Increasing Radiation Therapy Dose Is Associated With Improved Survival in Patients Undergoing Stereotactic Body Radiation Therapy for Stage I Non-Small-Cell Lung Cancer

被引:91
作者
Koshy, Matthew [1 ,2 ]
Malik, Renuka [2 ]
Weichselbaum, Ralph R. [1 ,2 ]
Sher, David J. [3 ]
机构
[1] Univ Chicago, Dept Radiat Oncol, Chicago, IL 60637 USA
[2] Univ Chicago, Dept Radiat & Cellular Oncol, Chicago, IL 60637 USA
[3] Rush Univ, Med Ctr, Dept Radiat Oncol, Chicago, IL 60612 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2015年 / 91卷 / 02期
关键词
LINEAR-QUADRATIC MODEL; PROSPECTIVE PHASE-II; CLINICAL-OUTCOMES; RADIOTHERAPY; RADIOSURGERY; RADIOBIOLOGY; COMORBIDITY;
D O I
10.1016/j.ijrobp.2014.10.002
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To determine the comparative effectiveness of different stereotactic body radiation therapy (SBRT) dosing regimens for early-stage nonesmall-cell lung cancer, using a large national database, focusing on the relative impact of dose as a function of tumor stage. Methods and Materials: The study included patients in the National Cancer Database from 2003 to 2006 with T1-T2N0M0 inoperable lung cancer (n=498). The biologically effective dose (BED) was calculated according to the linear quadratic formula using an alpha/beta ratio of 10. High versus lower-dose (HD vs LD) SBRT was defined as a calculated BED above or below 150 Gy. Overall survival was estimated using Kaplan-Meier methods and Cox proportional hazard regression. Results: The 5 most common dose fractionation schemes (percentage of cohort) used were 20 Gy x 3 (34%), 12 Gy x 4 (16%), 18 Gy x 3 (10%), 15 Gy x 3 (10%), and 16 Gy x 3 (4%). The median calculated BED was 150 Gy (interquartile range 106-166 Gy). The 3-year overall survival (OS) for patients who received HD versus LD was 55% versus 46% (log-rank P=. 03). On subset analysis of the T1 cohort there was no association between calculated BED and 3-year OS (61% vs 60% with HD vs LD, P=. 9). Among the T2 cohort, patients receiving HD experienced superior 3-year OS (37% vs 24%, P=. 01). On multivariable analysis, factors independently prognostic for mortality were female gender (hazard ratio [HR] 0.76, P=. 01), T2 tumor (HR 1.99, P=. 0001), and HD (HR 0.68, P=. 001). Conclusions: This comparative effectiveness analysis of SBRT dose for patients with stage I nonesmall-cell lung cancer suggests that higher doses (> 150 Gy BED) are associated with a significant survival benefit in patients with T2 tumors. (C) 2015 Elsevier Inc.
引用
收藏
页码:344 / 350
页数:7
相关论文
共 24 条
[1]   Outcome in a Prospective Phase II Trial of Medically Inoperable Stage I Non-Small-Cell Lung Cancer Patients Treated With Stereotactic Body Radiotherapy [J].
Baumann, Pia ;
Nyman, Jan ;
Hoyer, Morten ;
Wennberg, Berit ;
Gagliardi, Giovanna ;
Lax, Ingmar ;
Drugge, Ninni ;
Ekberg, Lars ;
Friesland, Signe ;
Johansson, Karl-Axel ;
Lund, Jo-Asmund ;
Morhed, Elisabeth ;
Nilsson, Kristina ;
Levin, Nina ;
Paludan, Merete ;
Sederholm, Christer ;
Traberg, Anders ;
Wittgren, Lena ;
Lewensohn, Rolf .
JOURNAL OF CLINICAL ONCOLOGY, 2009, 27 (20) :3290-3296
[2]   Relevance of biologically equivalent dose values in outcome evaluation of stereotactic radiotherapy for lung nodules [J].
Casamassima, Franco ;
Masi, Laura ;
Bonucci, Ivano ;
Polli, Caterina ;
Menichelli, Claudia ;
Gulisano, Massimo ;
Pacini, Stefania ;
Aterini, Stefano ;
Cavedon, Carlo .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2008, 71 (01) :145-151
[3]   The RSSearch™ Registry: patterns of care and outcomes research on patients treated with stereotactic radiosurgery and stereotactic body radiotherapy [J].
Davis, Joanne N. ;
Medbery, Clinton, III ;
Sharma, Sanjeev ;
Danish, Adnan ;
Mahadevan, Anand .
RADIATION ONCOLOGY, 2013, 8
[4]   ADAPTING A CLINICAL COMORBIDITY INDEX FOR USE WITH ICD-9-CM ADMINISTRATIVE DATABASES [J].
DEYO, RA ;
CHERKIN, DC ;
CIOL, MA .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1992, 45 (06) :613-619
[5]   STEREOTACTIC BODY RADIATION THERAPY FOR EARLY-STAGE NON-SMALL-CELL LUNG CARCINOMA: FOUR-YEAR RESULTS OF A PROSPECTIVE PHASE II STUDY [J].
Fakiris, Achilles J. ;
McGarry, Ronald C. ;
Yiannoutsos, Constantin T. ;
Papiez, Lech ;
Williams, Mark ;
Henderson, Mark A. ;
Timmerman, Robert .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2009, 75 (03) :677-682
[6]  
Hadziahmetovic M, 2010, DISCOV MED, V9, P411
[7]   Clinical outcomes of single-fraction stereotactic radiation therapy of lung tumors [J].
Hara, R ;
Itami, J ;
Kondo, T ;
Aruga, T ;
Uno, T ;
Sasano, N ;
Ohnishi, K ;
Kiyozuka, M ;
Fuse, M ;
Ito, M ;
Naoi, K ;
Kohno, Y .
CANCER, 2006, 106 (06) :1347-1352
[8]   Stereotactic Body Radiation Therapy for Treatment of Primary and Metastatic Pulmonary Malignancies [J].
Kelsey, Chris R. ;
Salama, Joseph K. .
SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA, 2013, 22 (03) :463-+
[9]   Dose-response relationship with clinical outcome for lung stereotactic body radiotherapy (SBRT) delivered via online image guidance [J].
Kestin, Larry ;
Grills, Inga ;
Guckenberger, Matthias ;
Belderbos, Jose ;
Hope, Andrew J. ;
Werner-Wasik, Maria ;
Sonke, Jan-Jakob ;
Bissonnette, Jean-Pierre ;
Xiao, Ying ;
Yan, Di .
RADIOTHERAPY AND ONCOLOGY, 2014, 110 (03) :499-504
[10]   The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery [J].
Kirkpatrick, John P. ;
Meyer, Jeffrey J. ;
Marks, Lawrence B. .
SEMINARS IN RADIATION ONCOLOGY, 2008, 18 (04) :240-243