Guckenberger Matthias, Heilman Katrin, Wulf Joern, Mueller Gerd, Beckmann Gabriele, Flentje Michael
Department of Radiation Oncology, Julius-Maximilians University, Josef-Schneider-Strasse 11, Wuerzburg, Germany.
Radiother Oncol. 2007 Dec;85(3):435-42. doi: 10.1016/j.radonc.2007.10.044. Epub 2007 Nov 28.
To evaluate the CT morphological pattern of tumor response and pulmonary injury after stereotactic body radiotherapy (SBRT) for early stage non-small lung cancer (NSCLC) and pulmonary metastases.
Seventy patients (lesions n=86) with pulmonary metastases (n=48) or primary early stage NSCLC (n=38) were analyzed. Patients were treated with hypofractionated SBRT (three to eight fractions with a single dose between 6 and 12.5 Gy; n=56) or with radiosurgery (26 Gy; n=30). The pattern and sequence of pulmonary injury and of tumor response was evaluated in 346 follow-up CT studies, 4.9 on average.
Symptomatic pneumonitis was observed in 10% after a median interval of 5 months. No pulmonary reaction was observed in most patients 6 weeks after treatment; spotted-streaky condensations were characteristic between 3 months and 6 months. Dense consolidation and retraction started after 9 months and the fibrotic remodelling process continued for years. Ten targets relapsed after a median of 7 months. At 12 months complete response was seen in 43% and the differentiation of residual tumor from pulmonary reaction was not possible in 33%.
A typical sequence of pulmonary reactions was observed without differences between hypofractionated treatment and radiosurgery. Onset of pneumonitis was later compared to conventionally fractionated radiotherapy.
评估立体定向体部放疗（SBRT）治疗早期非小细胞肺癌（NSCLC）及肺转移瘤后肿瘤反应和肺损伤的CT形态学模式。
分析70例患者（共86个病灶），其中肺转移瘤患者48例，早期原发性NSCLC患者38例。患者接受了大分割SBRT（3至8次分割，单次剂量6至12.5 Gy；n = 56）或放射外科治疗（26 Gy；n = 30）。在346次随访CT研究中评估了肺损伤和肿瘤反应的模式及顺序，平均随访4.9次。
10%的患者在中位间隔5个月后出现症状性肺炎。多数患者在治疗6周后未观察到肺部反应；3个月至6个月期间特征性表现为斑片状条纹状实变。9个月后开始出现致密实变和肺组织牵拉，纤维化重塑过程持续数年。10个靶病灶在中位时间7个月后复发。12个月时43%的患者达到完全缓解，33%的患者无法区分残留肿瘤与肺部反应。
观察到典型的肺部反应序列，大分割治疗与放射外科治疗之间无差异。与传统分割放疗相比，肺炎的发生时间较晚。
