文章：

在考虑对转移性非小细胞肺癌进行局部消融治疗前，等待一线系统治疗反应评估的影响

Impact of Waiting Response Evaluation to First-Line Systemic Therapy before Considering Local Ablative Therapy in Metastatic Non-Small-Cell Lung Cancer

原文发布日期：25 October 2023

DOI: 10.3390/cancers15215127

类型: Article

开放获取: 是

英文摘要：

Stereotactic radiotherapy (SRT) is gaining increasing importance in metastatic non-small-cell lung cancer (mNSCLC) management. The optimal sequence of tumor irradiation relative to systemic treatment remains unclear. If waiting response evaluation to first-line systemic therapy (FLST) before considering local treatment may allow for the exclusion of poorer prognosis progressive tumors that may not benefit from SRT, performing irradiation near immune check point inhibitor (ICI) first administration seems to improve their synergic effect. Herein, we aimed to determine whether delaying SRT after response evaluation to FLST would result in better prognosis. We compared overall survival (OS), progression-free survival (PFS), and time to first subsequent therapy (TFST) for 50 patients locally treated before or within 90 days of initiating FLST (early SRT), with 49 patients treated at least 90 days after initiating FLST (late SRT). Patients treated with conventional chemotherapy alone exhibited significantly poorer median OS, PFS, and TFST in the early SRT arm: (in months) 16.5 [8.33-NR] vs. 58.3 [35.05-NR] (p= 0.0015); 4.69 [3.57–8.98] vs. 8.20 [6.66–12.00] (p= 0.017); and 6.26 [4.82–11.8] vs. 10.0 [7.44–21.8] (p= 0.0074), respectively. Patient receiving ICI showed no difference in OS (NR [25.2-NR] vs. 36.6 [35.1-NR],p= 0.79), PFS (7.54 [6.23-NR] vs. 4.07 [2.52-NR],p= 0.19), and TFST (13.7 [9.48-NR] vs. 10.3 [3.54-NR],p= 0.49). These results suggest that delaying SRT treatment in order to filter a rapidly growing tumor may be less necessary when ICI is administered in mNSCLC.

摘要翻译： 

立体定向放疗（SRT）在转移性非小细胞肺癌（mNSCLC）治疗中的重要性日益凸显。肿瘤放疗与全身治疗的最佳时序安排尚未明确。若等待一线全身治疗（FLST）的疗效评估后再考虑局部治疗，可筛除预后较差、可能无法从SRT中获益的进展性肿瘤；但若在首次使用免疫检查点抑制剂（ICI）期间进行放疗，似乎能增强协同效应。本研究旨在探讨在FLST疗效评估后延迟SRT是否能改善预后。我们比较了50例在FLST启动前或启动后90天内接受局部治疗（早期SRT组）与49例在FLST启动至少90天后接受治疗（晚期SRT组）患者的总生存期（OS）、无进展生存期（PFS）及首次后续治疗时间（TFST）。结果显示，在单纯接受传统化疗的患者中，早期SRT组的中位OS、PFS和TFST均显著较差（单位：月）：OS为16.5 [8.33-未达到] vs. 58.3 [35.05-未达到]（p=0.0015）；PFS为4.69 [3.57–8.98] vs. 8.20 [6.66–12.00]（p=0.017）；TFST为6.26 [4.82–11.8] vs. 10.0 [7.44–21.8]（p=0.0074）。而接受ICI治疗的患者在OS（未达到[25.2-未达到] vs. 36.6 [35.1-未达到]，p=0.79）、PFS（7.54 [6.23-未达到] vs. 4.07 [2.52-未达到]，p=0.19）及TFST（13.7 [9.48-未达到] vs. 10.3 [3.54-未达到]，p=0.49）方面均无显著差异。这些结果表明，当mNSCLC患者接受ICI治疗时，为筛选快速进展肿瘤而延迟SRT的必要性可能降低。

原文链接：

Impact of Waiting Response Evaluation to First-Line Systemic Therapy before Considering Local Ablative Therapy in Metastatic Non-Small-Cell Lung Cancer