Clinical outcomes using carbon-ion radiotherapy and dose-volume histogram comparison between carbon-ion radiotherapy and photon therapy for T2b-4N0M0 non-small cell lung cancer-A pilot study.
Clinical outcomes using carbon-ion radiotherapy and dose-volume histogram comparison between carbon-ion radiotherapy and photon therapy for T2b-4N0M0 non-small cell lung cancer-A pilot study.
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DOI：
10.1371/journal.pone.0175589
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Nakano T
中科院分区：
文献类型：
--
作者：
Shirai K;Kawashima M;Saitoh JI;Abe T;Fukata K;Shigeta Y;Irie D;Shiba S;Okano N;Ohno T;Nakano T
碳离子放射治疗晚期非小细胞肺癌的安全性和有效性尚未确定。我们评估了T2 b-4 N 0 M0非小细胞肺癌患者碳离子放疗与光子治疗的临床结局和剂量体积直方图参数。2011年5月至2015年12月期间，23名患者接受了碳离子放射治疗。分别有7例、14例和2例患者患有T2 b、T3和T4。中位年龄为78岁（范围：53 - 91岁），22例男性患者。腺癌12例，鳞癌8例，非小细胞肺癌1例，临床诊断肺癌2例。11例可手术，12例不可手术。大部分患者（91%）接受碳离子放射治疗，相对生物学有效性（RBE）为60.0戈伊分4次或64.0戈伊分16次。计算局部控制率和总生存率。比较了碳离子放疗和光子治疗（包括三维适形放疗（3DCRT）和调强放疗（IMRT））的正常肺和肿瘤覆盖范围的剂量-体积直方图参数。存活患者的中位随访时间为25个月。3例患者局部复发，2年局部控制率为81%。随访期间5例死于肺癌，1例死于并发症。2年总生存率为70%。可手术患者的总生存率高于不可手术患者（100% vs. 43%; P = 0.04）。无≥2级放射性肺炎。在剂量-体积直方图分析中，与光子治疗相比，碳离子放射治疗对正常肺的剂量显著降低，肿瘤覆盖范围更大。碳离子放射治疗T2 b-4 N 0 M0非小细胞肺癌安全有效，剂量分布上级光子治疗。日本的一项多机构研究正在进行中，以前瞻性评估这些患者并确定碳离子放疗的使用。
The safety and efficacy of carbon-ion radiotherapy for advanced non-small cell lung cancer have not been established. We evaluated the clinical outcomes and dose-volume histogram parameters of carbon-ion radiotherapy compared with photon therapy in T2b–4N0M0 non-small cell lung cancer. Twenty-three patients were treated with carbon-ion radiotherapy between May 2011 and December 2015. Seven, 14, and 2 patients had T2b, T3, and T4, respectively. The median age was 78 (range, 53−91) years, with 22 male patients. There were 12 adenocarcinomas, 8 squamous cell carcinomas, 1 non-small cell lung carcinoma, and 2 clinically diagnosed lung cancers. Eleven patients were operable, and 12 patients were inoperable. Most patients (91%) were treated with carbon-ion radiotherapy of 60.0 Gy relative biological effectiveness (RBE) in 4 fractions or 64.0 Gy (RBE) in 16 fractions. Local control and overall survival rates were calculated. Dose-volume histogram parameters of normal lung and tumor coverages were compared between carbon-ion radiotherapy and photon therapies, including three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT). The median follow-up of surviving patients was 25 months. Three patients experienced local recurrence, and the 2-year local control rate was 81%. During follow-up, 5 patients died of lung cancer, and 1 died of intercurrent disease. The 2-year overall survival rate was 70%. Operable patients had a better overall survival rate compared with inoperable patients (100% vs. 43%; P = 0.04). There was no grade ≥2 radiation pneumonitis. In dose-volume histogram analysis, carbon-ion radiotherapy had a significantly lower dose to normal lung and greater tumor coverage compared with photon therapies. Carbon-ion radiotherapy was effectively and safely performed for T2b–4N0M0 non-small cell lung cancer, and the dose distribution was superior compared with those for photon therapies. A Japanese multi-institutional study is ongoing to prospectively evaluate these patients and establish the use of carbon-ion radiotherapy.