Biologically Effective Dose in Stereotactic Body Radiotherapy and Survival for Patients With Early-Stage NSCLC

被引:52
|
作者
Moreno, Amy C. [1 ]
Fellman, Bryan [2 ]
Hobbs, Brian P. [3 ]
Liao, Zhongxing [1 ]
Gomez, Daniel R. [1 ]
Chen, Aileen [1 ]
Hahn, Stephen M. [1 ]
Chang, Joe Y. [1 ]
Lin, Steven H. [1 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Unit 97,1515 Holcombe Blvd, Houston, TX 77030 USA
[2] Univ Texas MD Anderson Canc Ctr, Dept Biostat, Houston, TX 77030 USA
[3] Cleveland Clin, Lerner Res Inst, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA
基金
美国国家卫生研究院;
关键词
Stereotactic body radiation therapy; Stereotactic ablative radiation therapy; Biologically effective dose; Early-stage lung cancer; NSCLC; CELL LUNG-CANCER; RADIATION-THERAPY SBRT; TUMOR-CONTROL PROBABILITY; HETEROGENEITY CORRECTIONS; ABLATIVE RADIOTHERAPY; DOSIMETRIC EVALUATION; CLINICAL-OUTCOMES; TOXICITY; TRIAL;
D O I
10.1016/j.jtho.2019.08.2505
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Introduction: Stereotactic body radiotherapy (SBRT) results in excellent local control of stage I NSCLC. Radiobiology models predict greater tumor response when higher biologically effective doses (BED10) are given. Prior studies support a BED10 greater than or equal to 100 Gy with SBRT; however, data are limited comparing outcomes after various SBRT regimens. We therefore sought to evaluate national trends and the effect of using "low" versus "high" BED10 SBRT courses on overall survival (OS). Methods: This retrospective study used the National Cancer Data Base to identify patients diagnosed with clinical stage I (cT1-2aN0M0) NSCLC from 2004 to 2014 treated with SBRT. Patients were categorized into LowBED (100-129 Gy) or HighBED (>= 130 Gy) groups. A 1:1 matched analysis based on patient and tumor characteristics was used to compare OS by BED10 group. Tumor centrality was not assessed. Results: O 25,039 patients treated with LowBED (n = 14,756; 59%) or HighBED (n = 10,283; 41%) SBRT, 20,542 were matched. Shifts in HighBED to LowBED SBRT regimen use correlated with key publications in the literature. In the matched cohort, 5-year OS rates were 26% for LowBED and 34% for HighBED groups (p = 0.039). On multivariate analysis, receipt of LowBED was associated with significantly worse survival (hazard ratio = 1.046, 95% confidence interval: 1.004-1.090, p = 0.032). Conclusions: LowBED SBRT for treating stage I NSCLC is becoming more common. However, our findings suggest SBRT regimens with BED10 greater than or equal to 130 Gy may confer an additional survival benefit. Additional studies are required to evaluate the dose-response relationship and toxicities associated with modern HighBED SBRT. (C) 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:101 / 109
页数:9
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