修改意见
尊敬的编辑部及审稿专家：
您们好，感谢您们对文章提出的宝贵意见，针对提出的问题，作出修改答复如下，恳请指正，谢谢！
1. 关于本研究为什么没有历史对照？
文献报道关于转移性非小细胞肺癌的中位生存时间为8～10个月，本文通过回顾性研究显示螺旋断层放疗技术的加入使转移性非小细胞肺癌的中位生存时间延长至19.3个月。
国外也有类似的报道，放疗也可以延长转移性非小细胞肺癌的生存时间，见参考文献如下：
1. 2013 Nov;82(2):197-203. doi: 10.1016/j.lungcan.2013.07.026. Epub 2013 Aug 20
Is there an oligometastatic state in non-small cell lung cancer?
A systematic review of the literature. 1, , , .
1Department of Radiation Oncology, London Regional Cancer Program, London, Canada.
Abstract
OBJECTIVES:
Long-term survival has been observed in patients with oligometastatic non-small cell lung cancer (NSCLC) treated with locally ablative therapies to all sites of metastatic disease. We performed a systematic review of the evidence for the oligometastatic state in NSCLC. MATERIALS AND METHODS:
A systematic review of MEDLINE, EMBASE and conference abstracts was undertaken to identify survival outcomes and prognostic factors for NSCLC patients with 1-5 metastases
treated with surgical metastatectomy, Stereotactic Ablative Radiotherapy (SABR), or Stereotactic Radiosurgery (SRS), according to PRISMA guidelines.
RESULTS:
Forty-nine studies reporting on 2176 patients met eligibility criteria. The majority of patients (82%) had a controlled primary tumor and 60% of studies included patients with brain
metastases only. Overall survival (OS) outcomes were heterogeneous: 1 year OS: 15-100%, 2 year OS: 18-90% and 5 year OS: 8.3-86%. The median OS range was 5.9-52 months (overall median 14.8 months; for patients with controlled primary, 19 months). The median time to any progression was 4.5-23.7 months (overall median 12 months). Highly significant prognostic factors on multivariable analyses were: definitive treatment of the primary tumor, N-stage and disease-free interval of at least 6-12 months.
CONCLUSIONS:
Survival outcomes for patients with oligometastatic NSCLC are highly variable, and half of patients progress within approximately 12 months; however, long-term survivors do exist. Definitive treatment of the primary lung tumor and low-burden thoracic tumors are strongly associated with improved long-term survival. The only randomized data to guide management of oligometastatic NSCLC pertains to patients with brain metastases. For other oligometastatic NSCLC patients, randomized trials are needed, and we propose that these prognostic factors be utilized to guide clinical decision making and design of clinical trials.
2. 2014 Jul 15;89(4):880-7. doi: 10.1016/j.ijrobp.2014.04.007. Epub 2014 May 24.
Definitive primary therapy in patients presenting with
oligometastatic non-small cell lung cancer. 1, 2, 3, 3, 3, 3, 2, 3, 3, 4.
123Harvard Medical School, Boston, Massachusetts. Dana-Farber Cancer Institute, Boston, Massachusetts. Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts. 4
Hospital, Boston, Massachusetts. Electronic address: [email protected].
Abstract
PURPOSE:
Although palliative chemotherapy is the standard of care for patients with diagnoses of stage IV non-small cell lung cancer (NSCLC), patients with a small metastatic burden,
METHODS AND MATERIALS:
We identified 186 patients (26% of stage IV patients) prospectively enrolled in our institutional database from 2002 to 2012 with oligometastatic disease, which we defined as 5 or fewer distant metastatic lesions at diagnosis. Univariate and multivariable Cox proportional hazards models were used to identify patient and disease factors associated with improved survival. Using propensity score methods, we investigated the effect of definitive local therapy to the primary tumor on overall survival.
RESULTS:
Median age at diagnosis was 61 years of age; 51% of patients were female; 12% had squamous histology; and 33% had N0-1 disease. On multivariable analysis, Eastern
Cooperate Oncology Group performance status ≥ 2 (hazard ratio [HR], 2.43), nodal status, N2-3 (HR, 2.16), squamous pathology, and metastases to multiple organs (HR, 2.11) were associated with a greater hazard of death (all P
Definitive local therapy to the primary tumor was associated with prolonged survival (HR, 0.65, P=.043).
CONCLUSIONS:
Definitive local therapy to the primary tumor appears to be associated with improved survival in patients with oligometastatic NSCLC. Select patient and tumor characteristics, including good performance status, nonsquamous histology, and limited nodal disease, may predict for improved survival in these patients.
