Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan.
Radiat Oncol. 2012 Oct 31;7:182. doi: 10.1186/1748-717X-7-182.
The purpose of this study is to investigate the prognostic factors of stereotactic radiotherapy for stage I NSCLC to improve outcomes.
Stage I non-small cell lung cancer patients who were treated with stereotactic radiotherapy between 2005 and 2009 at our hospital were enrolled in this study. The primary endpoint was local control rate. Survival estimates were calculated from the completion date of radiotherapy using the Kaplan-Meier method. The prognostic factors including patients' characteristics and dose-volume histogram parameters were evaluated using Cox's proportional hazard regression model.
Eighty patients (81 lesions) treated with 3 dose levels, 48 Gy/4 fractions, 60 Gy/8 fractions and 60 Gy/15 fractions, were enrolled in this study. Median follow-up was 30.4 months (range, 0.3 - 78.5 months). A Cox regression model showed T factor (p = 0.013), biological effective dose calculated from prescribed dose (BED10) (p = 0.048), and minimum dose for PTV (p = 0.013) to be prognostic factors for local control. Three-year overall survival rate and local control rate were 89.9% (T1: 86.8%, T2: 100%) and 89.0% (T1: 97.9%; T2: 64.8%), respectively. When the 3-year local control rates were examined by prescribed doses, they were 100% for the dose per fraction of 48 Gy /4 fractions (105.6 Gy BED10), 82.1% for 60 Gy/8 fractions (105 Gy BED10), and 57.1% for 60 Gy/15 fractions (84 Gy BED10). The median value of the minimum dose for PTV (%) was 89.88 (%), and the 3-year local control rates were 100% in those with the minimum dose for PTV (%) ≥ 89.88% and 79.2% in those with the minimum dose for PTV (%) < 89.88%.
Our results suggest that T factor, BED10, and minimum dose for PTV influence the local control rate. Local control rate can be improved by securing the minimum dose for PTV.
本研究旨在探讨Ⅰ期非小细胞肺癌立体定向放疗的预后因素，以改善治疗效果。
本研究纳入了 2005 年至 2009 年在我院接受立体定向放疗的Ⅰ期非小细胞肺癌患者。主要终点为局部控制率。采用 Kaplan-Meier 法从放疗完成日期计算生存率。采用 Cox 比例风险回归模型评估包括患者特征和剂量-体积直方图参数在内的预后因素。
本研究纳入了 80 例（81 个病灶）患者，分别接受了 3 个剂量水平（48 Gy/4 个分次、60 Gy/8 个分次和 60 Gy/15 个分次）的治疗。中位随访时间为 30.4 个月（范围：0.3-78.5 个月）。Cox 回归模型显示 T 因子（p=0.013）、根据处方剂量计算的生物有效剂量（BED10）（p=0.048）和 PTV 的最小剂量（p=0.013）是局部控制的预后因素。3 年总生存率和局部控制率分别为 89.9%（T1：86.8%，T2：100%）和 89.0%（T1：97.9%；T2：64.8%）。当按处方剂量检查 3 年局部控制率时，48 Gy/4 个分次的剂量（105.6 Gy BED10）为 100%，60 Gy/8 个分次的剂量（105 Gy BED10）为 82.1%，60 Gy/15 个分次的剂量（84 Gy BED10）为 57.1%。PTV 的最小剂量（%）的中位数为 89.88（%），PTV 的最小剂量（%）≥89.88%的患者 3 年局部控制率为 100%，PTV 的最小剂量（%）<89.88%的患者为 79.2%。
我们的结果表明 T 因子、BED10 和 PTV 的最小剂量影响局部控制率。通过确保 PTV 的最小剂量，可以提高局部控制率。
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