Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON.
Curr Oncol. 2012 Aug;19(4):e264-9. doi: 10.3747/co.19.976.
Outcomes after treatment with accelerated hypofractionated radiotherapy in stage i medically inoperable non-small-cell lung cancer (nsclc) patients were determined.
Our single-institution retrospective review looked at medically inoperable patients with T1-2N0M0 nsclc treated with accelerated hypofractionated curative-intent radiotherapy between 1999 and 2009. Patients were staged mainly by computed tomography imaging of chest and abdomen, bone scan, and computed tomography/magnetic resonance imaging of brain. Positron-emission tomography (pet) staging was performed in 6 patients. Medical charts were reviewed to determine demographics, radiotherapy details, sites of failure, toxicity (as defined by the Common Terminology Criteria for Adverse Events, version 3.0) and vital status. The cumulative incidence of local and distant failure was calculated. Overall (os) and cause-specific (css) survival were estimated by the Kaplan-Meier method.
In the 60 patients treated during the study period, the dose regimens were 50 Gy in 20 fractions (n = 6), 55 Gy in 20 fractions (n = 8), 60 Gy in 20 fractions (n = 42), and 60 Gy in 25 fractions (n = 4). All patients were treated once daily. The median follow-up was 27 months (range: 4-94 months). The os rates at 2 and 5 years were 61% [95% confidence interval (ci): 50% to 75%] and 19% (95% ci: 10% to 34%) respectively. The css rates at 2 and 5 years were 79% (95% ci: 68% to 91%) and 39% (95% ci: 24% to 63%) respectively. The cumulative incidence of local failure was 20% at 5 years. The cumulative incidence of distant failure was 28% at 5 years. No patients experienced grade 3 or greater pneumonitis or esophagitis.
Accelerated hypofractionated regimens are well tolerated and provide good local control in medically inoperable patients with stage i nsclc. Such regimens may be a reasonable treatment alternative when stereotactic body radiation therapy is not feasible.
确定Ⅰ期不能手术的非小细胞肺癌（NSCLC）患者接受加速亚分次放疗后的治疗结果。
我们的单机构回顾性研究纳入了 1999 年至 2009 年间接受根治性加速亚分次放疗的Ⅰ期不能手术的 T1-2N0M0 NSCLC 患者。患者主要通过胸部和腹部 CT 扫描、骨扫描、脑部 CT/MRI 进行分期。6 例患者进行了正电子发射断层扫描（PET）分期。查阅病历以确定患者的人口统计学特征、放疗细节、失败部位、毒性（根据不良事件通用术语标准 3.0 版定义）和生存状况。计算局部和远处失败的累积发生率。通过 Kaplan-Meier 法估计总生存（OS）和原因特异性生存（CSS）。
在研究期间接受治疗的 60 例患者中，剂量方案分别为 50 Gy/20 次（n=6）、55 Gy/20 次（n=8）、60 Gy/20 次（n=42）和 60 Gy/25 次（n=4）。所有患者均接受每日 1 次放疗。中位随访时间为 27 个月（范围：4-94 个月）。2 年和 5 年的 OS 率分别为 61%（95%CI：50%-75%）和 19%（95%CI：10%-34%）。2 年和 5 年的 CSS 率分别为 79%（95%CI：68%-91%）和 39%（95%CI：24%-63%）。5 年时局部失败的累积发生率为 20%。5 年时远处失败的累积发生率为 28%。无 3 级或更高级别的放射性肺炎或食管炎发生。
对于Ⅰ期不能手术的 NSCLC 患者，加速亚分次放疗方案耐受良好，可提供良好的局部控制。当立体定向体部放疗不可行时，这些方案可能是一种合理的治疗选择。