修改意见
尊敬的编辑部及审稿专家：
您们好，感谢您们对文章提出的宝贵意见，针对提出的问题，作出修改答复如下，恳请指正，谢谢！
1. 关于本研究为什么没有历史对照？
文献报道关于转移性非小细胞肺癌的中位生存时间为8～10个月，本文通过回顾性研究显示螺旋断层放疗技术的加入使转移性非小细胞肺癌的中位生存时间延长至19.3个月。
国外也有类似的报道，放疗也可以延长转移性非小细胞肺癌的生存时间，见参考文献如下：
1. 2013 Nov;82(2):197-203. doi: 10.1016/j.lungcan.2013.07.026. Epub 2013 Aug 20
Is there an oligometastatic state in non-small cell lung cancer?
A systematic review of the literature. 1, , , .
1Department of Radiation Oncology, London Regional Cancer Program, London, Canada.
Abstract
OBJECTIVES:
Long-term survival has been observed in patients with oligometastatic non-small cell lung cancer (NSCLC) treated with locally ablative therapies to all sites of metastatic disease. We performed a systematic review of the evidence for the oligometastatic state in NSCLC. MATERIALS AND METHODS:
A systematic review of MEDLINE, EMBASE and conference abstracts was undertaken to identify survival outcomes and prognostic factors for NSCLC patients with 1-5 metastases
treated with surgical metastatectomy, Stereotactic Ablative Radiotherapy (SABR), or Stereotactic Radiosurgery (SRS), according to PRISMA guidelines.
RESULTS:
Forty-nine studies reporting on 2176 patients met eligibility criteria. The majority of patients (82%) had a controlled primary tumor and 60% of studies included patients with brain
metastases only. Overall survival (OS) outcomes were heterogeneous: 1 year OS: 15-100%, 2 year OS: 18-90% and 5 year OS: 8.3-86%. The median OS range was 5.9-52 months (overall median 14.8 months; for patients with controlled primary, 19 months). The median time to any progression was 4.5-23.7 months (overall median 12 months). Highly significant prognostic factors on multivariable analyses were: definitive treatment of the primary tumor, N-stage and disease-free interval of at least 6-12 months.
CONCLUSIONS:
Survival outcomes for patients with oligometastatic NSCLC are highly variable, and half of patients progress within approximately 12 months; however, long-term survivors do exist. Definitive treatment of the primary lung tumor and low-burden thoracic tumors are strongly associated with improved long-term survival. The only randomized data to guide management of oligometastatic NSCLC pertains to patients with brain metastases. For other oligometastatic NSCLC patients, randomized trials are needed, and we propose that these prognostic factors be utilized to guide clinical decision making and design of clinical trials.
2. 2014 Jul 15;89(4):880-7. doi: 10.1016/j.ijrobp.2014.04.007. Epub 2014 May 24.
Definitive primary therapy in patients presenting with
oligometastatic non-small cell lung cancer. 1, 2, 3, 3, 3, 3, 2, 3, 3, 4.
123Harvard Medical School, Boston, Massachusetts. Dana-Farber Cancer Institute, Boston, Massachusetts. Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts. 4
Hospital, Boston, Massachusetts. Electronic address: [email protected].
Abstract
PURPOSE:
Although palliative chemotherapy is the standard of care for patients with diagnoses of stage IV non-small cell lung cancer (NSCLC), patients with a small metastatic burden,
METHODS AND MATERIALS:
We identified 186 patients (26% of stage IV patients) prospectively enrolled in our institutional database from 2002 to 2012 with oligometastatic disease, which we defined as 5 or fewer distant metastatic lesions at diagnosis. Univariate and multivariable Cox proportional hazards models were used to identify patient and disease factors associated with improved survival. Using propensity score methods, we investigated the effect of definitive local therapy to the primary tumor on overall survival.
RESULTS:
Median age at diagnosis was 61 years of age; 51% of patients were female; 12% had squamous histology; and 33% had N0-1 disease. On multivariable analysis, Eastern
Cooperate Oncology Group performance status ≥ 2 (hazard ratio [HR], 2.43), nodal status, N2-3 (HR, 2.16), squamous pathology, and metastases to multiple organs (HR, 2.11) were associated with a greater hazard of death (all P
Definitive local therapy to the primary tumor was associated with prolonged survival (HR, 0.65, P=.043).
CONCLUSIONS:
Definitive local therapy to the primary tumor appears to be associated with improved survival in patients with oligometastatic NSCLC. Select patient and tumor characteristics, including good performance status, nonsquamous histology, and limited nodal disease, may predict for improved survival in these patients.