High-Dose Hypofractionated Proton Beam Radiation Therapy Is Safe and Effective for Central and Peripheral Early-Stage Non-Small Cell Lung Cancer: Results of a 12-Year Experience at Loma Linda University Medical Center
High-Dose Hypofractionated Proton Beam Radiation Therapy Is Safe and Effective for Central and Peripheral Early-Stage Non-Small Cell Lung Cancer: Results of a 12-Year Experience at Loma Linda University Medical Center
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DOI：
10.1016/j.ijrobp.2013.05.002
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发表时间：
2013-08-01
影响因子：
7
通讯作者：
Slater, Jerry D.
中科院分区：
文献类型：
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作者：
Bush, David A.;Cheek, Gregory;Slater, Jerry D.
目的：我们更新了之前关于使用大分割质子束放射治疗早期肺癌患者的报告。方法和材料：符合条件的受试者患有活检证实的非小细胞肺癌，并且因医学原因无法手术或拒绝手术。临床检查需要 T1 或 T2、N0、M0 分期。受试者仅接受原发肿瘤的大分割质子束治疗。给药剂量从 51 Gy 依次递增至 60 Gy，然后在 2 周内分 10 次递增至 70 Gy。终点包括毒性、肺功能、总生存期 (OS)、疾病特异性生存期 (DSS) 和局部控制 (LC)。 结果：对 111 名受试者的治疗结果进行了分析。患者群体具有以下平均特征；年龄73.2岁，肿瘤大小3.6厘米，1秒用力呼气量1.33升。随着剂量水平（51、60 和 70 Gy）的增加，整个组的 OS 有所改善，4 年 OS 分别为 18%、32% 和 51% (P = .006)。 4 年时，外周 T1 肿瘤的 LC 为 96%，DSS 为 88%，OS 为 60%。 T2 肿瘤患者在 70 Gy 剂量水平下表现出 LC 和生存率改善的趋势。在多变量分析中，较大的肿瘤尺寸与局部复发增加和生存率降低密切相关。中心位置与外围位置与任何结果指标均不相关。临床放射性肺炎未被发现是显着的并发症，并且没有患者在放射性肺炎治疗后需要类固醇治疗。治疗1年后肺功能保持良好。结论：大剂量大分割质子治疗对于周围型或中心型肺癌取得了良好的疗效。我们机构已采用 70 Gy 方案作为 T1 肿瘤的标准治疗方法。较大的 T2 肿瘤显示出通过更高剂量改善结果的趋势，这表明强化治疗可以看到更好的结果。 (C) 2013 爱思唯尔公司
Purpose: We update our previous reports on the use of hypofractionated proton beam radiation therapy for early-stage lung cancer patients.Methods and Materials: Eligible subjects had biopsy-proven non-small cell carcinoma of the lung and were medically inoperable or refused surgery. Clinical workup required staging of T1 or T2, N0, M0. Subjects received hypofractionated proton beam therapy to the primary tumor only. The dose delivered was sequentially escalated from 51 to 60 Gy, then to 70 Gy in 10 fractions over 2 weeks. Endpoints included toxicity, pulmonary function, overall survival (OS), disease-specific survival (DSS), and local control (LC).Results: One hundred eleven subjects were analyzed for treatment outcomes. The patient population had the following average characteristics; age 73.2 years, tumor size 3.6 cm, and 1.33 L forced expiratory volume in 1 second. The entire group showed improved OS with increasing dose level (51, 60, and 70 Gy) with a 4-year OS of 18%, 32%, and 51%, respectively (P = .006). Peripheral T1 tumors exhibited LC of 96%, DSS of 88%, and OS of 60% at 4 years. Patients with T2 tumors showed a trend toward improved LC and survival with the 70-Gy dose level. On multivariate analysis, larger tumor size was strongly associated with increased local recurrence and decreased survival. Central versus peripheral location did not correlate with any outcome measures. Clinical radiation pneumonitis was not found to be a significant complication, and no patient required steroid therapy after treatment for radiation pneumonitis. Pulmonary function was well maintained 1 year after treatment.Conclusions: High-dose hypofractionated proton therapy achieves excellent outcomes for lung carcinomas that are peripherally or centrally located. The 70-Gy regimen has been adopted as standard therapy for T1 tumors at our institution. Larger T2 tumors show a trend toward improved outcomes with higher doses, suggesting that better results could be seen with intensified treatment. (C) 2013 Elsevier Inc.