机构：[1]Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China[2]Shandong Academy of Medical Sciences, Jinan, Shandong, China[3]Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China四川省人民医院四川省肿瘤医院[4]Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland[5]Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China浙江省肿瘤医院[6]Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China河南省肿瘤医院[7]Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China[8]Department of Oncology, Tengzhou Central People’s Hospital, Tengzhou, Shandong, China[9]Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China[10]Department of Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China[11]School of Medicine and Life Sciences, University of Jinan- Shandong Academy of Medical Sciences, Jinan, Shandong, China[12]Shandong University, Jinan, Shandong, China[13]Department of Oncology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, China[14]Department of Radiation Oncology, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China[15]Department of Radiation Oncology, Case Western Reserve University, Cleveland, Ohio
IMPORTANCE Although thoracic twice-daily radiotherapy (TDRT) is one of the standards of care for small cell lung cancer, its association with brain metastases remains unknown. OBJECTIVE To investigate the association of TDRT vs once-daily radiotherapy (ODRT) with brain metastases after prophylactic cranial irradiation in patients with small cell lung cancer. DESIGN, SETTING, AND PARTICIPANTS In this multicenter cohort study, data on 778 consecutive patients with small cell lung cancer who had undergone thoracic radiotherapy (609 received ODRT and 169 received TDRT), chemotherapy, and prophylactic cranial irradiation were retrieved from the databases of 8 hospitals in China between July 1, 2003, and June 30, 2016. A 1: 1 propensity score matching approach was used to control for confounding between the ODRT and TDRT groups. Confounding covariates included 8 demographic variables and 8 treatment-related covariates. Data analysis was conducted from November 1, 2017, to May 31, 2018, and reanalyzed for revision. EXPOSURES The ODRT group received 50 to 66 Gy given in 25 to 33 fractions. The TDRT group received 45 Gy given in 30 fractions. MAIN OUTCOMES AND MEASURES The primary end point was brain metastases. Secondary end points included progression-free survival and overall survival. RESULTS Of the 778 patients (median age, 55 years [interquartile range, 48-61 years]), 204 were women and 574 were men. At a median follow-up of 23.6 months (interquartile range, 14.2-38.2 months), 131 patients (16.8%) experienced brain metastases. The rate of brain metastasis at 3 years in the TDRT group was significantly higher than in the ODRT group (26.0% vs 16.9%; hazard ratio, 1.55; 95% CI, 1.06-2.26; P = .03). Of the 338 matched patients (169 in the ODRT group vs 169 in the TDRT group), 60 (17.8%) experienced brain metastases, with a rate at 3 years of 14.9% in the ODRT group vs 26.0% in the TDRT group (hazard ratio, 1.71; 95% CI, 1.02-2.88; P = .04). Progression-free survival was similar in both the whole cohort and the matched cohort. Median overall survival in the ODRT group tended to be significantly longer than in the TDRT group after matching (47.2 vs 32.8 months; hazard ratio, 1.41; 95% CI, 0.99-2.01; P = .06). CONCLUSIONS AND RELEVANCE In this study, patients with small cell lung cancer who received thoracic TDRT appeared to have a higher risk of brain metastases than those who received ODRT, which supports the need for further prospective randomized clinical trials, especially in China and other parts of Asia.
基金：
National Natural Science Foundation of ChinaNational Natural Science Foundation of China; Shandong Provincial Key Project of Translational Medicine
第一作者机构：[1]Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China[2]Shandong Academy of Medical Sciences, Jinan, Shandong, China
共同第一作者：
通讯作者：
通讯机构：[1]Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China[2]Shandong Academy of Medical Sciences, Jinan, Shandong, China[*1]Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, 440 Jiyan Rd, Jinan 250117, Shandong, China[*2]Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, 440 Jiyan Rd, Jinan 250117, Shandong, China
推荐引用方式(GB/T 7714)：
Zeng Haiyan,Li Rui,Hu Chen,et al.Association of Twice-Daily Radiotherapy With Subsequent Brain Metastases in Adults With Small Cell Lung Cancer[J].JAMA NETWORK OPEN.2019,2(5):doi:10.1001/jamanetworkopen.2019.0103.
APA：
Zeng, Haiyan,Li, Rui,Hu, Chen,Qiu, Guoqin,Ge, Hong...&Yuan, Shuanghu.(2019).Association of Twice-Daily Radiotherapy With Subsequent Brain Metastases in Adults With Small Cell Lung Cancer.JAMA NETWORK OPEN,2,(5)
MLA：
Zeng, Haiyan,et al."Association of Twice-Daily Radiotherapy With Subsequent Brain Metastases in Adults With Small Cell Lung Cancer".JAMA NETWORK OPEN 2..5(2019)
医学