Department of Radiation Oncology, William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI 48073, USA.
J Clin Oncol. 2010 Feb 20;28(6):928-35. doi: 10.1200/JCO.2009.25.0928. Epub 2010 Jan 11.
PURPOSE To compare outcomes between lung stereotactic radiotherapy (SBRT) and wedge resection for stage I non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS One hundred twenty-four patients with T1-2N0 NSCLC underwent wedge resection (n = 69) or image-guided lung SBRT (n = 58) from February 2003 through August 2008. All were ineligible for anatomic lobectomy; of those receiving SBRT, 95% were medically inoperable, with 5% refusing surgery. Mean forced expiratory volume in 1 second and diffusing capacity of lung for carbon monoxide were 1.39 L and 12.0 mL/min/mmHg for wedge versus 1.31 L and 10.14 mL/min/mmHg for SBRT (P = not significant). Mean Charlson comorbidity index and median age were 3 and 74 years for wedge versus 4 and 78 years for SBRT (P < .01, P = .04). SBRT was volumetrically prescribed as 48 (T1) or 60 (T2) Gy in four to five fractions. Results Median potential follow-up is 2.5 years. At 30 months, no significant differences were identified in regional recurrence (RR), locoregional recurrence (LRR), distant metastasis (DM), or freedom from any failure (FFF) between the two groups (P > .16). SBRT reduced the risk of local recurrence (LR), 4% versus 20% for wedge (P = .07). Overall survival (OS) was higher with wedge but cause-specific survival (CSS) was identical. Results excluding synchronous primaries, nonbiopsied tumors, or pathologic T4 disease (wedge satellite lesion) showed reduced LR (5% v 24%, P = .05), RR (0% v 18%, P = .07), and LRR (5% v 29%, P = .03) with SBRT. There were no differences in DM, FFF, or CSS, but OS was higher with wedge. CONCLUSION Both lung SBRT and wedge resection are reasonable treatment options for stage I NSCLC patients ineligible for anatomic lobectomy. SBRT reduced LR, RR, and LRR. In this nonrandomized population of patients selected for surgery versus SBRT (medically inoperable) at physician discretion, OS was higher in surgical patients. SBRT and surgery, however, had identical CSS.
比较Ⅰ期非小细胞肺癌（NSCLC）患者行立体定向放疗（SBRT）与楔形切除术的疗效。
2003 年 2 月至 2008 年 8 月，124 例 T1-2N0 NSCLC 患者接受楔形切除术（n=69）或图像引导下肺部 SBRT（n=58）。所有患者均不适合行解剖性肺叶切除术；SBRT 组中，95%为不能手术的患者，5%拒绝手术。楔形切除术组的平均用力呼气 1 秒量（FEV1）和一氧化碳弥散量（DLCO）分别为 1.39 L 和 12.0 毫升/分/毫米汞柱，SBRT 组分别为 1.31 L 和 10.14 毫升/分/毫米汞柱（P=无显著差异）。楔形切除术组的平均 Charlson 合并症指数和中位年龄分别为 3 和 74 岁，SBRT 组分别为 4 和 78 岁（P<0.01，P=0.04）。SBRT 按 4 至 5 个分次给予 48（T1）或 60（T2）Gy 的容积剂量。
中位潜在随访时间为 2.5 年。30 个月时，两组间局部区域复发（RR）、局部区域复发（LRR）、远处转移（DM）或无任何失败（FFF）的差异均无统计学意义（P>0.16）。SBRT 降低了局部复发（LR）的风险，楔形切除术组为 4%，SBRT 组为 20%（P=0.07）。楔形切除术组的总生存（OS）更高，但与病因特异性生存（CSS）相同。排除同步原发性疾病、未行活检的肿瘤或病理性 T4 疾病（楔形切除术卫星病变）后，SBRT 组的 LR（5%对 24%，P=0.05）、RR（0%对 18%，P=0.07）和 LRR（5%对 29%，P=0.03）降低。两组间 DM、FFF 或 CSS 差异无统计学意义，但楔形切除术组 OS 更高。
对于不适合行解剖性肺叶切除术的Ⅰ期 NSCLC 患者，肺部 SBRT 和楔形切除术均为合理的治疗选择。SBRT 降低了 LR、RR 和 LRR。在这组非随机患者中，医生根据患者的具体情况选择手术或 SBRT（不能手术），手术患者的 OS 更高。然而，SBRT 和手术的 CSS 相同。
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