非小细胞肺癌的质子对光子放射疗法:来自系统性审查和元分析的最新证据
Chiung-Chen Fang1, Wen-Cheng Chen1, Ming-Shao Tsai2
1Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Chang Gung University, No. 6, Chia-Pu Rd., Chiayi 613, Taiwan.
Cancers
|February 13, 2026
概括
质子束疗法 (PBT) 与非小细胞肺癌 (NSCLC) 的光子辐射疗法没有长期生存优势. 然而,PBT可能会改善早期生存率,可能通过降低NSCLC患者急性治疗死亡率.
科学领域:
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
- 胸部瘤学 胸部瘤学
背景情况:
- 质子束疗法 (PBT) 与非小细胞肺癌 (NSCLC) 的光子辐射疗法相比,具有剂量学优势.
- 对PBT与NSCLC光子放射治疗对生存益处的比较临床证据仍然存在矛盾.
- 了解依赖时间的生存模式对于评估PBT的疗效至关重要.
研究的目的:
- 系统地审查和分析PBT与NSCLC光子放射治疗的临床结果.
- 评估与两种治疗方式相关的毒性概况.
- 专门调查时间依赖的生存模式,包括总生存率 (OS),无进展生存率 (PFS) 和局部无进展生存率 (LPFS).
主要方法:
- 在PubMed,EMBASE和Cochrane CENTRAL数据库中进行系统的文献搜索,截至2025年10月10日.
- 包括七项比较研究 (回顾性队列,多机构数据集,一个RCT) 涉及244,604名患者.
- 从卡普兰-梅尔曲线重建个体患者数据 (IPD) 并计算时间点生存和毒性的几率比率 (ORs).
主要成果:
- 整体综合分析显示,在NSCLC的PBT和光子辐射疗法之间,在OS,PFS或LPFS中没有显著差异.
- 对I阶段和I-II阶段NSCLC的敏感性和子组分析也显示没有显著的生存差异.
- 探索性分析表明,PBT (OR=0.60) 改善了1年的OS几率,但这种优势减少了3年和5年;没有观察到辐射肺炎或严重毒性的显著减少.
结论:
- 在长期的瘤控制中,PBT和NSCLC的光子辐射疗法似乎是可比的.
- PBT可能会提高1年整体存活率,可能是由于缓解急性治疗相关死亡率.
- 结果表明,PBT可能有利于高毒性风险的患者,支持基于模型的患者选择.
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