A comparison between accelerated hypofractionation and stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer (NSCLC): Results of a propensity score-matched analysis

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• 作者：Andrew Chiang^a ; Isabelle Thibault^b ; Andrew Warner^c ; George Rodrigues^c ; David Palma^c ; Hany Soliman^a ; Suneil Jain^d ; Ian Poon^a ; Patrick Cheung^a ; ^{patrick.cheung@sunnybrook.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Accelerated hypofractionation ; Stereotactic radiotherapy ; Lung cancer
• 刊名：Radiotherapy and Oncology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：118
• 期：3
• 页码：478-484
• 全文大小：673 K

文摘

Stereotactic ablative radiotherapy (SABR) has become standard for inoperable early-stage non-small cell lung cancer (NSCLC). However, there is no randomized evidence demonstrating benefit over more fractionated radiotherapy. We compared accelerated hypofractionation (AH) and SABR using a propensity score-matched analysis.

Materials and methods

From 1997–2007, 119 patients (T1–3N0M0 NSCLC) were treated with AH (48–60 Gy, 12–15 fractions). Prior to SABR, this represented our institutional standard. From 2008–2012, 192 patients (T1–3N0M0 NSCLC) were treated with SABR (48–52 Gy, 4–5 fractions). A total of 114 patients (57 per cohort) were matched (1:1 ratio, caliper: 0.10) using propensity scores.

Results

Median follow-up (range) for the AH cohort was 36.3 (2.5–109.1) months, while that for the SABR group was 32.5 (0.3–62.6) months. Three-year overall survival (OS) and local control (LC) rates were 49.5% vs. 72.4% [p = 0.024; hazard ratio (HR): 2.33 (1.28, 4.23), p = 0.006] and 71.9% vs. 89.3% [p = 0.077; HR: 5.56 (1.53, 20.2), p = 0.009], respectively. On multivariable analysis, tumour diameter and PET staging were predictive for OS, while the only predictive factor for LC was treatment cohort.

Conclusions

OS and LC were improved with SABR, although OS is more closely related to non-treatment factors. This represents one of the few studies comparing AH to SABR for early-stage lung cancer.