Stereotactic body radiation therapy for early stage non-small cell lung cancer: Results of a prospective trial
Stereotactic body radiation therapy for early stage non-small cell lung cancer: Results of a prospective trial
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DOI：
10.1016/j.lungcan.2009.05.007
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发表时间：
2010-04-01
期刊：
影响因子：
5.3
通讯作者：
Ragona, Riccardo
中科院分区：
文献类型：
--
作者：
Ricardi, Umberto;Filippi, Andrea Riccardo;Ragona, Riccardo
早期(IA-IB)非小细胞肺癌(NSCLC)患者被认为是不能手术的，通常采用传统的3D-CRT治疗，但在局部肿瘤控制和生存方面效果较差。根据最近报道的系列报道，低分割立体定向全身放射治疗(SBRT)似乎是一种有效的替代方案，局部控制率高，存活率有希望。我们在此报告了对62例I期非小细胞肺癌患者进行SBRT的前瞻性II期试验的最终结果，在一周的时间里，每隔一天给予三次，每次15GY，最高剂量为45GY；剂量规定为80%-等剂量，包括计划目标体积。患者被固定在专用的立体定向身体框架中；大体肿瘤体积周围的轴向边缘为5 mm，纵向边缘为10 mm。中位年龄为73.7岁。64.5%的患者病理证实为非小细胞肺癌。IA期43例，IB期19例。大多数患者没有任何毒性；大约10%的患者出现轻微的皮肤反应、疲劳、呼吸困难/咳嗽或一过性胸痛。中位随访时间为28个月，2例患者局部孤立复发，4例孤立结节复发，15例全身衰竭。3年局部控制率为87.8%，肿瘤特异性生存率为72.5%，总生存率为57.1%，20例非肿瘤相关死亡中有8例死亡。在多变量分析中，肿瘤体积与较好的预后相关。在我们的系列中，SBRT耐受性良好，并证实了其有效性，局部控制率和全球生存率优于报道的使用传统放射治疗的患者。需要更长的随访时间才能建立与外科手术系列的正确比较，并充分确定SBRT对如此脆弱的患者群体合并症的潜在负面影响。(C)2009爱思唯尔爱尔兰有限公司。保留所有权利。
Patients affected with early stage (IA-IB) non-small cell lung cancer (NSCLC), deemed medically inoperable, are usually treated by conventional 3D-CRT, with poor results in terms of local tumour control and survival. Hypofractionated stereotactic body radiation therapy (SBRT) appears to be a valid alternative option, with high rates of local control and promising survival rates according to recent reported series. We herein report the final results of a prospective phase II trial of SBRT in 62 stage I NSCLC patients, homogeneously treated with three fractions of 15 Gy each, given every other day during a 1 week time, up to a total dose of 45 Gy; dose was prescribed to the 80%-isodose encompassing planning target volume. Patients were immobilized in a dedicated stereotactic body frame; margins around gross tumour volume were 5 mm in the axial plane and 10 mm in the longitudinal direction. Median age was 73.7 years. A pathologic confirmation of NSCLC was obtained in 64.5% of patients. Forty-three patients had stage IA and 19 stage IB disease. The majority of patients did not experience any toxicity; mild skin reactions, fatigue, dyspnea/cough or transient thoracic pain were recorded in approximately 10% of patients. With a median follow-up time of 28 months, 2 patients experienced an isolated local relapse, 4 an isolated nodal relapse and 15 a systemic failure. At 3 years, local control rate was 87.8%, cancer-specific survival 72.5%, overall survival 57.1%, with 8 out of 20 non-cancer related deaths. In multivariate analysis, tumour volume was associated with a better outcome. In our series, SBRT was well tolerated and confirmed its efficacy, with local control and survival rates globally superior to those reported using conventional radiotherapy. A longer follow-up is needed in order to establish a correct comparison with surgical series, and to fully ascertain a potential negative impact of SBRT on comorbidities of such a fragile patients population. (C) 2009 Elsevier Ireland Ltd. All rights reserved.