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Cardiac Dose in Locally Advanced Lung Cancer: Results From a Statewide Consortium.

局部晚期肺癌的心脏剂量: 来自全州联盟的结果。

  • 影响因子:2.28
  • DOI:10.1016/j.prro.2019.07.013
  • 作者列表:"Dess RT","Sun Y","Muenz DG","Paximadis PA","Dominello MM","Grills IS","Kestin LL","Movsas B","Masi KJ","Matuszak MM","Radawski JD","Moran JM","Pierce LJ","Hayman JA","Schipper MJ","Jolly S","Michigan Radiation Oncology Quality Consortium.
  • 发表时间:2020-01-01
Abstract

PURPOSE:The heart has been identified as a potential significant organ at risk in patients with locally advanced non-small cell lung cancer treated with radiation. Practice patterns and radiation dose delivered to the heart in routine practice in academic and community settings are unknown. METHODS AND MATERIALS:Between 2012 and 2017, 746 patients with stage III non-small cell lung cancer were treated with radiation within the statewide Michigan Radiation Oncology Quality Consortium (MROQC). Cardiac radiation dose was characterized, including mean and those exceeding historical or recently proposed Radiation Therapy Oncology Group and NRG Oncology constraints. Sites were surveyed to determine dose constraints used in practice. Patient-, anatomic-, and treatment-related associations with cardiac dose were analyzed using multivariable regression analysis and inverse probability weighting. RESULTS:Thirty-eight percent of patients had a left-sided primary, and 80% had N2 or N3 disease. Median prescription was 60 Gy (interquartile range, 60-66 Gy). Twenty-two percent of patients were prescribed 60 Gy in 2012, which increased to 62% by 2017 (P < .001). Median mean heart dose was 12 Gy (interquartile range, 5-19 Gy). The volume receiving 30 Gy (V30 Gy) exceeded 50% in 5% of patients, and V40 Gy was >35% in 3% of cases. No heart dose constraint was uniformly applied. Intensity modulated radiation therapy (IMRT) usage increased from 33% in 2012 to 86% in 2017 (P < .001) and was significantly associated with more complex cases (larger planning target volume, higher stage, and preexisting cardiac disease). In multivariable regression analysis, IMRT was associated with a lower percent of the heart receiving V30 Gy (absolute reduction = 3.0%; 95% confidence interval, 0.5%-5.4%) and V50 Gy (absolute reduction = 3.6%; 95% confidence interval, 2.4%-4.8%) but not mean dose. In inverse probability weighting analysis, IMRT was associated with 29% to 48% relative reduction in percent of the heart receiving V40-V60 Gy without increasing lung or esophageal dose or compromising planning target volume coverage. CONCLUSIONS:Within MROQC, historical cardiac constraints were met in most cases, yet 1 in 4 patients received a mean heart dose exceeding 20 Gy. Future work is required to standardize heart dose constraints and to develop treatment approaches that allow for constraints to be met without compromising other planning goals.

摘要

目的: 在接受放射治疗的局部晚期非小细胞肺癌患者中,心脏已被确定为潜在的重要危险器官。在学术和社区环境中的常规实践中,向心脏递送的实践模式和辐射剂量是未知的。 方法和材料: 在 2012 至 2017 之间,746 例III期非小细胞肺癌患者在全州密歇根放射肿瘤学质量联盟 (MROQC) 内接受放射治疗。对心脏放射剂量进行了表征,包括平均值和超过历史或最近提出的放射治疗肿瘤学组和NRG肿瘤学约束的那些。调查位点以确定在实践中使用的剂量限制。使用多变量回归分析和逆概率加权分析患者、解剖和治疗与心脏剂量的相关性。 结果: 38% 的患者有左侧原发性,80% 有N2 或N3 疾病。中位处方为 60 Gy (四分位距,60-66 Gy)。2012 年,22% 的患者接受了 60 Gy的处方,到 2017 年,这一比例增加到 62% (P <.001)。平均心脏剂量中位数为 12 Gy (四分位距,5-19 Gy)。50% 的患者接受 30 gy (v30gy) 的体积超过 5%,35% 的患者v40gy> 3%。没有均匀地施加心脏剂量约束。调强放射治疗 (IMRT) 使用率从 2012 年的 33% 增加到 2017 年的 86% (P <.001),并且与更复杂的病例显著相关 (更大的计划目标量,更高的阶段,和预先存在的心脏疾病)。在多变量回归分析中,IMRT与接受V30 Gy的心脏百分比较低相关 (绝对降低 = 3.0%; 95% 置信区间,0.5%-5.4%) 和v50gy (绝对减少 = 3.6%; 95% 置信区间,2.4%-4.8%),但不是平均剂量。在逆概率加权分析中,IMRT与接受V40-V60 Gy的心脏百分比相对减少 29% 至 48% 相关,但不增加肺或食管剂量或影响计划目标体积覆盖。 结论: 在MROQC中,大多数病例都符合历史心脏限制,但每 4 例患者中就有 1 例接受了超过 20 gy的平均心脏剂量。未来的工作需要标准化心脏剂量限制,并开发治疗方法,允许在不损害其他规划目标的情况下满足限制。

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影响因子:6.93
发表时间:2020-01-15
DOI:10.1002/ijc.32532
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影响因子:6.93
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DOI:10.1002/ijc.32530
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肺肿瘤方向

肺肿瘤,又叫支气管肺癌,是常见的恶性肿瘤之一。肺肿瘤的治疗为包括手术、中药、放疗、化疗及免疫等多学科的综合治疗。

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