Coon Devin, Gokhale Abhay S, Burton Steven A, Heron Dwight E, Ozhasoglu Cihat, Christie Neil
Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, USA.
Clin Lung Cancer. 2008 Jul;9(4):217-21. doi: 10.3816/CLC.2008.n.032.
The aim of this study was to assess the outcomes of patients treated with stereotactic body radiation therapy (SBRT) in patients with primary, recurrent, or metastatic lung lesions, with a focus on positron emission tomography (PET)/computed tomography (CT)-based management.
Fifty-one patients with primary stage I non-small-cell lung cancer (NSCLC; n = 26), recurrent lung cancer after definitive treatment (n = 12), or solitary lung metastases (n = 13) were treated with SBRT between 2005 and 2007. Patients were treated with the CyberKnife Robotic Radiosurgery System with Synchrony respiratory tracking. A dose of 60 Gy was delivered in 3 fractions. All patients had CT or PET/CT performed at approximately 3-month intervals after treatment.
The median follow-up was 12 months. Local control at median follow-up was 85% in patients with stage I NSCLC, 92% in patients with recurrent lung cancer, and 62% in the patients with solitary lung metastasis. Analysis of the 28 patients with pre- and post-treatment PET/CT scans demonstrated that those with stable disease (n = 4) had a mean standardized uptake value (SUV) decrease of 28%, partial responders (n = 11) had a decrease of 48%, and patients with a complete response (n = 11) had a decrease of 94%. Patients with progressive disease (n = 2) had an SUV decrease of only 0.4%. Only 2 patients (7%) who had reduced fluorodeoxyglucose avidity later progressed locally. No correlations were found between pretreatment SUV and tumor response, disease progression, or survival. Overall 1-year survival rates were 81%, 67%, and 85% among the patients with primary NSCLC, recurrent lung cancer, and solitary lung metastases, respectively.
Stereotactic body radiation therapy with CyberKnife is an effective treatment for patients with medically inoperable recurrent or metastatic lung cancer. Positron emission tomography/CT is valuable in staging, planning, and evaluating treatment response and might predict long-term outcome.
本研究旨在评估立体定向体部放射治疗（SBRT）对原发性、复发性或转移性肺部病变患者的治疗效果，重点关注基于正电子发射断层扫描（PET）/计算机断层扫描（CT）的管理。
2005年至2007年间，51例患者接受了SBRT治疗，其中包括26例I期原发性非小细胞肺癌（NSCLC）、12例根治性治疗后复发性肺癌以及13例孤立性肺转移瘤患者。患者使用带有同步呼吸追踪功能的射波刀机器人放射外科系统进行治疗。分3次给予60 Gy的剂量。所有患者在治疗后约每3个月进行一次CT或PET/CT检查。
中位随访时间为12个月。I期NSCLC患者中位随访时的局部控制率为85%，复发性肺癌患者为92%，孤立性肺转移瘤患者为62%。对28例治疗前后进行PET/CT扫描的患者分析显示，病情稳定（n = 4）的患者平均标准化摄取值（SUV）下降28%，部分缓解者（n = 11）下降48%，完全缓解患者（n = 11）下降94%。疾病进展患者（n = 2）的SUV仅下降0.4%。仅有2例（7%）氟脱氧葡萄糖摄取降低的患者随后出现局部进展。治疗前SUV与肿瘤反应、疾病进展或生存之间未发现相关性。原发性NSCLC、复发性肺癌和孤立性肺转移瘤患者的1年总生存率分别为81%、67%和85%。
射波刀立体定向体部放射治疗是治疗医学上无法手术的复发性或转移性肺癌患者的有效方法。正电子发射断层扫描/CT在分期、治疗计划制定以及评估治疗反应方面具有重要价值，并且可能预测长期预后。
