Stereotactic Body Radiotherapy Using a Radiobiology-Based Regimen for Stage I Non-Small-Cell Lung Cancer
Stereotactic Body Radiotherapy Using a Radiobiology-Based Regimen for Stage I Non-Small-Cell Lung Cancer
复制标题
DOI：
10.1097/jto.0000000000000525
复制
发表时间：
2015-06-01
影响因子：
20.4
通讯作者：
Asai, Ryuji
中科院分区：
文献类型：
--
作者：
Shibamoto, Yuta;Hashizume, Chisa;Asai, Ryuji
简介：虽然在日本I期非小细胞肺癌的立体定向体部放疗（SBRT）中最常用的方案是4天内分4次给予48戈伊，但为了控制较大的肿瘤，需要更高的剂量，并且分次间隔应长于24小时以利用再氧合。我们报告我们的研究测试以下方案的最终结果：对于直径小于1.5、1.5-3和大于3 cm的肿瘤，分别给予44、48和52戈伊，分四次给药，间隔时间大于或等于3天。方法：在180例经组织学证实的患者中，120例医学上不可手术，60例可手术。患者的中位年龄为77岁（范围：29-89岁）。SBRT进行了6 MV光子使用四个非共面和三个共面光束。结果：180例患者的5年总生存率为戈伊，60例可手术患者的5年总生存率为66%。肿瘤小于或等于3 cm的5年局部控制率为86%（44/48戈伊），肿瘤大于3 cm的5年局部控制率为73%（52戈伊; p = 0.076）。13%的患者发生≥ 2级放射性肺炎（44/48-戈伊组为10%，52-戈伊组为21%; p = 0.056）。其他2级毒副反应均小于4%。结论：首次前瞻性SBRT研究获得了合理的局部控制率和总生存率，且毒副反应可接受。包括剂量递增在内的方案改进可能会导致更好的结局。
Introduction: Although the protocol of 48 Gy in four fractions over 4 days has been most often employed in stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer in Japan, higher doses are necessary to control larger tumors, and interfraction intervals should be longer than 24 hours to take advantage of reoxygenation. We report the final results of our study testing the following regimen: for tumors less than 1.5, 1.5-3, and greater than 3 cm in diameter, 44, 48, and 52 Gy, respectively, were given in four fractions with interfraction intervals of greater than or equal to 3 days.Methods: Among 180 histologically proven patients entered, 120 were medically inoperable and 60 were operable. The median patient age was 77 years (range, 29-89). SBRT was performed with 6-MV photons using four noncoplanar and three coplanar beams. Isocenter doses of 44, 48, and 52 Gy were given to four, 124, and 52 patients, respectively.Results: The 5-year overall survival rate was 52.2% for all 180 patients and 66% for 60 operable patients. The 5-year local control rate was 86% for tumors less than or equal to 3 cm (44/48 Gy) and 73% for tumors greater than 3 cm (52 Gy; p = 0.076). Grade greater than or equal to 2 radiation pneumonitis developed in 13% (10% for the 44/48-Gy group and 21% for the 52-Gy group; p = 0.056). Other grade 2 toxicities were all less than 4%.Conclusions: Our first prospective SBRT study yielded reasonable local control and overall survival rates and acceptable toxicity. Refinement of the protocol including dose escalation may lead to better outcome.