Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University in St, Louis, 4921 Parkview Place, Campus Box 8224, St, Louis, MO 63110, USA.
Radiat Oncol. 2013 Jan 3;8:4. doi: 10.1186/1748-717X-8-4.
Ongoing prospective trials exploring stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) often exclude minimally invasive adenocarcinoma or adenocarcnioma in situ, formerly bronchioloalveolar carcinoma (BAC), due to concerns for accurate target delineation on CT. We performed a patterns of failure analysis to compare outcomes between BAC and other NSCLC subtypes.
One hundred twenty patients with early stage NSCLC were treated with SBRT from 2004-2009. Pathologic confirmation of NSCLC was obtained in 97 patients. Radiotherapy was delivered according to RTOG guidelines. The log-rank test was used to compare outcomes between BAC and other NSCLC.
Median follow-up was 29 months. The median SBRT dose was 5400 cGy. Thirteen patients had radiographically diagnosed BAC and five patients had biopsy confirmed BAC, of which two had both. The three-year local control was 100% for biopsy-proven or radiographically diagnosed BAC (n = 18) and 86% for all other NSCLC subtypes (n = 102) (p = 0.13). Likewise, no significant difference was detected between BAC and other NSCLC for 3-year regional failure (12% vs. 20%, p = 0.45), progression-free survival (57.6% vs. 53.5%, p = 0.84) or overall survival (35% vs. 47%, p = 0.66). There was a trend towards lower three-year rates of freedom from distant failure in patients with any diagnosis of BAC compared to those without (26% vs. 38%, p = 0.053).
Compared to other NSCLC subtypes, BAC appears to have similar patterns of failure and survival after treatment with SBRT, however there may be an increased risk of distant metastases with BAC. RTOG guideline-based target delineation provides encouraging local control rates for patients with BAC.
目前正在进行的探索立体定向体部放射治疗（SBRT）治疗早期非小细胞肺癌（NSCLC）的前瞻性试验，由于对 CT 上准确靶区勾画的担忧，通常排除了微创腺癌或原位腺癌，即以前的细支气管肺泡癌（BAC）。我们进行了失败模式分析，以比较 BAC 和其他 NSCLC 亚型之间的结果。
2004 年至 2009 年间，120 例早期 NSCLC 患者接受 SBRT 治疗。97 例患者获得 NSCLC 病理证实。根据 RTOG 指南进行放射治疗。对数秩检验用于比较 BAC 和其他 NSCLC 之间的结果。
中位随访时间为 29 个月。SBRT 剂量中位数为 5400cGy。13 例患者有影像学诊断的 BAC，5 例患者有活检证实的 BAC，其中 2 例既有影像学诊断又有活检证实。经活检证实或影像学诊断的 BAC（n=18）的 3 年局部控制率为 100%，所有其他 NSCLC 亚型（n=102）为 86%（p=0.13）。同样，BAC 和其他 NSCLC 之间 3 年区域失败（12%比 20%，p=0.45）、无进展生存期（57.6%比 53.5%，p=0.84）或总生存期（35%比 47%，p=0.66）也无显著差异。与无 BAC 诊断的患者相比，任何诊断为 BAC 的患者 3 年远处无失败率有降低的趋势（26%比 38%，p=0.053）。
与其他 NSCLC 亚型相比，BAC 在接受 SBRT 治疗后的失败和生存模式似乎相似，但 BAC 可能有更高的远处转移风险。基于 RTOG 指南的靶区勾画为 BAC 患者提供了令人鼓舞的局部控制率。
