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[WCLC访谈]CONVERT试验:同期放化疗适合老年局限期小细胞肺癌患者

作者:肿瘤瞭望   日期:2016/12/13 20:17:22  浏览量:27860

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在第17届世界肺癌大会专场(WCLC 2016)的小细胞肺癌治疗进展OA05口头报告专场,克里斯蒂NHS信托基金会(The Christie NHS FoundationTrust, UK)的Marianna Christodoulou报告了CONVERT研究中老年患者的研究结果

  在第17届世界肺癌大会专场(WCLC 2016)的小细胞肺癌治疗进展OA05口头报告专场,克里斯蒂NHS信托基金(The Christie NHS FoundationTrust, UK)的Marianna Christodoulou报告了CONVERT研究中老年患者的研究结果[OA05.06: Compliance and Outcome of Elderly Patients Treated in the Concurrent Once–Daily versus Twice–Daily RadioTherapy (CONVERT) Trial]。她在本次会议上还获得了奖项(Heine H. Hansen Lectureship Award)。
 
  Marianna Christodoulou在《肿瘤瞭望》的采访中介绍了这项报告的主要内容:
 
  肺癌是全球癌症死亡的主要原因。小细胞肺癌更具侵袭性,患者预后非常差。 CONVERT研究是一项针对PS评分良好的局限期小细胞肺癌(LS-SCLC)同期放化疗(cCTRT)的全球随机对照试验,一组接受胸部放疗每日两次(BD, 45Gy/30f/19d),另一组接受胸部放疗每日一次(OD,66Gy/33f/45d)。
 
  在我报告的这项研究中,我们观察了CONVERT研究中老年患者的治疗结果。这是一个非常重要的问题,临床上老年小细胞肺癌患者占很大比例,但是指导老年患者治疗的研究证据还严重不足。这项研究显示,在CONVERT试验研究中,老年患者同期放化疗的结果可与年轻患者相媲美,意味着我们可以在临床用这种方案治疗老年患者。我们需要仔细选择适合同期放化疗的患者。当然,对于适合的老年患者,这种治疗已被证明是安全和有效的。我们需要进一步研究那些不适合的患者会怎么样。现在非常需要专门针对老年小细胞肺癌患者的研究。
 
  这项研究结果鼓舞人心,我们向前迈进了一步。在英国曼彻斯特的克里斯蒂医院(Christie Hospital),Corinne Faivre-Finn 教授主导了 CONVERT试验,我们计划针对大样本的老年小细胞肺癌患者开展研究。
 
Compliance and Outcome of Elderly Patients Treated in the Concurrent Once–Daily versus Twice–Daily RadioTherapy (CONVERT) Trial
 
Background: A significant proportion of limited-stage small cell lung cancer are elderly. However, there is paucity of data on the efficacy and safety of concurrent chemo-radiotherapy in the elderly to guide treatment decisionmaking.
 
Methods: Data from the CONVERT trial was retrospectively analysed to compare the outcome of patients 70 years or older to patients younger than 70 years. Patients were randomised 1:1 to receive 45Gy in 30 twice-daily fractions over 3 weeks or 66Gy in 33 once-daily fractions over 6.5 weeks starting on day 22 of cycle 1 chemotherapy (4 to 6 cycles of Cisplatin 25mg/ m2 days 1-3 or 75mg/m2 day 1 with Etoposide 100mg/m2 days 1-3), followed by Prophylactic Cranial Irradiation if indicated. Radiotherapy planning was with a 3D conformal technique or intensity modulated radiotherapy.
 
Results: Of 547 patients randomised between April 2008 and November 2013, 57 patients were excluded for the purposes of this analysis as they did not receive concurrent chemo-radiotherapy. Of the 490 included patients, 67 (13.7%) were age 70 years or older with median age of 73 years (70-82). Patients’ characteristics were well balanced apart from more male in the elderly group (p=0.02). There was no significant difference in the number of chemotherapy cycles administered in the two groups (p=0.24). A higher proportion of patients received 30 or 33 fractions of radiotherapy as per protocol in the younger group (85% vs. 73%; p=0.03). Neutropenia grade 3/4 occurred more frequently in the elderly group (84% vs. 70%; p=0.02) but there was no statistically significant difference in neutropenic sepsis (4% vs. 7%; p=0.07) and non-haematological acute/late toxicities. There were two vs. six treatment-related deaths in the elderly and younger group respectively (p=0.67). At median follow up of 46 months for those alive; two-year survival was 53% (95% CI 41-64) vs. 57% (95% CI 52-61), median survival was 29 months vs. 30 months in the elderly vs. younger group respectively. Hazard ratios for overall survival and progression free survival were 1.15 (95% CI 0.84-1.59; logrank p=0.38) and 1.04 (95% CI 0.76-1.41; log-rank p=0.81) respectively. In the elderly group median survival was not significantly different in patients who received once vs. twice daily radiotherapy (p=0.91).
 
Conclusion: Radiotherapy treatment delivery was higher in the younger group but toxicity and survival rates were similar in elderly compared to younger patients. Concurrent chemo-radiotherapy with modern radiotherapy techniques is a treatment option for elderly patients with good performance status.

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CONVERT试验同期化放疗同时化放疗局限期小细胞肺癌小细胞肺癌治疗

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