Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA.
Radiother Oncol. 2010 May;95(2):178-84. doi: 10.1016/j.radonc.2010.02.007. Epub 2010 Mar 29.
Elective nodal irradiation (ENI) and involved field radiotherapy (IFRT) are definitive radiotherapeutic approaches used to treat patients with locally advanced non-small cell lung cancer (NSCLC). ENI delivers prophylactic radiation to clinically uninvolved lymph nodes, while IFRT only targets identifiable gross nodal disease. Because clinically uninvolved nodal stations may harbor microscopic disease, IFRT raises concerns for increased nodal failures. This retrospective cohort analysis evaluates failure rates and treatment-related toxicities in patients treated at a single institution with ENI and IFRT.
We assessed all patients with stage III locally advanced or stage IV oligometastatic NSCLC treated with definitive radiotherapy from 2003 to 2008. Each physician consistently treated with either ENI or IFRT, based on their treatment philosophy.
Of the 108 consecutive patients assessed (60 ENI vs. 48 IFRT), 10 patients had stage IV disease and 95 patients received chemotherapy. The median follow-up time for survivors was 18.9 months. On multivariable logistic regression analysis, patients treated with IFRT demonstrated a significantly lower risk of high grade esophagitis (Odds ratio: 0.31, p = 0.036). The differences in 2-year local control (39.2% vs. 59.6%), elective nodal control (84.3% vs. 84.3%), distant control (47.7% vs. 52.7%) and overall survival (40.1% vs. 43.7%) rates were not statistically significant between ENI vs. IFRT.
Nodal failure rates in clinically uninvolved nodal stations were not increased with IFRT when compared to ENI. IFRT also resulted in significantly decreased esophageal toxicity, suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients.
选择性淋巴结照射（ENI）和累及野放疗（IFRT）是治疗局部晚期非小细胞肺癌（NSCLC）的明确放疗方法。ENI 对临床未受累的淋巴结进行预防性放疗，而 IFRT 仅针对可识别的大体淋巴结疾病。由于临床未受累的淋巴结站可能存在微观疾病，IFRT 增加了淋巴结失败的风险。本回顾性队列分析评估了单一机构采用 ENI 和 IFRT 治疗的患者的失败率和治疗相关毒性。
我们评估了 2003 年至 2008 年期间接受根治性放疗的所有局部晚期 III 期或 IV 期寡转移 NSCLC 患者。每位医生根据其治疗理念，一致采用 ENI 或 IFRT 治疗。
在评估的 108 例连续患者中（60 例 ENI 与 48 例 IFRT），10 例患者患有 IV 期疾病，95 例患者接受了化疗。幸存者的中位随访时间为 18.9 个月。在多变量逻辑回归分析中，接受 IFRT 治疗的患者发生高级别食管炎的风险显著降低（优势比：0.31，p = 0.036）。ENI 与 IFRT 之间，2 年局部控制率（39.2% vs. 59.6%）、选择性淋巴结控制率（84.3% vs. 84.3%）、远处控制率（47.7% vs. 52.7%）和总生存率（40.1% vs. 43.7%）的差异无统计学意义。
与 ENI 相比，IFRT 并未增加临床未受累淋巴结站的淋巴结失败率。IFRT 还导致食管毒性显著降低，这表明 IFRT 可能允许更大比例的患者同时接受系统化疗。
