A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis

被引：11

作者：

Yan, Michael ^{[1
]}

Sigurdson, Samantha ^{[1
]}

Greifer, Noah ^{[2
]}

Kennedy, Thomas A. C. ^{[1
]}

Toh, Tzen S. ^{[3
,4
]}

Lindsay, Patricia E. ^{[5
,6
]}

Weiss, Jessica ^{[7
]}

Hueniken, Katrina ^{[4
,7
]}

Yeung, Christy ^{[8
]}

Sugumar, Vijithan ^{[9
]}

Sun, Alexander ^{[5
,6
]}

Bezjak, Andrea ^{[5
,6
]}

Cho, B. C. John ^{[5
,6
]}

Raman, Srinivas ^{[5
,6
]}

Hope, Andrew J. ^{[5
,6
]}

Giuliani, Meredith E. ^{[5
,6
]}

Stuart, Elizabeth A. ^{[2
]}

Owen, Timothy ^{[1
]}

Ashworth, Allison ^{[1
]}

Robinson, Andrew ^{[1
]}

de Moraes, Fabio Ynoe ^{[1
]}

Liu, Geoffrey ^{[4
,10
,11
]}

Lok, Benjamin H. ^{[5
,6
,10
,11
]}

机构：

[1] Queens Univ, Canc Ctr Southeastern Ontario, Dept Oncol, Kingston, ON K7L 5P9, Canada

[2] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Mental Hlth, Baltimore, MD 21205 USA

[3] Univ Sheffield, Med Sch, Sheffield S10 2RX, S Yorkshire, England

[4] Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Toronto, ON M5G 2M9, Canada

[5] Princess Margaret Canc Ctr, Radiat Med Program, Toronto, ON M5G 2M9, Canada

[6] Univ Toronto, Dept Radiat Oncol, Toronto, ON M5T 1P5, Canada

[7] Princess Margaret Canc Ctr, Dept Biostat, Toronto, ON M5G 2M9, Canada

[8] Univ Toronto, Dept Lab Med & Pathobiol, Toronto, ON M5G 0A4, Canada

[9] Western Univ, Dept Physiol & Pharmacol, London, ON N6A 5C1, Canada

[10] Univ Toronto, Fac Med, Inst Med Sci, Toronto, ON M5S 1A8, Canada

[11] Univ Toronto, Dept Med Biophys, Toronto, ON M5G 1L7, Canada

来源：

CANCERS | 2021年 / 13卷 / 12期

基金：

加拿大健康研究院; 加拿大创新基金会;

关键词：

small-cell lung cancer; hypofractionation; radiotherapy; propensity score; OPEN-LABEL; RADIOTHERAPY; RADIATION; CHEMOTHERAPY; MANAGEMENT; SURVIVAL; FRACTIONATION; REPOPULATION; OUTCOMES; IMPACT;

D O I：

10.3390/cancers13122895

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Simple Summary The optimal thoracic radiotherapy schedule for limited-stage small cell lung cancer (LS-SCLC) patients remains controversial. We conducted a propensity score adjusted analysis of LS-SCLC patients treated at our institutions with 40Gy/15 fractions versus 45Gy/30 twice daily. After overlap weighting for clinical and treatment variables and attaining good balance, we did not find a significant difference in overall survival, locoregional recurrence risk, thoracic response, or >= grade 3 toxicity. Moderate hypofractionation, with its similar outcomes and logistical advantages, may present a reasonable alternative to twice daily radiotherapy. Despite evidence for the superiority of twice-daily (BID) radiotherapy schedules, their utilization in practice remains logistically challenging. Hypofractionation (HFRT) is a commonly implemented alternative. We aim to compare the outcomes and toxicities in limited-stage small-cell lung cancer (LS-SCLC) patients treated with hypofractionated versus BID schedules. A bi-institutional retrospective cohort review was conducted of LS-SCLC patients treated with BID (45 Gy/30 fractions) or HFRT (40 Gy/15 fractions) schedules from 2007 to 2019. Overlap weighting using propensity scores was performed to balance observed covariates between the two radiotherapy schedule groups. Effect estimates of radiotherapy schedule on overall survival (OS), locoregional recurrence (LRR) risk, thoracic response, any >= grade 3 (including lung, and esophageal) toxicity were determined using multivariable regression modelling. A total of 173 patients were included in the overlap-weighted analysis, with 110 patients having received BID treatment, and 63 treated by HFRT. The median follow-up was 20.4 months. Multivariable regression modelling did not reveal any significant differences in OS (hazard ratio [HR] 1.67, p = 0.38), LRR risk (HR 1.48, p = 0.38), thoracic response (odds ratio [OR] 0.23, p = 0.21), any >= grade 3+ toxicity (OR 1.67, p = 0.33), >= grade 3 pneumonitis (OR 1.14, p = 0.84), or >= grade 3 esophagitis (OR 1.41, p = 0.62). HFRT, in comparison to BID radiotherapy schedules, does not appear to result in significantly different survival, locoregional control, or toxicity outcomes.

引用

页数：16

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