Annals of medicine · 2026
Omission of clinical target volume in radiotherapy for unresectable stage III non-small cell lung cancer: a propensity score matching analysis.
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Ding Wenxin, Liang Jing, Chen Chaoying, Zhao Jingsheng, Xu Chaojiu, Zhang Jinhua, Zhou Hao, Wu Honghua, Long Jian, Zuo Quan, Yang Zhi
Аннотация
OBJECTIVE: To investigate the efficacy and adverse reactions of radiotherapy with omitted clinical target volume (CTV) in unresectable stage III non-small cell lung cancer (NSCLC).
METHODS: A total of 423 NSCLC patients admitted to our hospital from June 2020 to April 2024 were enrolled. Among them, 112 patients met the inclusion criteria, including 58 patients in the experimental group and 54 patients in the control group. After 1:1 propensity score matching (PSM), 66 patients were included in the final analysis, with 33 patients in each group. All patients received radical radiotherapy and were divided into experimental and control groups based on whether CTV was omitted. The efficacy and adverse reactions between the two groups were analyzed.
RESULTS: The objective response rates were 45.4% in the experimental group and 57.5% in the control group (p = 0.325), showing no significant difference. Median locoregional recurrence-free survival (LRFS) was 28.2 months versus 23.2 months (p = 0.830). Median progression-free survival (PFS) was 21.3 months versus 17.3 months (p = 0.973). Median distant metastasis-free survival (DMFS) was not reached in the experimental group versus 20.9 months in the control group (p = 0.545). Median overall survival (OS) was not reached in the experimental group versus 26.2 months in the control group (p = 0.496). None of these differences were statistically significant. Regarding adverse reactions, the incidence of grade ≥2 radiation pneumonitis was significantly lower in the experimental group (6.1%) than in the control group (24.2%, p = 0.039), while there was no significant difference in immune-related pneumonitis between the groups.
CONCLUSION: In this cohort study of patients with unresectable stage III non-small cell lung carcinoma (NSCLC) undergoing radiation therapy, no statistically significant difference in survival was observed with omission of the CTV. However, omitting the CTV could reduce the incidence of grade ≥2 radiation pneumonitis, thereby alleviating the adverse reactions associated with this condition.
METHODS: A total of 423 NSCLC patients admitted to our hospital from June 2020 to April 2024 were enrolled. Among them, 112 patients met the inclusion criteria, including 58 patients in the experimental group and 54 patients in the control group. After 1:1 propensity score matching (PSM), 66 patients were included in the final analysis, with 33 patients in each group. All patients received radical radiotherapy and were divided into experimental and control groups based on whether CTV was omitted. The efficacy and adverse reactions between the two groups were analyzed.
RESULTS: The objective response rates were 45.4% in the experimental group and 57.5% in the control group (p = 0.325), showing no significant difference. Median locoregional recurrence-free survival (LRFS) was 28.2 months versus 23.2 months (p = 0.830). Median progression-free survival (PFS) was 21.3 months versus 17.3 months (p = 0.973). Median distant metastasis-free survival (DMFS) was not reached in the experimental group versus 20.9 months in the control group (p = 0.545). Median overall survival (OS) was not reached in the experimental group versus 26.2 months in the control group (p = 0.496). None of these differences were statistically significant. Regarding adverse reactions, the incidence of grade ≥2 radiation pneumonitis was significantly lower in the experimental group (6.1%) than in the control group (24.2%, p = 0.039), while there was no significant difference in immune-related pneumonitis between the groups.
CONCLUSION: In this cohort study of patients with unresectable stage III non-small cell lung carcinoma (NSCLC) undergoing radiation therapy, no statistically significant difference in survival was observed with omission of the CTV. However, omitting the CTV could reduce the incidence of grade ≥2 radiation pneumonitis, thereby alleviating the adverse reactions associated with this condition.