Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2010 Nov 1;78(3):651-8. doi: 10.1016/j.ijrobp.2009.08.068. Epub 2010 Mar 6.
To assess clinical outcomes and complications in patients with non-small-cell lung cancer (NSCLC) treated with helical tomotherapy (HT) with or without chemotherapy.
Data from 37 NSCLC patients treated between January 2007 and August 2008 were analyzed retrospectively. Twenty-eight patients had Stage III disease. Concurrent and neoadjuvant chemotherapy was given to 24 and 14 patients, respectively. Radiotherapy was delivered to a total dose of 60-70.4 Gy at 2.0-2.4 Gy per fraction to the gross tumor volume and 50-64 Gy at 1.8-2.0 Gy per fraction to the planning target volume.
With a median follow-up of 18 months (range, 6-27 months), 2-year local control and overall survival rates were 63% and 56% for all 37 patients, respectively, and were 78% and 75% for the patients with Stage III disease who received concurrent chemoradiotherapy alone. Acute esophagitis and treatment-related pneumonitis (TRP) ≥Grade 3 occurred in 5 and 7 patients, respectively. Four patients died of treatment-related death (TRD) after HT. In univariate analysis, poor performance status, total lung V(5), contralateral lung (CL) V(5), and V(10) were associated with TRD. Only CL V(5) remained significant in the multivariate analysis (p = 0.029).
HT with chemotherapy has shown promising clinical outcomes, esophagitis, and TRPs. However, HT has produced a somewhat high rate of fatal pulmonary complications. Our data suggest that CL V(5) should be considered and kept as low as possible (<60%) in addition to the conventional dosimetric factors.
评估接受螺旋断层放疗（HT）联合或不联合化疗的非小细胞肺癌（NSCLC）患者的临床结果和并发症。
回顾性分析了 2007 年 1 月至 2008 年 8 月期间治疗的 37 例 NSCLC 患者的数据。28 例患者患有 III 期疾病。24 例患者接受同步化疗，14 例患者接受新辅助化疗。放疗总剂量为 60-70.4Gy，每次分割剂量为 2.0-2.4Gy，用于大体肿瘤体积；50-64Gy，每次分割剂量为 1.8-2.0Gy，用于计划靶区。
中位随访时间为 18 个月（范围 6-27 个月），所有 37 例患者的 2 年局部控制率和总生存率分别为 63%和 56%，单独接受同步放化疗的 III 期患者的 2 年局部控制率和总生存率分别为 78%和 75%。5 例患者发生急性食管炎，7 例患者发生治疗相关肺炎（TRP）≥3 级。4 例患者在 HT 后因治疗相关死亡（TRD）而死亡。单因素分析显示，较差的体能状态、全肺 V(5)、对侧肺（CL）V(5)和 V(10)与 TRD 相关。多因素分析仅显示 CL V(5)有显著性（p = 0.029）。
HT 联合化疗显示出有希望的临床结果、食管炎和 TRP。然而，HT 导致致命性肺部并发症的发生率略高。我们的数据表明，除了常规剂量学因素外，还应考虑并尽可能降低 CL V(5)（<60%）。
