Janssen Stefan, Dickgreber Nicolas J, Koenig Carolin, Bremer Michael, Werner Martin, Karstens Johann H, Welte Tobias, Meyer Andreas
Department of Radiation Oncology, Medical School Hannover, Germany.
Onkologie. 2012;35(7-8):408-12. doi: 10.1159/000340064. Epub 2012 Jul 3.
Local hypofractionated stereotactic radiation treatment (hfSRT) of early stage non-small cell lung cancer (NSCLC) represents a highly effective treatment alternative in medically inoperable patients.
Between June 2007 and December 2010, 65 patients with NSCLC were treated with image-guided hypofractionated radiotherapy. The Union Internationale Contre le Cancer (UICC) stage distribution was: IA, n = 19; IB, n = 15; IIB, n = 5; IIIA, n = 10; IIIB, n = 6; and IV, n = 10. The fractionation schedule used was 3 × 12.5 Gy (n = 36) prescribed to the encompassing 67% isodose line for peripheral primary tumours, and 8 × 6 Gy (n = 26) or 8 × 5 Gy (n = 3) prescribed to the encompassing 80% isodose line for centrally located tumours.
Mean follow-up was 13.8 months (range 1-41 months). Until now 6 patients developed a local recurrence, 2 of them in combination with mediastinal lymph node failure. The 1-year actuarial local control rate was 93% and overall survival 79%. Pneumonitis was seen in 14 patients (21.5%) (Common Terminology Criteria for Adverse Events (CTCAE) grade I: n = 12, and II: n = 2) after a median time period of 9.5 months. No patient developed pneumonitis of CTCAE grade III or higher.
Image-guided hfSRT is effective and feasible in patients with non-operable NSCLC, even in higher stages, whenever local control is crucial and there are contraindications against systemic therapy.
早期非小细胞肺癌（NSCLC）的局部大分割立体定向放射治疗（hfSRT）是医学上无法手术的患者的一种高效治疗选择。
2007年6月至2010年12月期间，65例NSCLC患者接受了图像引导下的大分割放射治疗。国际抗癌联盟（UICC）分期分布为：IA期，n = 19；IB期，n = 15；IIB期，n = 5；IIIA期，n = 10；IIIB期，n = 6；IV期，n = 10。对于周围型原发性肿瘤，采用的分割方案为3×12.5 Gy（n = 36），处方剂量至包含67%等剂量线；对于中心型肿瘤，采用8×6 Gy（n = 26）或8×5 Gy（n = 3），处方剂量至包含80%等剂量线。
平均随访时间为13.8个月（范围1 - 41个月）。截至目前，6例患者出现局部复发，其中2例合并纵隔淋巴结转移。1年精算局部控制率为93%，总生存率为79%。14例患者（21.5%）出现肺炎（不良事件通用术语标准（CTCAE）I级：n = 12，II级：n = 2），中位发生时间为9.5个月。无患者出现CTCAE III级或更高等级的肺炎。
图像引导下的hfSRT对于无法手术的NSCLC患者是有效且可行的，即使在更高分期，只要局部控制至关重要且存在全身治疗禁忌证。
