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Optimal adjuvant radiotherapy dose for stage I, II or III Merkel cell carcinoma: an analysis of the National Cancer Database.

I、II或III期Merkel细胞癌的最佳辅助放疗剂量: 国家癌症数据库分析。

  • 影响因子:2.04
  • DOI:10.1093/jjco/hyz153
  • 作者列表:"Yusuf M","Gaskins J","Wall W","Tennant P","Bumpous J","Dunlap N
  • 发表时间:2020-02-17
Abstract

BACKGROUND:We performed an analysis of the National Cancer Database to determine optimal doses of conventionally-fractionated adjuvant radiotherapy for patients with stage I/II or III Merkel cell carcinoma. METHODS:The cohort included 2735 patients with resected Merkel cell carcinoma of the head and neck, trunk or extremities receiving radiotherapy. Exclusion criteria included doses of radiotherapy <30 or >80 Gy, or dose per fraction >200 or <180 cGy. Recursive partitioning analysis and spline models were used to select dose thresholds. Multivariable Cox regression was performed to validate thresholds with respect to overall survival. RESULTS:Recursive partitioning analysis models defined a threshold of 57 Gy for stage I/II Merkel cell carcinoma, above which 3-year overall survival rate was decreased (P < 0.0001). The 3-year overall survival rate for patients receiving 50.0-57.0 Gy (81.2%) was greater compared to doses of 30.0-49.9 Gy (75.3%) or >57.0 Gy (70%, P < 0.0001). Doses > 57.0 Gy were associated with an increased hazard of death (1.31, confidence interval 1.07-1.60) with respect to doses of 50.0-57.0 Gy. Doses < 50.0 Gy for stage III Merkel cell carcinoma were associated with worsened 3-year overall survival (P < 0.0001) and increased hazard of death (2.01, confidence interval 1.43-2.82) with respect to doses between 50.0 and 57.0 Gy. CONCLUSIONS:Our results support doses of 50-57 Gy for most patients with stage I/II Merkel cell carcinoma receiving conventionally-fractionated adjuvant radiotherapy. In contrast to a prior National Cancer Database analysis, our results suggest doses ≥ 50 Gy should be strongly considered for patients with stage III Merkel cell carcinoma regardless of anatomic subsite.

摘要

背景: 我们对国家癌症数据库进行了分析,以确定I/II期或III期Merkel细胞癌患者常规分割辅助放疗的最佳剂量。 方法: 队列包括 2735 例切除的头颈部、躯干或四肢Merkel细胞癌接受放疗的患者。排除标准包括放疗剂量 <30 或> 80 Gy,或每部分剂量> 200 或 <180 cGy。采用递归分区分析和样条模型选择剂量阈值。进行多变量Cox回归以验证总生存期的阈值。 结果: 递归分区分析模型定义了I/II期Merkel细胞癌的阈值为 57 Gy,超过此阈值,3 年总生存率降低 (P <0.0001)。接受 50.0-57.0 Gy (81.2%) 的患者的 3 年总生存率高于 30.0-49.9 Gy (75.3%) 或> 57.0 Gy (70%,P <0.0001)。剂量> 57.0 Gy与 1.31-1.07 Gy剂量相比,死亡风险增加 (1.60,置信区间 50.0-57.0)。剂量 <50.0 Gy的III期Merkel细胞癌与恶化的 3 年总生存率 (P < 0.0001) 和死亡风险增加相关 (2.01,置信区间 1.43-2.82) 关于 50.0 和 57.0 Gy之间的剂量。 结论: 我们的结果支持大多数接受常规分割辅助放疗的I/II期Merkel细胞癌患者 50-57 Gy的剂量。与之前的国家癌症数据库分析相反,我们的结果表明,对于III期Merkel细胞癌患者,无论解剖部位如何,都应强烈考虑剂量 ≥ 50 Gy。

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皮肤肿瘤方向

皮肤肿瘤是发生在皮肤的细胞增生性疾病,是一种常见病。发生于皮内或皮下组织的新生物,种类很多,临床上分良性肿瘤和恶性肿瘤。恶性肿瘤可以不断增殖,引起转移,威胁生命,称为皮肤癌。

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