elcc热点透视iii期nsclc同步放化疗中不同化疗方案对脑转移的发生并无影响

1、ELCC 热点III期NSCLC同步放化疗中不同化疗方案对脑转移的发生并无影响2016-04-15ioncology编者按：第六届欧洲肺癌大会（ELCC）发布了多项研究的结果，邀请了同济大学附属市肺科医院肿瘤科的教授和教授对一项研究壁报做出点评。第六届欧洲肺癌大会（ELCC）的一项回顾性研究显示，约10%的III期非小细胞肺癌患者在接受放化疗后1年内发生脑转移，而同步放化疗中不同的化疗方案对脑转移的发生并无影响摘要号115PD- Braetastases (BM) development after chemoradiation(CRT) for stage III non-small cel

2、l matter。g cancer (NSCLC): Does the type of chemotherapy研究共入组了838例患者，其中接受同步放化疗者为737例，接受序贯放化疗者为101例。研究者发现，11%的患者在1年内发生脑转移，其中5%的患者以脑转移为唯一的首次复发原因，年轻的、女性、肺患者更容易发生脑转移。接受同步放化疗患者1年内脑转移发生率为11%，而接受序贯放化疗的患者为10%，以脑转移为唯一的首次复发原因的患者分别为5%和4%，均无显著差别。研究者进一步对“同步放化疗中不同的化疗方案对脑转移的发生的影响”进行了探索分析（低剂量顺铂单药、VP-16联合顺铂方案、长春瑞滨联合

3、顺铂方案、多西紫杉醇联合顺铂方案）。结果发现，不同化疗方案之间，无论是第1年的脑转移发生率还是以脑转移为唯一的首次复发原因的比例，均无显著差别。同步放化疗是不可切除的III期非小细胞肺癌的标准治疗。多项Meta分析及III期临床研究均证实，与序贯放化疗相比，同步放化疗可显著改善患者的长期生存，同时局部控制更佳。但是，研究同样也显示，同步放化疗相对于序贯放化疗，在远处转移控制方面并无优势。在 Auperin等进行的meta分析中（J Clin Oncol. 2010 May 1;28(13):2181-90），接受同步放化疗的患者3年和5年远处转移发生率分别为40.6%和39.5%，而接受序贯放

4、化疗的患者为39.5%和39.1% （HR 1.04, 95% CI, 0.86-1.25, P=0.69），均无显著差别。同样，在Curran等进行的研究中（J NCancer Inst. 2011 Oct 5;103(19):1452-60），在序贯放化疗组，脑转移发生率为12%，而在同步放化疗组，脑转移发生率为14%和13%，同样无显著差别。因此，该项回顾性研究再次证实，同步放化疗相对于序贯放化疗，在远处转移（脑转移）控制方面并无优势。研究者同时对同步放化疗中不同的化疗方案对脑转移的发生的影响进行了探索分析，但发同的对的发，对哦 的 。OrtuarJMDB和JMEI研究的，了一，劌肺癌的

5、发（3.2% vs. 6.6%, OR 0.49, 95% CI, 0.32-0.76; P=.001），研究，了，结果一研究。 发的 PROCLAIM研究（J Clin Oncol. 2016 Mar 20;34(9):953-62），EP，攘（发的18.7% vs. 19.5%, P=0.893），一研究同同的对的发的 ，的。 摘要原文115PD- Brasmall celletastases (BM) development after chemoradiation (CRT) for stage III non-g cancer (NSCLC): Does the type of ch

6、emotherapy matter?Background：BM occur frequently within 1 year after CRT for stage III NSCLC. It is unknownwhether the specific chemotherapy used influensubsequent BM development.Methods：Retrospective multicenter study including all consecutive stage III NSCLC patients(pts) who completed CRT. Primar

7、y endpos: BM development withhe 1st year andwhether this was the only site ofrelapse. Differenbetn regimens were assessedwilogistic regresmincluding known BM risk factors (age, gender, histology, T-and N-sus) and the specific chemotherapy used (concurrent (cCRT) vs sequential (sCRT),within cCRT: low

8、 dose cisplatonotherapy (LDC) high dose polychemotherapy;(non-)taxane high dose polychemotherapy LDC; chemotherapy subgroups of 50 pts).Results：Betn January 2006 and June 2014, 838 pts were eligible (737 cCRT, 101 sCRT).11% developed BM within a year, 5% had BM as only site ofrelapse. BM pts weresig

9、nificantly younger (mean age 59 vs 63 years, p0.001), female (49% vs 35%, p=0.009), andhad adenocarcinoma histology (51% vs 37%, p0.001). 11% of cCRT and 10% of sCRT ptsdeveloped BM (p=0.834). For 5% and 4% respectively, this was the only site ofrelapse(p=0.724). In both high dose cCRT (N=346) and L

10、DC (N=391) BM were found in 11% withinone year of stage III NSCLC diagnosis (p=0.927). In 4% and 5%, respectively, BM were the onlysite ofrelapse (p=0.399).The chemotherapy used (cCRT versus sCRT) had no influence on BM development, not withinone year nor as only site ofrelapse (OR 0.87 (p=0.695) an

11、d OR 0.89 (p=0.838),respectively). LDC versus high dose cCRT was not significantly different: neither within oneyear nor as only site ofrelapse (OR 0.96 (p=0.861) and OR 1.36 (p=0.404), respectively).Comparable results were found for LDC versus high dose non-taxane (N=277) and high dosetaxane regimens (N=69) and for cCRT regimens with 50 patients (LDC versuscisplatin/etoide (N=188), cisplatin/vinorelbin (N=65),kly cisplat