Stereotactic body radiotherapy for patients with non-small-cell lung cancer using RapidArc delivery and a steep dose gradient: prescription of 60% isodose line of maximum dose fitting to the planning target volume
Stereotactic body radiotherapy for patients with non-small-cell lung cancer using RapidArc delivery and a steep dose gradient: prescription of 60% isodose line of maximum dose fitting to the planning target volume
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DOI：
10.1093/jrr/rry112
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发表时间：
2019-05-01
影响因子：
2
通讯作者：
Kunieda, Etsuo
中科院分区：
文献类型：
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作者：
Tsurugai, Yuichiro;Takeda, Atsuya;Kunieda, Etsuo
我们对早期非小细胞肺癌患者使用RapidArc和风险适应的60%等剂量计划进行立体定向全身放射治疗的结果进行了回顾性调查，包括肺部毒性。我们评估了2011至2017年间分期为cT1a-2bN0M0的患者，总剂量为40-60Gy，分五次治疗，最大剂量的60%等剂量线包围了具有治疗意图的计划目标体积。使用年龄调整的Charlson共病指数(AACCI)对合并症和年龄进行评级。研究与总生存期(OS)相关的因素。共有237名患者、250个皮损符合条件。中位随访时间为28.0个月。术后3年局部复发率为0.8%，无1例发生孤立局部复发。3年OS、肺癌死亡和合并疾病死亡分别为72.7%、8.2%和19.1%。对OS、AACCI和[18F]-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描的最大标准摄取值进行多因素相关分析仍有显著意义。3级毒性仅限于6名患者(2.4%)的放射性肺炎(4名3级患者和2名5级患者)。其中，3名患者患有特发性间质性肺炎。总剂量与3级放射性肺炎的发生率无关(P=0.69)。使用60%等剂量处方和RapidArc，可在毒性可接受的情况下实现最大限度的局部控制。尽管OS可能取决于患者的背景，但旨在提高局部控制率的剂量递增对医学上不能手术的患者可能是有益的。
We retrospectively investigated outcomes, including pulmonary toxicities, of stereotactic body radiation therapy using RapidArc and a risk-adapted 60% isodose plan for early-stage non-small-cell lung cancer patients. We evaluated patients staged as cT1a-2bN0M0 between 2011 and 2017 and treated with a total dose of 40-60 Gy in five fractions to the 60% isodose line of the maximum dose encompassing the planning target volume with curative intent. Comorbidities and age were rated using an age-adjusted Charlson comorbidity index (AACCI). Factors associated with overall survival (OS) were investigated. A total of 237 patients with 250 lesions were eligible. The median follow-up was 28.0 months. The local recurrence rate at 3 years was 0.8%; none of the patients developed isolated local recurrence. OS, deaths from lung cancer, and deaths from intercurrent disease at 3 years were 72.7%, 8.2% and 19.1%, respectively. On multivariate analysis for correlating factors with OS, AACCI and maximal standardized uptake value on [18F]-fluorodeoxyglucose positron emission tomography/computed tomography remained significant. Grade 3 toxicities were limited to radiation pneumonitis in six (2.4%) patients (Grade 3 in four patients and Grade 5 in two patients). Among those, three patients had idiopathic interstitial pneumonia. The total dose was unrelated to the incidence of Grade 3 radiation pneumonitis (P = 0.69). Using the 60% isodose prescription and RapidArc, maximal local control was achieved with acceptable toxicities. Although the OS may depend on patient background, dose escalation aiming at higher local control can be beneficial for medically inoperable patients.