Stereotactic Body Radiation Therapy Can Be Used Safely to Boost Residual Disease in Locally Advanced Non-Small Cell Lung Cancer: A Prospective Study
Stereotactic Body Radiation Therapy Can Be Used Safely to Boost Residual Disease in Locally Advanced Non-Small Cell Lung Cancer: A Prospective Study
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DOI：
10.1016/j.ijrobp.2012.11.011
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发表时间：
2013-04-01
影响因子：
7
通讯作者：
McGarry, Ronald C.
中科院分区：
文献类型：
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作者：
Feddock, Jonathan;Arnold, Susanne M.;McGarry, Ronald C.
目的：报道一项前瞻性的单机构研究结果，评价常规放化疗(CRT)和立体定向全身放射治疗(SBRT)作为治疗II-III期非小细胞肺癌(NSCLC)残留病变的一种方法的可行性。方法与材料：根据放射治疗肿瘤组方案0813的定义，无转移性病变且放射学证据有限的患者(原发灶残留100Gy，周边肿瘤10Gyx2次(总计20Gy)，内侧性肿瘤6.5Gyx3次(总计19.5Gy))。结果：中位随访13个月后，4例患者发生急性3级放射性肺炎，1例(2.9%)出现晚期和持续性的3级放射性肺炎。无1例患者发生4级或5级RP。计算了平均肺剂量、V2.5、V5、V10和V20的SBRT加速值，没有发现对RP有显著预测作用。只有高龄(P=.0147)、既往吸烟状况(P=.0505)和高CRT平均肺剂量(P=.0295)与RP的发生显著相关。分析时，原发灶的精确局部控制率为82.9%，仅有6例患者复发。结论：基于直线加速器的SBRT用于确定的CRT后有限残留NSCLC的剂量递增是可行的，并且不会增加高于标准放疗的毒性风险。(C)2013年爱思唯尔公司。
Purpose: To report the results of a prospective, single-institution study evaluating the feasibility of conventional chemoradiation (CRT) followed by stereotactic body radiation therapy (SBRT) as a means of dose escalation for patients with stage II-III non-small cell lung cancer (NSCLC) with residual disease.Methods and Materials: Patients without metastatic disease and with radiologic evidence of limited residual disease (100 Gy to the residual primary tumor, consisting of 10 Gy x 2 fractions (20 Gy total) for peripheral tumors, and 6.5 Gy x 3 fractions (19.5 Gy total) for medial tumors using the Radiation Therapy Oncology Group protocol 0813 definitions. The primary endpoint was the development of grade >= 3 radiation pneumonitis (RP).Results: After a median follow-up of 13 months, 4 patients developed acute grade 3 RP, and 1 (2.9%) developed late and persistent grade 3 RP. No patients developed grade 4 or 5 RP. Mean lung dose, V2.5, V5, V10, and V20 values were calculated for the SBRT boost, and none were found to significantly predict for RP. Only advancing age (P=.0147), previous smoking status (P=.0505), and high CRT mean lung dose (P=.0295) were significantly associated with RP development. At the time of analysis, the actuarial local control rate at the primary tumor site was 82.9%, with only 6 patients demonstrating recurrence.Conclusions: Linear accelerator-based SBRT for dose escalation of limited residual NSCLC after definitive CRT was feasible and did not increase the risk for toxicity above that for standard radiation therapy. (C) 2013 Elsevier Inc.