Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer
Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer
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DOI：
10.1016/j.ijrobp.2016.10.041
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发表时间：
2017-02-01
影响因子：
7
通讯作者：
Lin, Steven H.
中科院分区：
文献类型：
--
作者：
Verma, Vivek;Simone, Charles B., II;Lin, Steven H.
目的：对于不能手术的I期（T1-T2N0）小细胞肺癌（SCLC），国家指南推荐化疗加或不加常规分级放疗。目前的多机构队列研究调查了立体定向消融放射治疗（SABR）对这一人群的作用。方法和材料：对组织学证实为T1-T2N0M0期SCLC患者的临床和治疗特点、毒性、结局和失败模式进行评估。采用Kaplan-Meier分析评价生存结局。单变量和多变量分析确定了预测结果的因素。结果：来自24家机构的74例患者，治疗了76个病变（中位随访18个月）。中位年龄和肿瘤大小分别为72岁和2.5 cm。化疗和预防性颅脑照射分别占56%和23%。SABR的中位剂量和分度为50 Gy和5分。1年和3年当地防治率分别为97.4%和96.1%。中位无病生存期（DFS）为49.7个月。1年和3年的DFS分别为58.3%和53.2%。中位、1年和3年疾病特异性生存期分别为52.3个月、84.5%和64.4%。中位、1年和3年总生存期（OS）分别为17.8个月、69.9%和34.0%。接受化疗的患者经历了中位DFS （61.3 vs 9.0个月，P = 0.02）和OS （31.4 vs 14.3个月，P = 0.02）的增加。在多变量分析中，接受化疗独立预测DFS/OS的更好结局（P = 0.01）。毒性不常见；5.2%为>= 2级肺炎。治疗后失败最常见的是远处复发（45.8%），其次是淋巴结（25.0%）和其他肺（20.8%）。治疗的中位时间为5至7个月。结论：从迄今为止最大的T1-T2N0期SCLC SABR报告的结果来看，SABR （>= 50 Gy）联合化疗应被视为一种标准选择。(C) 2016年由Elsevier Inc.出版。
Purpose: For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population.Methods and Materials: The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes.Results: From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3% and 53.2% at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P = .02) and OS (31.4 vs 14.3 months; P = .02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P = .01). Toxicities were uncommon; 5.2% experienced grade >= 2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and "elsewhere lung" (20.8%). The median time to each was 5 to 7 months.Conclusions: From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (>= 50 Gy) with chemotherapy should be considered a standard option. (C) 2016 Published by Elsevier Inc.