Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: Updated results of 257 patients in a Japanese multi-institutional study
Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: Updated results of 257 patients in a Japanese multi-institutional study
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DOI：
10.1097/jto.0b013e318074de34
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发表时间：
2007-07-01
影响因子：
20.4
通讯作者：
Araki, Tsutomu
中科院分区：
文献类型：
--
作者：
Onishi, Hiroshi;Shirato, Hiroki;Araki, Tsutomu
介绍：大分割立体定向放射治疗（HypoFXSRT）最近已被用于治疗小肺肿瘤。我们回顾性分析了治疗结果的HypoFXSRT为I期非小细胞肺癌（NSCLC）治疗在日本的多institutional study.Methods：这是一项回顾性研究，回顾性分析257例I期非小细胞肺癌（中位年龄，74岁：164 T1 N 0 M0，93 T2 N 0 M0）与HypoFXSRT单独治疗在14个机构。立体定向三维治疗采用非共面动态弧或多个静态端口。在等中心点的总剂量为18至75戈伊，分1至22次给药。按α/β = 10计算，中位生物学有效剂量（BED）为111戈伊（范围57-180戈伊）。结果：随访38个月（中位时间），14例（5.4%）出现2级以上肺部并发症。36例患者（14.0%）发生局部进展，BED ≥ 100戈伊的局部复发率为8.4%，低于100戈伊的局部复发率为42.9%（p < 0.001）。在接受100戈伊或以上BED治疗的患者中，可进行医学手术的患者的5年总生存率为70.8%，而接受100戈伊以下BED治疗的患者的5年总生存率为30.2（p < 0.05）。虽然这是一项回顾性研究，但对于I期NSCLC，BED小于180戈伊的HypoFXSRT几乎是安全的，BED ≥ 100戈伊的局部控制率和5年总生存率均上级优于常规放疗。对于所有的治疗方法和方案，局部控制率和生存率更好的BED为100戈伊或更高相比，小于100戈伊。HypoFXSRT对于I期NSCLC患者的治愈性治疗是可行的。
Introduction: Hypofractionated stereotactic radiotherapy (HypoFXSRT) has recently been used for the treatment of small lung tumors. We retrospectively analyzed the treatment outcome of HypoFXSRT for stage I non-small cell lung cancer (NSCLC) treated in a Japanese multi-institutional study.Methods: This is a retrospective study to review 257 patients with stage I NSCLC (median age, 74 years: 164 T1N0M0, 93 T2N0M0) were treated with HypoFXSRT alone at 14 institutions. Stereotactic three-dimensional treatment was performed using noncoplanar dynamic arcs or multiple static ports. A total dose of 18 to 75 Gy at the isocenter was administered in one to 22 fractions. The median calculated biological effective dose (BED) was 111 Gy (range, 57-180 Gy) based on alpha/beta = 10.Results: During follow-up (median, 38 months), pulmonary complications of above grade 2 arose in 14 patients (5.4%). Local progression occurred in 36 patients (14.0%), and the local recurrence rate was 8.4% for a BED of 100 Gy or more compared with 42.9% for less than 100 Gy (p < 0.001). The 5-year overall survival rate of medically operable patients was 70.8% among those treated with a BED of 100 Gy or more compared with 30.2% among those treated with less than 100 Gy (p < 0.05).Conclusions: Although this is a retrospective study, HypoFXSRT with a BED of less than 180 Gy was almost safe for stage I NSCLC, and the local control and overall survival rates in 5 years with a BED of 100 Gy or more were superior to the reported results for conventional radiotherapy. For all treatment methods and schedules, the local control and survival rates were better with a BED of 100 Gy or more compared with less than 100 Gy. HypoFXSRT is feasible for curative treatment of patients with stage I NSCLC.