Lancet Oncol:只放疗不手术,IA期NSCLC患者的生存预后完全不输肺叶切除+淋巴结清扫!

2021-09-16 Nebula MedSci原创

可手术治疗的 IA 期 NSCLC 患者采用立体定向消融放疗后的长期生存率不劣于胸腔镜肺叶切除+纵膈淋巴结清扫术

既往一项 STARS 和 ROSEL 试验的汇总分析报道,早期非小细胞肺癌(NSCLC)采用立体定向消融放疗(SABR)治疗的生存预后优于手术治疗,但该分析存在明显的局限性。

本研究报告了修正的 STARS 试验的长期随访结果,在该试验中,SABR 组重新积累了更大的样本量,并采用了前瞻性注册的协议指定的倾向性匹配比较,还纳入了接受视频辅助的胸腔镜肺叶切除术和纵膈淋巴结清扫术(VATS L-MLND)的当代机构队列。

受试患者为年满 18 岁的、Zubrod 表现状态 0-2 分、组织学确诊的、新诊断的 N0M0期 NSCLC 患者(鳞癌、腺癌、大细胞癌或未明确具体分类的 NSCLC),且要求肿瘤直径≤ 3 cm。该试验未纳入之前汇总分析中的患者。SABR 剂量为 54 Gy(分 3 次,用于周围型病灶)或 50 Gy(分 4 次,用于中央型病灶,同时对大体肿瘤进行综合强化,总计 60 Gy)。主要终点是 3 年总生存期。

接受SABR或VATS L-MLND治疗的患者的OS(A)和PFS(B)

2015 年 9月 1 日至 2017 年 1 月 31 日,共招募了 80 位患者,均被纳入了疗效和安全性分析。中位随访了 5.1 年(范围 3.9-5.8 年)。3 年总生存率为 91%(95% CI 85-98),5 年总生存率为 87%(79-85)。

倾向性匹配的 VATS-MLND 队列的 3 年和 5 年总生存率分别是 91%(95% CI 85-98)和 84%(76-93)。由于 SABR 后的 3 年总生存率不低于在 VATS L-MLND 组中观察到的生存率,因此 SABR 治疗早期 NSCLC 的效果不劣于 VATS L-MLND。最后,在多变量分析中,两个患者队列之间的总生存期没有显著差异(风险比 0.86,p=0.65)。

SABR 的耐受性良好,未发生 4-5 级的毒性反应,仅发生了 3 例 2-3 级的不良反应:3 级呼吸困难、2 级肺炎和 2 级肺纤维化(各一例)。未报道严重不良反应。

综上所述,可手术治疗的 IA 期 NSCLC 患者采用立体定向消融放疗后的长期生存率不劣于胸腔镜肺叶切除+纵膈淋巴结清扫术

原始出处:

Joe Y Chang, et al. Stereotactic ablative radiotherapy for operable stage I non-small-cell lung cancer (revised STARS): long-term results of a single-arm, prospective trial with prespecified comparison to surgery. The Lancet Oncology. September 13, 2021. https://doi.org/10.1016/S1470-2045(21)00401-0

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    2022-07-22 jklm09
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    2022-08-03 howi
  4. 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  5. 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  6. 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  7. 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  8. 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  9. 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    2021-09-16 ms9000000195591334

    学习了#学习#

    0

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