Risk-adapted stereotactic body radiation therapy for central and ultra-central early-stage inoperable non-small cell lung cancer
Risk-adapted stereotactic body radiation therapy for central and ultra-central early-stage inoperable non-small cell lung cancer
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针对中心型和超中心型早期不可手术非小细胞肺癌的风险适应性立体定向放射治疗
DOI：
10.1111/cas.14185
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发表时间：
2019-09-09
期刊：
影响因子：
5.7
通讯作者：
Yuan, Zhi-Yong
中科院分区：
文献类型：
--
作者：
Meng, Mao-Bin;Wang, Huan-Huan;Yuan, Zhi-Yong
目的：探讨风险适应立体定向全身放射治疗(SBRT)方案对早期中央型和超中央型不能手术的非小细胞肺癌患者的疗效和安全性。从2006年到2015年，80例不能手术的T1-2N0M0非小细胞肺癌患者接受了两种中位剂量水平的治疗：对于中心性病变(即在近端支气管树2厘米范围内，但不毗邻；n=43)，规定60Gy六次(范围，48-60Gy4-8次)，用于中心性病变(即，在近端支气管树2厘米以内，但不毗邻)；对于超中央型病变(即，邻接近端支气管树)，开出56Gy七次(范围，48Gy5-10次)；N=37)。主要终点是总生存期(OS)；次要终点包括无进展生存期(PFS)、肿瘤局部控制率(LC)和毒性。超中心型患者的中位OS和PFS分别为64.47个月和32.10个月，而中央型患者未达到。中央型病变与超中央型病变的局部失败、区域性失败和任何远距离失败的中位时间分别为：27.37个月对26.07个月，20.90个月对12.53个月，20.85个月对15.53个月，均P<；0.05。多因素分析显示，肿瘤分类(超中心)和计划靶区体积=52.76毫升分别是OS、PFS和LC的不良预后因素(均P&t；0.05)。除1例5级毒性外，其余毒性均为1-2级。我们的结果表明，与中央型患者相比，超中央型肿瘤的OS、PFS和LC较差，这是因为使用了风险适应的SBRT计划，允许同等和有利的毒副作用。
To determine the therapeutic efficacy and safety of risk-adapted stereotactic body radiation therapy (SBRT) schedules for patients with early-stage central and ultra-central inoperable non-small cell lung cancer. From 2006 to 2015, 80 inoperable T1-2N0M0 NSCLC patients were treated with two median dose levels: 60 Gy in six fractions (range, 48-60 Gy in 4-8 fractions) prescribed to the 74% isodose line (range, 58%-79%) for central lesions (ie within 2 cm of, but not abutting, the proximal bronchial tree; n = 43), and 56 Gy in seven fractions (range, 48-60 Gy in 5-10 fractions) prescribed to the 74% isodose line (range, 60%-80%) for ultra-central lesions (ie abutting the proximal bronchial tree; n = 37) on consecutive days. Primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS), tumor local control rate (LC), and toxicity. Median OS and PFS were 64.47 and 32.10 months (respectively) for ultra-central patients, and not reached for central patients. Median time to local failure, regional failure, and any distant failures for central versus ultra-central lesions were: 27.37 versus 26.07 months, 20.90 versus 12.53 months, and 20.85 versus 15.53 months, respectively, all P < .05. Multivariate analyses showed that tumor categorization (ultra-central) and planning target volume >= 52.76 mL were poor prognostic factors of OS, PFS, and LC, respectively (all P < .05). There was one grade 5 toxicity; all other toxicities were grade 1-2. Our results showed that ultra-central tumors have a poor OS, PFS, and LC compared with central patients because of the use of risk-adapted SBRT schedules that allow for equal and favorable toxicity profiles.