Department of Radiation Oncology, Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, CA 92093-0843, USA.
Clin Lung Cancer. 2009 Nov;10(6):433-7. doi: 10.3816/CLC.2009.n.081.
Surgical resection for stage I non-small-cell lung cancer (NSCLC) is not always feasible because of the high likelihood of medical comorbidity in this patient population. We report our experience using conventional and hypofractionated radiation therapy schedules with a conformal approach.
Between 1991 and 2006, 102 patients with medically or otherwise inoperable stage T1/T2 N0 NSCLC were treated with curative radiation therapy alone at our institution. Patients received a median total dose of 6600 cGy, with median daily dose fractions of 250 cGy. The following outcomes were analyzed: local failure-free survival (LFFS; time to local failure or death from any cause), time to local or distal failure or death as first event, and overall survival (OS). Local failure was defined as an increase in size on imaging studies. Toxicities were evaluated using Common Terminology Criteria for Adverse Events, version 3.0.
Median follow-up was 20.9 months (range, 4.0-138.9 months). Median LFFS was 21.2 months (95% CI, 17.3-27.2 months), and median OS was 21.3 months (95% CI, 17.9-28.8 months). Analysis of competing risks showed that at 5 years, the probability of local failure as the first detected event was 15.1% (95% CI, 8.5%-23.4%), the probability of distal failure as the first detected event was 18% (95% CI, 10.9%-26.5%), and the probability of death without recording a failure was 51.6% (95% CI, 40.6%-61.5%). No patients experienced grade >or= 4 toxicity, and only 4 patients experienced grade 3 toxicity.
Conformal radiation therapy is an effective and safe alternative to surgery for selected patients with stage I NSCLC.
由于该患者人群中存在较高的合并症可能性，因此并非总是可以进行 I 期非小细胞肺癌（NSCLC）的手术切除。我们报告了使用常规和适形分割放射治疗方案的经验。
1991 年至 2006 年期间，我们机构治疗了 102 名患有不可手术的 I 期 T1/T2 N0 NSCLC 的患者，这些患者接受了单纯的根治性放射治疗。患者接受了中位数为 6600 cGy 的总剂量，中位数日剂量分为 250 cGy。分析了以下结果：局部无失败生存率（LFFS；局部失败或任何原因死亡的时间），局部或远处失败或死亡的首次事件时间，以及总生存率（OS）。局部失败定义为影像学检查中肿瘤增大。使用不良事件通用术语标准，版本 3.0 评估毒性。
中位随访时间为 20.9 个月（范围，4.0-138.9 个月）。中位 LFFS 为 21.2 个月（95%CI，17.3-27.2 个月），中位 OS 为 21.3 个月（95%CI，17.9-28.8 个月）。竞争风险分析表明，5 年后，局部失败作为首次检测事件的概率为 15.1%（95%CI，8.5%-23.4%），远处失败作为首次检测事件的概率为 18%（95%CI，10.9%-26.5%），无失败记录的死亡概率为 51.6%（95%CI，40.6%-61.5%）。没有患者发生>或=4 级毒性，只有 4 例患者发生 3 级毒性。
对于选定的 I 期 NSCLC 患者，适形放射治疗是手术的有效且安全的替代方法。
