Department of Radiation Oncology, Sunnybrook Health Sciences Centre and Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Int J Radiat Oncol Biol Phys. 2011 Feb 1;79(2):459-65. doi: 10.1016/j.ijrobp.2009.11.003. Epub 2010 Apr 10.
To retrospectively review the results of a single-institution series of accelerated hypofractionated radiotherapy for early-stage non-small-cell lung cancer (NSCLC) in patients who are medically inoperable or who refuse surgery.
Peripherally located T1 to T3 N0 M0 tumors were treated with 48 to 60 Gy in 12 to 15 fractions between 1996 and 2007. No elective nodal irradiation was delivered. Patient, tumor, and treatment information was abstracted from the medical records.
A total of 124 tumors were treated in 118 patients (56 male and 62 female). Median age at diagnosis was 76.3 years (range, 49-90 years). In all, 113 patients (95.8%) were not surgical candidates because of medical comorbidities. The 2- and 5-year overall survival (OS) rates were 51.0% and 23.3%, respectively, and the 2- and 5-year cause-specific survival (CSS) rates were 67.6% and 59.8%, respectively. The 2- and 5-year actuarial local control (LC) rates were 76.2% and 70.1%, respectively. Univariate analysis revealed that tumor size less than 3 cm compared with greater than 3 cm resulted in significantly improved OS (40.0% vs. 5.0% at 5 years; p = 0.0002), CSS (69.7% vs. 45.1% at 5 years; p = 0.0461), and a trend toward better LC (82.5% vs. 66.9% at 2 years, 76.6% vs. 60.8% at 5 years; p = 0.0685). Treatment was well tolerated and there were no treatment delays because of acute toxicity.
Accelerated hypofractionated radiotherapy with 48 to 60 Gy using fractions of 4 Gy per day provides very good results for small tumors in medically inoperable patients with early-stage NSCLC.
回顾分析 1996 年至 2007 年间，对因身体状况不适合手术或拒绝手术的局部晚期非小细胞肺癌（NSCLC）患者采用的大分割加速放疗的单中心治疗结果。
采用 4 Gy/次，共 12-15 次，总剂量 48-60 Gy 对 T1-3N0M0 期外周型肿瘤进行治疗。未行选择性淋巴结照射。从病历中提取患者、肿瘤和治疗相关信息。
118 例患者的 124 个肿瘤接受了治疗（男 56 例，女 62 例）。中位诊断年龄为 76.3 岁（49-90 岁）。所有患者（113 例，95.8%）因合并内科疾病而不适合手术。2 年和 5 年总生存率（OS）分别为 51.0%和 23.3%，2 年和 5 年疾病特异性生存率（CSS）分别为 67.6%和 59.8%。2 年和 5 年局部控制率（LC）分别为 76.2%和 70.1%。单因素分析显示，肿瘤直径＜3cm 者的 OS（5 年：40.0% vs. 5.0%；p=0.0002）、CSS（5 年：69.7% vs. 45.1%；p=0.0461）均显著优于直径＞3cm 者，且 LC 也有改善趋势（2 年：82.5% vs. 66.9%；5 年：76.6% vs. 60.8%；p=0.0685）。患者对治疗耐受良好，无因急性毒性反应而导致的治疗延迟。
对于不能手术或拒绝手术的早期 NSCLC 患者，采用 4 Gy/次的大分割加速放疗（总剂量 48-60Gy）治疗小肿瘤，可获得非常好的结果。
