Stereotactic Radiosurgery/Stereotactic Body Radiotherapy for Recurrent Lung Neoplasm: An Analysis of Outcomes in 100 Patients
Stereotactic Radiosurgery/Stereotactic Body Radiotherapy for Recurrent Lung Neoplasm: An Analysis of Outcomes in 100 Patients
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DOI：
10.1016/j.athoracsur.2015.04.113
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发表时间：
2015-12-01
影响因子：
4.6
通讯作者：
Christie, Neil A.
中科院分区：
文献类型：
--
作者：
Pennathur, Arjun;Luketich, James D.;Christie, Neil A.
背景。尽管进行了完全切除或根治性放化疗，仍有大量患者出现复发或持续性肺癌。立体定向放射外科（SRS）/立体定向全身放射治疗正在成为治疗早期肺肿瘤的重要方式； SRS 还可以为患有复发性肺病的患者提供替代治疗选择。我们对大量患者进行 SRS 治疗复发性肺肿瘤后的结果进行了评估。方法。经过一种或多种既往肺癌治疗后，选定的患有有限复发、持续或进展疾病的患者接受了立体定向放射外科治疗。胸外科医生对所有患者进行评估，在需要时放置基准，并与放射肿瘤学家和医学物理学家密切合作制定治疗计划。根据我们的早期经验，规定单次 20 Gy 辐射，随后分三到五次增加到 45 到 60 Gy。评估的主要终点是总生存率。结果。我们用 SRS 治疗了 100 名复发性肺癌患者（中位年龄 72 岁）。术后30天死亡率为0%；中位随访时间为 51 个月（范围：5 至 123 个月）。整个组的中位总生存期为 23 个月（95% 置信区间：19 至 41）。 2 年和 5 年总生存概率分别为 49%（95% 置信区间：40% 至 60%）和 31%（95% 置信区间：23% 至 43%）。结论。我们的经验表明，SRS 是安全的，并且为特定的复发性寡转移或持续性肺癌患者提供了另一种治疗方式。胸外科医生应积极参与SRS并持续评估这种治疗策略的疗效。 (C) 2015 年，胸外科医师协会
Background. A significant number of patients have recurrent or persistent lung cancer despite complete resection or treatment with definitive chemoradiation. Stereotactic radiosurgery (SRS)/stereotactic body radiation therapy is emerging as an important modality for the treatment of early-stage lung neoplasm; SRS may also offer an alternative treatment option for patients with recurrent lung disease. We evaluated outcomes after treatment with SRS for recurrent lung neoplasm in a large series of patients.Methods. Selected patients with limited recurrent, persistent, or progressive disease after one or more prior treatments for lung cancer were offered SRS. Thoracic surgeons evaluated all patients, placed fiducials when needed, and planned treatment in close collaboration with radiation oncologists and medical physicists. In our early experience, a single fraction of 20 Gy radiation was prescribed and was subsequently increased to 45 to 60 Gy in three to five fractions. The primary endpoint evaluated was overall survival.Results. We treated 100 patients with recurrent lung cancer (median age 72 years) with SRS. The post-procedure 30-day mortality rate was 0%; median follow-up was 51 months (range, 5 to 123). The median overall survival for the entire group was 23 months (95% confidence interval: 19 to 41). The probability of 2-year and 5-year overall survival was 49% (95% confidence interval: 40% to 60%) and 31% (95% confidence interval: 23% to 43%), respectively.Conclusions. Our experience indicates that SRS is safe, and offers an alternative modality for selected patients with recurrent oligometastatic or persistent lung cancer. Thoracic surgeons should actively participate in SRS and continue to evaluate the efficacy of this treatment strategy. (C) 2015 by The Society of Thoracic Surgeons