Department of Radiation Oncology, School of Medicine, University of California, San Francisco, California 94115, USA.
J Thorac Oncol. 2011 Nov;6(11):1857-64. doi: 10.1097/JTO.0b013e318229a41e.
For patients with stage III non-small cell lung cancer treated with induction chemotherapy (ICT), delayed initiation of subsequent radiotherapy (RT) may allow for repopulation in the interval between treatment modalities and during the early phase of RT. We quantified the impact of postinduction RT timing by evaluating the pace of tumor regrowth.
Institutionally approved retrospective review identified 21 analyzable patients with stage III non-small cell lung cancer who had platinum-based ICT followed by RT+/- chemotherapy from 2002 to 2009. Radiographic response was determined by RECIST criteria and the volume of the single largest tumor mass on the pre-ICT, post-ICT, and RT-planning computed tomography scans.
After ICT, the median percent volume change from pre-ICT baseline was -41% (range -86 to +86%). By the RT-planning computed tomography scan, the median percent volume change from the post-ICT timepoint was +40% (range -11 to +311%) and the median volume change was +20 ml (range -4 to 102 ml); these changes were significant (p = 0.0002). Similar results were seen for tumor diameter. A correlation was observed between the amount of delay and degree of regrowth for percent volume (p = 0.0006) and percent diameter change (p = 0.003). A delay greater than 21 days produced greater increases in percent volume change (p = 0.002) and percent diameter (p = 0.055) than lesser delays.
After ICT, tumor regrowth can occur within a few weeks. Radiation treatment planning should begin as soon as possible after the administration of ICT to maximize the benefits of cytoreduction.
对于接受诱导化疗（ICT）治疗的 III 期非小细胞肺癌患者，随后延迟开始放疗（RT）可能会允许在治疗方式之间的间隔期间和 RT 的早期阶段发生细胞再增殖。我们通过评估肿瘤再生长的速度来量化诱导后 RT 时间的影响。
机构批准的回顾性研究确定了 21 名可分析的 III 期非小细胞肺癌患者，他们在 2002 年至 2009 年间接受了基于铂类的 ICT 治疗，随后进行了 RT+/-化疗。通过 RECIST 标准和 ICT 前、ICT 后和 RT 计划 CT 扫描上的单个最大肿瘤质量的体积来确定放射学反应。
在 ICT 之后，从 ICT 基线的中位数百分比体积变化为 -41%（范围 -86 至 +86%）。在 RT 计划 CT 扫描时，从 ICT 时间点的中位数百分比体积变化为 +40%（范围 -11 至 +311%），中位数体积变化为+20 ml（范围 -4 至 102 ml）；这些变化具有统计学意义（p = 0.0002）。对于肿瘤直径也观察到类似的结果。观察到延迟量与体积百分比变化（p = 0.0006）和直径百分比变化（p = 0.003）之间存在相关性。延迟时间大于 21 天会导致体积百分比变化（p = 0.002）和直径百分比（p = 0.055）的增加更大。
在 ICT 之后，肿瘤可能在几周内发生再生长。为了最大限度地发挥细胞减灭的益处，应在 ICT 给药后尽快开始进行放射治疗计划。
