Impact of radiation dose to the immune system on prognosis for peripheral early-stage NSCLC treated with stereotactic body radiation therapy
10.3760/cma.j.cn113030-20230807-00042
- VernacularTitle:预估免疫细胞受照剂量对周围型早期NSCLC患者预后的影响
- Author:
Meigui LI
1
;
Jiacheng LI
;
Xiaofeng WANG
;
Hui BAI
;
Zhiyong YUAN
;
Jun LIANG
Author Information
1. 天津医科大学肿瘤医院放疗科/国家肿瘤临床医学研究中心/天津市“肿瘤防治”重点实验室/天津市恶性肿瘤临床医学研究中心，天津 300060
- Keywords:
Carcinoma, non-small cell lung, early-stage;
Stereotactic body radiation therapy;
Radiotherapy dose;
Immune system;
Cancer-specific survival
- From:
Chinese Journal of Radiation Oncology
2024;33(5):405-412
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effects of radiation dose to the host immune system during radiotherapy on disease progression and survival in patients with peripheral early-stage non-small cell lung cancer (ES-NSCLC) receiving stereotactic body radiation therapy (SBRT).Methods:Clinical data of pathologically confirmed ES-NSCLC patients who were treated with SBRT at Tianjin Medical University Cancer Institute and Hospital between January 2007 and December 2020 were retrospectively analyzed. The prognostic significance of the estimated dose of radiation to immune cells (EDRIC) in ES-NSCLC patients undergoing SBRT was cited and validated. EDRIC was calculated using the model developed by Kong et al. and improved by Ladbury et al. Kaplan-Meier method and Cox proportional hazards regression were adopted to estimate cancer-specific survival (CSS), progression-free survival (PFS), local progression-free survival (LPFS), and distant metastasis-free survival (DMFS). Pearson's correlation was used to assess the correlation between variables. Results:The median prescription dose/fraction was 60 Gy/5 fractions (range: 48-60 Gy in 3-10 fractions). The median follow-up time was 52.17 (1.17-154.77) months. The median gross tumor volume (GTV) and EDRIC were 10.98 (0.91-120.34) cm 3 and 2.064 (0.426-6.015) Gy, respectively. Person's correlation analysis showed that GTV was positively correlated with EDRIC ( r=0.712, P<0.001). In multivariate analysis, EDRIC was an important prognostic variable of CSS and DMFS. Higher EDRIC was significantly associated with worse CSS ( HR=1.763, P=0.004) and DMFS ( HR=1.902, P=0.004). Compared to patients with EDRIC ≤ 1.56 Gy, those with EDRIC > 2.64 Gy and EDRIC between <2.06-2.64 Gy exhibited significantly lower CSS ( P<0.001, P=0.049). There were significant differences in DMFS among the groups divided by quartiles of EDRIC (compared to EDRIC ≤1.56 Gy, the P values were <0.001, 0.004, and 0.022 respectively). Conclusions:EDRIC is an important predictor of CSS and DMFS in ES-NSCLC patients treated with SBRT, suggesting that radiation dose to the immune system is a critical determinant of treatment outcomes. EDRIC can be used to quantify the effects of radiation therapy on the host immune system.
