Lee Joo Ho, Wu Hong-Gyun, Kim Hak Jae, Park Charn Il, Lee Se-Hoon, Kim Dong-Wan, Heo Dae Seog
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
Radiat Oncol J. 2013 Mar;31(1):18-24. doi: 10.3857/roj.2013.31.1.18. Epub 2013 Mar 31.
The purpose of this study was to assess the clinical outcomes of hypofractionated radiotherapy (HFRT) with three-dimensional conformal technique for medically inoperable patients with early stage non-small-cell lung cancer (NSCLC) and to evaluate prognostic factors.
We performed a retrospective review of 26 patients who underwent HFRT for early stage NSCLC between September 2005 and August 2011. Only clinical stage T1-3N0 was included. The median RT dose was 70 Gy (range, 60 to 72 Gy) and the median biologically equivalent dose (BED) was 94.5 Gy (range, 78.0 to 100.8 Gy). In 84.6% of patients, 4 Gy per fraction was used. Neoadjuvant chemotherapy with paclitaxel and cisplatin was given to 2 of 26 patients.
The median follow-up time for surviving patients was 21 months (range, 13 to 49 months). The overall response rate was 53.9%, and the initial local control rate was 100%. The median survival duration was 27.8 months. Rates of 2-year overall survival, progression-free survival (PFS), local control (LC), and locoregional-free survival (LRFS) were 54.3%, 61.1%, 74.6%, and 61.9%, respectively. Multivariate analysis showed that BED (>90 vs. ≤90 Gy) was an independent prognostic factor influencing PFS, LC, and LRFS. Severe toxicities over grade 3 were not observed.
Radical HFRT can yield satisfactory disease control with acceptable rates of toxicities in medically inoperable patients with early stage NSCLC. HFRT is a viable alternative for clinics and patients ineligible for stereotactic ablative radiotherapy. BED over 90 Gy and 4 Gy per fraction might be appropriate for HFRT.
本研究旨在评估三维适形技术的大分割放疗（HFRT）用于医学上无法手术的早期非小细胞肺癌（NSCLC）患者的临床疗效，并评估预后因素。
我们对2005年9月至2011年8月间接受HFRT治疗的26例早期NSCLC患者进行了回顾性研究。仅纳入临床分期为T1-3N0的患者。中位放疗剂量为70 Gy（范围60至72 Gy），中位生物等效剂量（BED）为94.5 Gy（范围78.0至100.8 Gy）。84.6%的患者每次分割剂量为4 Gy。26例患者中有2例接受了紫杉醇和顺铂的新辅助化疗。
存活患者的中位随访时间为21个月（范围13至49个月）。总缓解率为53.9%，初始局部控制率为100%。中位生存时间为27.8个月。2年总生存率、无进展生存率（PFS）、局部控制率（LC）和无区域复发生存率（LRFS）分别为54.3%、61.1%、74.6%和61.9%。多因素分析显示，BED（>90 Gy与≤90 Gy）是影响PFS、LC和LRFS的独立预后因素。未观察到3级以上的严重毒性反应。
根治性HFRT可在医学上无法手术的早期NSCLC患者中产生令人满意的疾病控制效果，且毒性发生率可接受。对于不符合立体定向消融放疗条件的临床和患者，HFRT是一种可行的替代方案。BED超过90 Gy且每次分割剂量为4 Gy可能适用于HFRT。
