Impact of mediastinal tumor burden and lymphatic spread in locally advanced non-small-cell lung cancer: A secondary analysis of the multicenter randomized PET-Plan trial

IF 4.9 1区 医学 Q1 ONCOLOGY Radiotherapy and Oncology Pub Date : 2024-09-03 DOI:10.1016/j.radonc.2024.110521
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引用次数: 0

Abstract

Purpose

The aim of this secondary analysis of the prospective randomized phase 2 PET-Plan trial (ARO-2009-09; NCT00697333) was to evaluate the impact of mediastinal tumor burden and lymphatic spread in patients with locally advanced non-small-cell lung cancer (NSCLC).

Methods

All patients treated per protocol (n = 172) were included. Patients received isotoxically dose-escalated chemoradiotherapy up to a total dose of 60–74 Gy in 30–37 fractions, aiming as high as possible while adhering to normal tissue constraints. Radiation treatment (RT) planning was based on an 18F-FDG PET/CT targeting all lymph node (LN) stations containing CT positive LNs (i.e. short axis diameter > 10 mm), even if PET-negative (arm A) or targeting only LN stations containing PET-positive nodes (arm B). LN stations were classified into echelon 1 (ipsilateral hilum), 2 (ipsilateral station 4 and 7), and 3 (rest of the mediastinum, contralateral hilum). The endpoints were overall survival (OS), progression-free survival (PFS), and freedom from local progression (FFLP).

Results

The median follow-up time (95 % confidence interval [CI]) was 41.1 (33.8 − 50.4) months. Patients with a high absolute number of PET-positive LN stations had worse OS (hazard ratio [HR] = 1.09; 95 % CI 0.99 − 1.18; p = 0.05) and PFS (HR = 1.12; 95 % CI 1.04 − 1.20; p = 0.003), irrespective of treatment arm allocation. The prescribed RT dose to the LNs did not correlate with any of the endpoints when considering all patients. However, in patients in arm B (i.e., PET-based selective nodal irradiation), prescribed RT dose to each LN station correlated significantly with FFLP (HR=0.45; 95 % CI 0.24–0.85; p = 0.01). Furthermore, patients with involvement of echelon 3 LN stations had worse PFS (HR = 2.22; 95 % CI 1.16–4.28; p = 0.02), also irrespective of allocation.

Conclusion

Mediastinal tumor burden and lymphatic involvement patterns influence outcome in patients treated with definitive chemoradiotherapy for locally advanced NSCLC. Higher dose to LNs did not improve OS, but did improve FFLP in patients treated with PET-based dose-escalated RT.

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纵隔肿瘤负荷和淋巴扩散对局部晚期非小细胞肺癌的影响:多中心随机 PET-Plan 试验的二次分析。
目的:这项对前瞻性随机 2 期 PET-Plan 试验(ARO-2009-09;NCT00697333)的二次分析旨在评估纵隔肿瘤负荷和淋巴扩散对局部晚期非小细胞肺癌(NSCLC)患者的影响:方法:纳入所有按方案接受治疗的患者(n = 172)。患者接受等毒性剂量递增的化放疗,总剂量为60-74 Gy,分30-37次进行,在遵守正常组织限制的前提下尽量提高剂量。放射治疗(RT)计划以18F-FDG PET/CT为基础,靶向所有含有CT阳性淋巴结(即短轴直径大于10毫米)的淋巴结站,即使PET阴性(A组)或仅靶向含有PET阳性淋巴结的淋巴结站(B组)。LN站被分为第1梯队(同侧腹股沟)、第2梯队(同侧第4和第7站)和第3梯队(纵隔其余部分、对侧腹股沟)。终点为总生存期(OS)、无进展生存期(PFS)和无局部进展(FFLP):中位随访时间(95% 置信区间 [CI])为 41.1 (33.8 - 50.4) 个月。PET阳性LN站绝对数量较多的患者的OS(危险比[HR] = 1.09; 95 % CI 0.99 - 1.18; p = 0.05)和PFS(HR = 1.12; 95 % CI 1.04 - 1.20; p = 0.003)较差,与治疗臂的分配无关。考虑到所有患者,对淋巴结的规定 RT 剂量与任何终点均无相关性。但是,在B组(即基于PET的选择性结节照射)患者中,每个LN站的处方RT剂量与FFLP显著相关(HR=0.45;95 % CI 0.24-0.85;p = 0.01)。此外,第3梯队LN站受累的患者PFS较差(HR = 2.22; 95 % CI 1.16-4.28; p = 0.02),这也与分配无关:结论:纵隔肿瘤负荷和淋巴受累模式会影响局部晚期NSCLC明确化放疗患者的预后。在接受基于 PET 的剂量递增 RT 治疗的患者中,增加淋巴结的剂量并不能改善 OS,但却能改善 FFLP。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Radiotherapy and Oncology
Radiotherapy and Oncology 医学-核医学
CiteScore
10.30
自引率
10.50%
发文量
2445
审稿时长
45 days
期刊介绍: Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
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