Stereotactic body radiation therapy-based treatment model for stage I medically inoperable small cell lung cancer
Stereotactic body radiation therapy-based treatment model for stage I medically inoperable small cell lung cancer
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DOI：
10.1016/j.prro.2012.10.003
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发表时间：
2013-10-01
影响因子：
3.3
通讯作者：
Djemil, Toufik
中科院分区：
文献类型：
--
作者：
Videtic, Gregory M. M.;Stephans, Kevin L.;Djemil, Toufik
目的：报道医学上不能手术的I期小细胞肺癌（SCLC）患者采用立体定向全身放射治疗（SBRT）来治疗原发肿瘤。方法和材料：我们的机构审查委员会批准的SBRT登记显示，430例患者中有6例I期SCLC，时间间隔为6年（2004-2010）。所有患者都有活检证实疾病，并被胸外科医生认为医学上不能手术。我们的机构方法是联合SBRT，铂-依托泊苷化疗（CHT）和预防性颅脑照射（PCI）。SBRT使用Novalis/BrainLAB平台和ExacTrac （BrainLAB, Westchester， IL）进行图像引导。结果：患者特征包括Karnofsky表现量表中位80分，中位年龄68岁，4名女性，1名患者就诊时仍在吸烟。50%的病例肺功能受损导致不能手术。肿瘤特征包括中位肿瘤大小2.6 cm，中位正电子发射断层扫描标准摄取值（max）为9。SBRT为60 Gy/3次（3例）、50 Gy/5次（2例）、30 Gy/1次（1例）。中位随访时间为11.9个月。没有3级或以上毒性，有1例2级毒性。3例患者在分析时存活，3例患者死于非癌症原因。1年，局部控制率100%，无局部淋巴结衰竭，1例发生远处功能衰竭（肝）。1年总生存率和无病生存率分别为63%和75%。结论：采用SBRT治疗医学上不能手术的I期SCLC是合理的，具有良好的局部控制和促进疾病特异性生存。没有区域性淋巴结衰竭支持正电子发射断层扫描对纵隔的分期。铂基CHT在弱势人群中可能是可行的。(C) 2013年美国放射肿瘤学会。Elsevier Inc.出版。版权所有。
Purpose: To report on medically inoperable stage I small cell lung cancer (SCLC) patients for whom stereotactic body radiation therapy (SBRT) was employed to manage the primary tumor.Methods and Materials: Review of our institutional review board approved SBRT registry revealed 6 cases of stage I SCLC out of 430 patients over a 6-year interval (2004-2010). All patients had biopsy proven disease and deemed medically inoperable by a thoracic surgeon. Our institutional approach was to treat with a combination of SBRT, platinum-etoposide chemotherapy (CHT) and prophylactic cranial irradiation (PCI). SBRT was delivered using a Novalis/BrainLAB platform and ExacTrac (BrainLab, Westchester, IL) for image guidance.Results: Patient characteristics included a median Karnofsky performance scale of 80, a median age of 68 years, 4 females, and 1 patient still smoking at presentation. Impaired pulmonary function caused inoperability in 50% of cases. Tumor characteristics included median tumor size of 2.6 cm and median positron emission tomography-standard uptake value(max) of 9. The SBRT was 60 Gy/3 fractions (3 patients), 50 Gy/5 fractions (2 patients), 30 Gy/1 fraction (1 patient). Median follow-up was 11.9 months. There was no grade 3 or higher, and 1 grade 2, toxicity. Three patients were alive at analysis and 3 patients had died of non-cancer causes. At 1 year, local control was 100%, there was no regional nodal failure, and 1 patient had distant failure (liver). Overall and disease-free survivals at 1 year were 63% and 75%, respectively.Conclusions: Employing SBRT for stage I medically inoperable SCLC is rational, with excellent local control and encouraging disease-specific survival. The absence of regional nodal failure supports positron emission tomography for mediastinal staging. Platinum-based CHT may be feasible in vulnerable populations. (C) 2013 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.