Department of Radiation Oncology, Tsukuba University, Ibaraki, Japan.
J Thorac Oncol. 2012 Feb;7(2):370-5. doi: 10.1097/JTO.0b013e31823c485f.
This study was performed retrospectively to evaluate the outcome of patients with stage III non-small cell lung cancer (NSCLC) after proton beam therapy (PBT) alone.
The subjects were 57 patients with histologically confirmed NSCLC (stage IIIA/IIIB: 24/33) who received PBT without concurrent chemotherapy. The cohort included 32 cases of squamous cell carcinoma, 18 adenocarcinoma, and 7 non-small cell carcinoma. Lymph node metastases were N0 7, N1 5, N2 30, and N3 15. Planned total doses ranged from 50 to 84.5 GyE (median, 74 GyE).
Planned treatment was completed in 51 patients (89%). At the time of analysis, 20 patients were alive, and the median follow-up periods were 16.2 months for all patients and 22.2 months for survivors. The median overall survival period was 21.3 months (95% confidence interval: 14.2-28.4 months), and the 1- and 2-year overall survival rates were 65.5% (52.9-78.0%) and 39.4% (25.3-53.5%), respectively. Disease progression occurred in 38 patients, and the 1- and 2-year progression-free survival rates were 36.2% (23.1-49.4%) and 24.9% (12.7-37.2%), respectively. Local recurrence was observed in 13 patients, and the 1- and 2-year local control rates were 79.1% (66.8-91.3%) and 64.1% (47.5-80.7%), respectively. Grade ≥ 3 lung toxicity was seen in six patients, esophageal toxicity occurred at grade ≤ 2, and there was no cardiac toxicity.
The prognosis of patients with unresectable stage III NSCLC is poor without chemotherapy. Our data suggest that high-dose PBT is beneficial and tolerable for these patients.
本研究回顾性评估了单纯质子束治疗（PBT）治疗 III 期非小细胞肺癌（NSCLC）患者的疗效。
57 例经组织学证实的 NSCLC（III 期/IIIB 期：24/33）患者接受了单纯 PBT 治疗，未接受同期化疗。队列包括 32 例鳞状细胞癌、18 例腺癌和 7 例非小细胞癌。淋巴结转移为 N0 7 例、N1 5 例、N2 30 例和 N3 15 例。计划总剂量范围为 50 至 84.5 GyE（中位数为 74 GyE）。
51 例患者（89%）完成了计划治疗。在分析时，20 例患者存活，所有患者的中位随访时间为 16.2 个月，幸存者的中位随访时间为 22.2 个月。中位总生存期为 21.3 个月（95%置信区间：14.2-28.4 个月），1 年和 2 年总生存率分别为 65.5%（52.9-78.0%）和 39.4%（25.3-53.5%）。38 例患者出现疾病进展，1 年和 2 年无进展生存率分别为 36.2%（23.1-49.4%）和 24.9%（12.7-37.2%）。13 例患者出现局部复发，1 年和 2 年局部控制率分别为 79.1%（66.8-91.3%）和 64.1%（47.5-80.7%）。6 例患者出现≥3 级肺部毒性，2 级及以下出现食管毒性，无心脏毒性。
无化疗的不可切除 III 期 NSCLC 患者预后较差。我们的数据表明，高剂量 PBT 对这些患者有益且可耐受。
