对医学上无法手术的 I 期肺癌患者进行立体定向体部放疗（SBRT）后肺功能测试（PFT）变化的综合分析。
Comprehensive analysis of pulmonary function Test (PFT) changes after stereotactic body radiotherapy (SBRT) for stage I lung cancer in medically inoperable patients.
作者信息
Stephans Kevin L, Djemil Toufik, Reddy Chandana A, Gajdos Stephen M, Kolar Mathew, Machuzak Michael, Mazzone Peter, Videtic Gregory M M
机构信息
Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
出版信息
J Thorac Oncol. 2009 Jul;4(7):838-44. doi: 10.1097/JTO.0b013e3181a99ff6.
BACKGROUND
To assess for variables predicting pulmonary function test (PFT) changes after stereotactic body radiotherapy (SBRT) for medically inoperable stage I lung cancer.
METHODS
We reviewed 92 consecutive patients undergoing SBRT for stage I lung cancer between February 2004 and August 2007. A total of 102 lesions were treated using prescriptions of 20 Gy x 3 (n = 40), 10 Gy x 5 (n = 56), and 5 Gy x 10 (n = 6). Institutional practice was 10 Gy x 5 before March 1, 2006 before changing to 20 Gy x 3 to conform to RTOG 0236 unless otherwise dictated clinically.
RESULTS
Median pretreatment forced expiratory volume at 1 second (FEV1) was 1.21 liter (50% of predicted) and median diffusion capacity to carbon monoxide (DLCO) was 56.5. There was no significant overall change in PFT's after SBRT. Individual patients experienced both substantial improvements and declines (10% declined at least 14% predicted FEV1% and 19% predicted DLCO). The mean change in FEV1 was -0.05 liter (range, -0.98 to +1.29 liter; p = 0.22) representing -1.88% predicted baseline FEV1 (range, -33 to + 43%; p = 0.62). DLCO declined 2.59% of predicted (range, -37 to +33%; p = 0.27). Conformality index, V5 and V10 were associated with individual patient changes in FEV1% (p = 0.033, p = 0.0036, p = 0.025, respectively), however, correlations were small and overall treatment dose did not predict for changes (p = 0.95). There was no significant difference in FEV1 (p = 0.55) or FEV1% (p = 0.37) changes for central versus peripheral locations. No factors predicted for individual changes in DLCO. Patients with FEV1% below the median of the study population had significantly longer overall survival (p = 0.0065). Although patients dying of cardiac disease died earlier than those dying of other causes, FEV1% below median was not associated with a lower risk of dying of cardiac disease or with lower Charlson comorbidity index.
CONCLUSIONS
(1) SBRT was well tolerated and PFT changes were minimal. (2) Central lesions were safely treated with 50 Gy.
背景
评估立体定向体部放疗（SBRT）治疗医学上无法手术的Ⅰ期肺癌后预测肺功能测试（PFT）变化的变量。
方法
我们回顾了2004年2月至2007年8月期间连续接受SBRT治疗的92例Ⅰ期肺癌患者。总共102个病灶接受了20 Gy×3（n = 40）、10 Gy×5（n = 56）和5 Gy×10（n = 6）的处方剂量治疗。2006年3月1日前机构的治疗方案是10 Gy×5，之后改为20 Gy×3以符合RTOG 0236，除非临床另有指示。
结果
治疗前1秒用力呼气容积（FEV1）的中位数为1.21升（预测值的50%），一氧化碳弥散量（DLCO）的中位数为56.5。SBRT后PFT没有显著的总体变化。个别患者的肺功能既有显著改善也有下降（10%的患者FEV1至少下降了预测值的14%，DLCO下降了预测值的19%）。FEV1的平均变化为-0.05升（范围为-0.98至+1.29升；p = 0.22），相当于预测基线FEV1的-1.88%（范围为-33至+43%；p = 0.62）。DLCO下降了预测值的2.59%（范围为-3�至+33%；p = 0.27）。适形指数、V5和V10与个体患者FEV1%的变化相关（分别为p = 0.033、p = 0.0036、p = 0.025），然而，相关性较小，且总体治疗剂量不能预测变化情况（p = 0.95）。中央型与周围型病变在FEV1（p = 0.55）或FEV1%（p = 0.37）变化方面无显著差异。没有因素可预测DLCO的个体变化。FEV1%低于研究人群中位数的患者总生存期显著更长（p = 0.0065）。尽管死于心脏病的患者比死于其他原因的患者死亡更早，但FEV1%低于中位数与死于心脏病的风险较低或Charlson合并症指数较低无关。
结论
（1）SBRT耐受性良好，PFT变化最小。（2）中央型病变用50 Gy的剂量可安全治疗。
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