOI: 10.1186/1471‐2407‐13‐474.
[16] Postmus PE, Brambilla E, Chansky K, et al.The IASLC lung cancer staging project: proposals for revision of the M descriptors in the forthcoming(seventh)edition of the TNM classification of lung cancer[J]. J Thorac Oncol, 2007,2(8): 686‐693.DOI: 10.1097/JTO.0 b013e31811f4703.
[17] 李凤虎,卢冰,付和谊,等.546例Ⅳ期非小细胞肺癌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.
[18] Hellman S, Weichselbaum RR.Oligometastases[J]. J Clin Oncol, 1995,13(1): 8‐10.DOI: 10.1200/JCO.1995.13.1.8.
[19] Iyengar P, Wardak Z, Gerber DE, et al.Consolidative radiotherapy for limited metastatic non‐small‐cell lung cancer: a phase 2 randomized clinical Trial[J]. JAMA Oncol, 2018,4(1): e173501.DOI: 10.1001/jamaoncol.2017.3501.
[20] Arrieta O, Maldonado F, Turcott JG, et al.Prophylactic cranial irradiation reduces brain metastases and improves overall survival in high‐risk metastatic non‐small cell lung cancer patients: a randomized phase 2 study(PRoT‐BM trial)[J]. Int J Radiat Oncol Biol Phys, 2021,110(5): 1442‐1450.DOI: 10.1016/j.ijrobp.2021.02.044.
[21] Hörner‐Rieber J, Bernhardt D, Blanck O, et al.Long‐term follow‐up and patterns of recurrence of patients with oligometastatic NSCLC treated with pulmonary SBRT[J]. Clin Lung Cancer, 2019,20(6): e667‐e677.DOI: 10.1016/j.cllc.2019.06.024.
[22] Ma L, Qiu B, Zhang J, et al.Survival and prognostic factors of non‐small cell lung cancer patients with postoperative locoregional recurrence treated with radical radiotherapy[J]. Chin J Cancer,2017,36(1):93.DOI:10.1186/s40880‐017‐0261‐0.
[23] Petrelli F, Ghidini A, Cabiddu M, et al.Addition of radiotherapy to the primary tumour in oligometastatic NSCLC: a systematic review and meta‐analysis[J]. Lung Cancer, 2018,126:194‐200.DOI: 10.1016/j.lungcan.2018.11.017.
[24] 邓蓉,李涛,李建成,等.Ⅳ期NSCLC化疗同期3 DRT前瞻性、多中心Ⅱ期临床研究——不同病理类型生存再分析(PPRA‐RTOG003)[J]. 中华放射肿瘤学杂志,2016,25(10): 1051‐1056.DOI: 10.3760/cma.j.issn.1004‐4221.2016.10.006.
Deng R, Li T, Li JC, et al.A prospective, multicenter, phase Ⅱ clinical study of three‐dimensional radiotherapy concurrent chemothery for stage Ⅳ non‐small‐cell lung cancer‐the impact of different pathological types on survival(PPRA‐RTOG003)[J]. Chin J Radiat Oncol, 2016,25(10): 1051‐1056.DOI: 10.3760/cma.j.issn.1004‐4221.2016.10.006.