Clinical evaluation of stereotactic radiation therapy for recurrent or second primary mediastinal lymph node metastases originating from non-small cell lung cancer.
Clinical evaluation of stereotactic radiation therapy for recurrent or second primary mediastinal lymph node metastases originating from non-small cell lung cancer.
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立体定向放射治疗非小细胞肺癌复发或第二原发纵隔淋巴结转移的临床评价
DOI：
10.18632/oncotarget.3704
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发表时间：
2015-06-20
期刊：
影响因子：
--
通讯作者：
Yuan ZY
中科院分区：
文献类型：
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作者：
Meng MB;Wang HH;Zaorsky NG;Zhao XZ;Wu ZQ;Jiang B;Song YC;Zhuang HQ;Li FT;Zhao LJ;Wang CL;Li K;Wang P;Yuan ZY
目的评价立体定向放射治疗（SRT，立体定向体部RT [SBRT]和分次立体定向RT [FSRT]）治疗非小细胞肺癌（NSCLC）复发或继发原发性纵隔淋巴结转移（R/SP-MLNM）患者的安全性和有效性。方法回顾性分析2006年10月至2013年7月在我院接受SRT治疗的非小细胞肺癌（NSCLC）患者的临床资料。入选患者分为A组（既往未接受RT）和B组（既往接受RT）。主要终点为总生存期（OS）。次要终点为MLNM局部对照（LC）、症状缓解时间和毒性（使用不良事件通用术语标准（CTCAE v4.0））。结果33例患者接受了治疗（A组16例，19枚R/SP-MLNM; B组17例，17枚R/SP-MLNM）。对于整个队列，中位OS为25.5个月，中位随访时间为20.9个月（范围：3.2-82）。1年和3年精算LC率分别为100%和86%。在中位6天（范围，3-18）后，52%的患者观察到症状缓解。5例患者（15%;均在B组）发生CTCAE v4.0 ≥ 3级毒性，其中2例患者发生5级毒性。结论：我们建议对既往接受过RT（特别是LN站7）的患者使用SRT治疗R/SP-MLNM时应格外谨慎。对于以前没有RT的患者，SRT似乎是安全有效的治疗方式;前瞻性研究是必要的。
Aims To evaluate the safety and efficacy of stereotactic radiotherapy (SRT, both stereotactic body RT [SBRT] and fractionated stereotactic RT [FSRT]) in the treatment of patients with recurrent or second primary mediastinal lymph node metastases (R/SP-MLNMs) originating from non-small cell lung cancer (NSCLC). Methods Between 10/2006 and 7/2013, patients with R/SP-MLNMsoriginating from NSCLC were enrolled and treated with SRT at our hospital; their data was stored in prospectively-collected database. The enrolled patients were divided into Group A (without prior RT) and Group B (with prior RT). The primary end-point was overall survival (OS). The secondary end-points were the MLNM local control (LC), the time to symptom alleviation, and toxicity using the Common Terminology Criteria for Adverse Events (CTCAE v4.0). Results Thirty-three patients were treated (16 in Group A with 19 R/SP-MLNMs and 17 in Group B with 17 R/SP-MLNMs). For the entire cohort, the median OS was 25.5 months with a median follow-up of 20.9 months (range, 3.2-82). The 1-year and 3-year actuarial LC rates were 100% and 86%, respectively. Symptom alleviation was observed in 52% of patients, after a median of 6 days (range, 3-18). CTCAE v4.0 ≥ Grade 3 toxicities occurred in 5 patients (15%; all in Group B); among them, Grade 5 in 2 patients. Conclusions We recommend exercising extreme caution in using SRT for R/SP-MLNMs in patients who received prior RT (particularly to LN station 7). For patients without previous RT, SRT appears to be safe and efficacious treatment modality; prospective studies are warranted.