Lack of a Dose-Effect Relationship for Pulmonary Function Changes After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer
Lack of a Dose-Effect Relationship for Pulmonary Function Changes After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer
复制标题
DOI：
10.1016/j.ijrobp.2012.09.016
复制
发表时间：
2013-03-15
影响因子：
7
通讯作者：
Grills, Inga S.
中科院分区：
文献类型：
--
作者：
Guckenberger, Matthias;Klement, Rainer J.;Grills, Inga S.
目的：评估立体定向体部放疗（SBRT）治疗早期非小细胞肺癌（NSCLC）后肿瘤大小、处方剂量和肺部剂量对治疗后肺功能测试（PFT）变化的影响。方法和材料：分析基于5个国际机构治疗的191例患者：入选标准为SBRT前后PFT的可用性以及肺和计划靶体积（PTV）的剂量-体积直方图;排除接受超过1个SBRT疗程治疗的患者。使用线性回归分析、受试者操作特征分析和莱曼正常组织并发症概率模型评估早期（1-6个月，中位3个月）和晚期（7-24个月，中位12个月）PFT变化与肿瘤大小、计划靶体积（PTV）剂量和肺剂量之间的相关性。将PTV剂量换算成生物学有效剂量，肺剂量换算成2戈伊当量剂量，进行相关性分析。SBRT后6个月，1秒用力呼气量和一氧化碳弥散量变化为-1.4%（95%置信区间[CI]，-3.4%至0）和-7.6%（95% CI，-10.2%至3.4%）。SBRT后7-24个月观察到PFT适度降低，变化分别为-8.1%（95% CI，-13.3%至5.3%）和-12.4%（95% CI，-15.5%至6.9%）。使用线性回归分析、受试者操作特征分析和正常组织并发症概率建模，所有评估的肿瘤大小、PTV剂量、平均肺剂量以及暴露于最小剂量5-70戈伊的肺的绝对和相对体积的参数与早期和晚期PFT变化无关。基于前SBRT PFTs（大于或等于，小于中位数）的亚组分析没有发现任何剂量-效应关系。结论：本研究未能证明一个显着的剂量-效应关系SBRT后肺功能的变化，早期非小细胞肺癌。(C)2013 Elsevier Inc.
Purpose: To evaluate the influence of tumor size, prescription dose, and dose to the lungs on posttreatment pulmonary function test (PFT) changes after stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC).Methods and Materials: The analysis is based on 191 patients treated at 5 international institutions: inclusion criteria were availability of pre- and post-SBRT PFTs and dose-volume histograms of the lung and planning target volume (PTV); patients treated with more than 1 SBRT course were excluded. Correlation between early (1-6 months, median 3 months) and late (7-24 months, median 12 months) PFT changes and tumor size, planning target volume (PTV) dose, and lung doses was assessed using linear regression analysis, receiver operating characteristics analysis, and Lyman's normal tissue complication probability model. The PTV doses were converted to biologically effective doses and lung doses to 2 Gy equivalent doses before correlation analyses.Results: Up to 6 months after SBRT, forced expiratory volume in 1 second and carbon monoxide diffusion capacity changed by -1.4% (95% confidence interval [CI], -3.4% to 0) and -7.6% (95% CI, -10.2% to -3.4%) compared with pretreatment values, respectively. A modest decrease in PFTs was observed 7-24 months after SBRT, with changes of -8.1% (95% CI, -13.3% to -5.3%) and -12.4% (95% CI, -15.5% to -6.9%), respectively. Using linear regression analysis, receiver operating characteristic analysis, and normal tissue complication probability modeling, all evaluated parameters of tumor size, PTV dose, mean lung dose, and absolute and relative volumes of the lung exposed to minimum doses of 5-70 Gy were not correlated with early and late PFT changes. Subgroup analysis based on pre-SBRT PFTs (greater or equal and less than median) did not identify any dose-effect relationship.Conclusions: This study failed to demonstrate a significant dose-effect relationship for changes of pulmonary function after SBRT for early-stage non-small cell lung cancer. (C) 2013 Elsevier Inc.