广泛期SCLC一线化学免疫联合治疗后放疗的疗效及不良反应

Efficacy and toxicity analysis of thoracic radiotherapy for extensive-stage small cell lung cancer patients after first-line chemoimmunotherapy

目的探索一线化学、免疫联合治疗背景下,胸部放疗(TRT)用于广泛期小细胞肺癌(ES-SCLC)的安全性及疗效。方法回顾性分析2018年1月至2021年12月中国医学科学院肿瘤医院收治的56例一线含铂化疗联合免疫治疗后接受胸部放疗的ES-SCLC患者的病历资料。因临床实际原因,未设置对照组。通过Kaplan-Meier法计算总生存(OS)、无进展生存(PFS)及无局部复发生存(LRFS),采用Cox比例风险回归模型进行预后的单因素及多因素分析,利用Fine-Grey竞争风险模型计算累积局部复发(LRR)率。结果在56例患者中,47例在疾病进展前接受了巩固TRT,9例在疾病进展后接受了挽救TRT,全组患者的中位随访时间为21个月(95%CI为19.8~22.2个月),中位生存期未达到,中位PFS期为9个月(95%CI为7.0~13.0个月),1年、18个月OS率分别为84.9%、62.1%。其中,巩固TRT组的1年、18个月OS率分别为84.1%,64.5%,中位PFS期达到10个月;1年、18个月LRFS率分别为73.6%、66.0%;1、2年累积LRR率分别为24.9%、30.8%。全组除6例患者出现了4级血液学不良反应外,未见其他4-5级不良事件(AE)。3例(5%)患者出现3级放射性食管炎;10例(18%)患者出现1-2级治疗相关肺炎,其中5例(9%)免疫相关肺炎、5例(9%)放射性肺炎。结论一线化学、免疫治疗联合TRT在ES-SCLC患者中具有良好的安全性,可能有潜在的生存获益。

ObjectiveTo evaluate the safety and efficacy of thoracic radiotherapy(TRT)for extensive-stage small cell lung cancer(ES-SCLC)patients in the era of first-line chemoimmunotherapy.MethodsMedical records of 56 patients with ES-SCLC who received thoracic radiotherapy after first-line platinum-based chemotherapy plus immunotherapy in Cancer Hospital Chinese Academy of Medical Sciences from January 2018 to December 2021 were retrospectively analyzed.The control group was not established for clinical causes.The overall survival(OS),progression-free survival(PFS)and local recurrence-free survival(LRFS)were calculated using the Kaplan-Meier method.Univariate and multivariate analyses were employed to identify prognostic factors using the Cox proportional hazards model.The cumulative incidence of local regional recurrence(LRR)was estimated using the Fine-Grey competing risks regression model.ResultsAmong 56 patients in our cohort,47 patients received consolidative TRT(cTRT)before progression and 9 patients received salvage TRT after progression.The median follow-up time was 21 months(95%CI=19.8-22.2 months),the median OS was not reached,the median PFS was 9 months(95%CI=7.0-13.0 months),and the 1-year and 18-month OS rates were 84.9%,62.1%.In the cTRT group,the 1-year and 18-month OS rates were 84.1%,64.5%,with the median PFS of 10 months;1-year and 18-month LRFS rates were 73.6%and 66.0%,respectively;the cumulative incidence of LRR at 1-year and 2-year were 24.9%and 30.8%,respectively.No other 4-5 grade adverse events(AE)were reported except 6 patients presenting with 4 grade hematologic toxicities.Three grade radiation esophagitis occurred in 3 patients(5%).Ten patients(18%)developed 1-2 grade treatment-related pneumonitis,including 5(9%)patients with immune related pneumonitis and 5(9%)patients with radiation pneumonitis.ConclusionThe application of TRT after first-line chemoimmunotherapy is safe and may has potential survival benefit for patients with ES-SCLC.