Department of Radiation Oncology, MAASTRO Clinic, Maastricht, The Netherlands.
Radiother Oncol. 2011 Nov;101(2):260-6. doi: 10.1016/j.radonc.2011.09.012. Epub 2011 Nov 5.
To assess toxicity and feasibility of reirradiation with stereotactic body radiotherapy (SBRT) after prior lung SBRT for primary lung cancer or lung metastases.
Twenty-nine patients reirradiated with SBRT on 32 lung lesions (11 central, 21 peripheral) were retrospectively reviewed. Median follow-up time was 12 months (range 1-97). The primary endpoint was toxicity, secondary endpoints were local control and overall survival time. Toxicity was scored according to the NCI-CTCAE version 3.
Grade 3-4 toxicity was scored 14 times in eight patients. Three patients died because of massive bleeding (grade 5). Larger clinical target volumes (CTV) and central tumour localization were associated with more severe toxicity. There was no correlation between mean lung dose (MLD) and lung toxicity. Local control at 5 months after reirradiation was 52%, as assessed by CT-scan (n=12) or X-thorax (n=3). A larger CTV was associated with poorer local control. Kaplan-Meier estimated 1- and 2-year survival rates were 59% and 43%, respectively.
Reirradiation with SBRT is feasible although increased risk of toxicity was reported in centrally located tumours. Further research is warranted for more accurate selection of patients suitable for reirradiation with SBRT.
评估在原发性肺癌或肺转移瘤行立体定向体部放疗（SBRT）后再次行 SBRT 的毒性和可行性。
回顾性分析 29 例在 32 个肺部病变（11 个中央，21 个周围）中接受 SBRT 再放疗的患者。中位随访时间为 12 个月（范围 1-97）。主要终点是毒性，次要终点是局部控制和总生存时间。毒性根据 NCI-CTCAE 第 3 版进行评分。
8 例患者中有 14 次出现 3-4 级毒性。3 例患者因大出血（5 级）死亡。较大的临床靶区（CTV）和中央肿瘤定位与更严重的毒性相关。平均肺剂量（MLD）与肺毒性之间无相关性。再放疗后 5 个月的 CT 扫描（n=12）或 X 线胸片（n=3）评估的局部控制率为 52%。CTV 越大，局部控制越差。Kaplan-Meier 估计的 1 年和 2 年生存率分别为 59%和 43%。
SBRT 再放疗是可行的，尽管中央肿瘤的毒性风险增加。需要进一步研究，以更准确地选择适合 SBRT 再放疗的患者。
