周一“星”视角|SBRT与CRT治疗无法手术的Ⅰ期NSCLC：3期随机临床试验；评估ChatGPT作为肺癌手术常见问题的患者资源

Anand Swaminath1, Sameer Parpia2, Marcin Wierzbicki3, Vijayananda Kundapur4, Sergio Faria5, Gordon S Okawara1, Theodoros K Tsakiridis1, Naseer Ahmed6, Alexis Bujold7, Khalid Hirmiz8, Timothy Owen9, Nelson Leong10, Kevin Ramchandar11, Edith Filion12, Harold Lau13, Zsolt Gabos14, Robert Thompson15, Brian Yaremko16, Selma Mehiri17, Alexander V Louie18, Kimmen Quan1, Mark N Levine2, James R Wright1, Timothy J Whelan1

1 Department of Oncology, McMaster University, and the Division of Radiation Oncology Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada.

2 Department of Oncology, McMaster University, Hamilton, Ontario, Canada.

3 Juravinski Cancer Centre, Department of Medical Physics, McMaster University, Hamilton, Ontario, Canada.

4 Saskatchewan Cancer Agency, Department of Radiation Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

5 Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.

6 Section of Radiation Oncology, Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba and CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.

7 Département de Radio-oncologie Clinique-Enseignement-Recherche, Centre intégré universitaire de soins et services sociaux de l'Est-de-l'Île-de-Montréal - Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.

8 Department of Radiation Oncology, Windsor Regional Cancer Centre, Windsor, Ontario, Canada.

9 Department of Oncology, Queen's University, Cancer Centre of Southeast Ontario at Kingston Health Sciences Centre, Kingston, Ontario, Canada.

10 Allan Blair Cancer Centre, Department of Radiation Oncology, University of Saskatchewan, Regina, Saskatchewan, Canada.

11 Department of Oncology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.

12 Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Notre Dame Hospital, Montreal, Quebec, Canada.

13 Department of Oncology, University of Calgary, Calgary, Alberta, Canada.

14 Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.

15 Department of Radiation Oncology, Dalhousie University, Saint John, New Brunswick, Canada.

16 Department of Radiation Oncology, Western University, London, Ontario, Canada.

17 Département de Radio-oncologie, CISSS Montérégie, Hôpital Charles Lemoyne, Montreal, Quebec, Canada.

18 Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.

Objective: 

To examine whether stereotactic body radiotherapy (SBRT) would improve local control (LC) compared with hypofractionated conventional radiotherapy (CRT).

Methods: 

This phase 3 randomized clinical trial (RCT) was conducted in 16 Canadian centers. Patients with medically inoperable stage I (≤5 cm) NSCLC were randomized 2:1 to SBRT of 48 Gy in 4 fractions (peripheral NSCLC) or 60 Gy in 8 fractions (central NSCLC) vs CRT of 60 Gy in 15 fractions. Data were collected from May 2014 to January 2020, and data were analyzed from July 2022 to July 2023. The primary objective was to determine the effectiveness of SBRT compared with CRT based on LC at 3 years. Secondary outcomes included event-free survival, overall survival, and toxic effects. All radiation plans were subject to real-time/final review. Local failures were centrally adjudicated. The study was designed to detect a 3-year LC improvement of SBRT from 75% to 87.5%. The target sample size was 324 patients.

Results: 

Of 233 included patients, 119 (51.1%) were male, and the mean (SD) age was 75.4 (7.7) years; the median (IQR) follow-up was 36.1 (26.4-52.8) months. A total of 154 patients received SBRT and 79 received CRT. The 3-year LC was 87.6% (95% CI, 81.9%-93.4%) for SBRT and 81.2% (95% CI, 71.9%-90.5%) for CRT (hazard ratio [HR], 0.61; 95% CI, 0.31-1.20; P = 0.15). The HR was 1.02 (95% CI, 0.72-1.45; P = 0.87) for event-free survival and 1.18 (95% CI, 0.80-1.76; P = 0.40) for overall survival. Minimal acute toxic effects were observed. Among those randomized to SBRT, late grade 3 or 4 toxic effects occurred in 5 of 45 (11%) with central NSCLC and 2 of 109 (1.8%) with peripheral NSCLC; among those randomized to CRT, in 1 of 19 (5%) with central NSCLC and 1 of 60 (2%) with peripheral NSCLC. One patient who received SBRT for an ultracentral lesion (target overlapping proximal bronchus) experienced a possible treatment-related grade 5 event (hemoptysis).

Conclusion: 

This RCT compared lung SBRT with hypofractionated CRT that included central/ultracentral tumors. No difference was detected in LC between groups. Severe toxic effects were limited, including patients with central tumors. The trial provides important prospective data evaluating SBRT; however, further research is necessary to determine if SBRT is more effective than CRT for peripheral and central NSCLC.

[CITATION]: Swaminath A, Parpia S, Wierzbicki M, et al. Stereotactic vs Hypofractionated Radiotherapy for Inoperable Stage I Non-Small Cell Lung Cancer: The LUSTRE Phase 3 Randomized Clinical Trial. JAMA Oncol. 2024 Sep 19:e243089.

[DOI]: 10.1001/jamaoncol.2024.3089

[IF]: 22.5