Calvo F A, Ortiz de Urbina D, Abuchaibe O, Azinovic I, Aristu J, Santos M, Escude L, Herreros J, Llorens R
Department of Oncology, Clinica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
Int J Radiat Oncol Biol Phys. 1990 Jul;19(1):103-9. doi: 10.1016/0360-3016(90)90141-6.
A phase I-II study of intraoperative radiotherapy (IORT) for Stage III lung cancer was performed in 34 patients during a period of 58 months. Loco-regional treatment included tumor resection if technically feasible, IORT boost of electron beams using moderate single doses (10-15 Gy) to tumor bearing areas and external photon beam irradiation (46-50 Gy in 5 weeks) using conventional fields. Indications for this study were unresectable hiliar tumors (14, 41%), and mediastinal, hiliar and/or chest wall residual disease following resection (20, 59%). Thirty-four procedures, with 40 IORT fields, have been analyzed to describe the relevant technical aspects and the toxicity. IORT was delivered using acrylic transparent cones of different diameters. Surgical approach consisted in a lateral thoracotomy in all patients (21 right side and 13 left side). Tissues included within the IORT field were: tumor or residual tumor tissues (34, 100%), collapsed lung parenchyma and main bronchus not surgically manipulated (14, 41%), bronchial stump and vascular suture following resection (19, 55%), mediastinal structures (20, 58%), and brachial plexus (1, 3%). The bronchial suture was covered with pleural or pericardial flap after IORT in 10 cases (29%). Life threatening toxicity related to IORT consisted in broncho-pleural fistula (1, 3%) and massive hemoptysis (1, 3%). Other reversible toxic events were acute pneumonitis (12, 85%) and esophagitis (10, 50%). Long term asymptomatic lung fibrosis was detected in 11 cases (32%). Median survival time for the entire group has been 12 months. With a median follow-up time of 12 months the freedom from thoracic recurrence rate is 30% (65% in cases with tumor resection). Projected actuarial survival rates at 4 years were 28% for resected group and 7% for unresected cases. This experience supports IORT as a feasible alternative modality to be used in the management of locally advanced lung cancer. Tolerance of thoracic organs to moderate doses of IORT appeared to be adequate and local control is achieved in certain patients. These results deserve further investigation and confirmation trials.
在58个月期间，对34例III期肺癌患者进行了术中放疗（IORT）的I-II期研究。局部区域治疗包括：若技术可行则进行肿瘤切除；对肿瘤部位使用中等单剂量（10 - 15 Gy）电子束进行IORT增强照射；使用传统野进行外照射光子束放疗（5周内46 - 50 Gy）。本研究的适应症为不可切除的肺门肿瘤（14例，41%），以及切除术后纵隔、肺门和/或胸壁残留病灶（20例，59%）。已对34例手术（共40个IORT野）进行分析，以描述相关技术方面及毒性情况。IORT使用不同直径的丙烯酸透明锥体进行照射。所有患者均采用侧开胸手术（21例右侧，13例左侧）。IORT野内包含的组织有：肿瘤或残留肿瘤组织（34例，100%）、未手术处理的萎陷肺实质和主支气管（14例，41%）、切除术后的支气管残端和血管缝线（19例，55%）、纵隔结构（20例，58%）以及臂丛神经（1例，3%）。10例（29%）患者在IORT后用胸膜或心包瓣覆盖支气管缝线。与IORT相关的危及生命的毒性反应包括支气管胸膜瘘（1例，3%）和大量咯血（1例，3%）。其他可逆性毒性事件为急性肺炎（12例，85%）和食管炎（10例，50%）。11例（32%）患者检测到长期无症状性肺纤维化。整个组的中位生存时间为12个月。中位随访时间为12个月时，无胸内复发率为30%（肿瘤切除病例中为65%）。预计切除组4年精算生存率为28%，未切除病例为7%。这一经验支持IORT作为局部晚期肺癌治疗中一种可行的替代方式。胸部器官对中等剂量IORT的耐受性似乎足够，且部分患者实现了局部控制。这些结果值得进一步研究和验证试验。
