Guillerme F, Clavier J-B, Schumacher C, Falcoz P-E, Bourrhala K, Santelmo N, Hassler S, Schott R, Quoix E, Massard G, Noël G
Département de Radiothérapie, Centre Paul-Strauss, 3 rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France.
Cancer Radiother. 2013 Jul-Aug;17(4):272-81. doi: 10.1016/j.canrad.2013.01.021. Epub 2013 May 24.
Recent clinical results of dose escalation with stereotactic body radiation therapy to increase local tumour control for patients with stage I non-small-cell lung cancer who either refuse surgery or are medically inoperable resulted in making it a standard treatment in this setting. This treatment technique was implemented at the Paul-Strauss Centre, Strasbourg, in 2010. The objective of this study is to describe and analyze the data of the first 20 treated patients.
From October 2010 to May 2012, 20 patients were treated with this technique for T1N0M0 or T2N0M0 lung tumour. The indication was proposed by the multidisciplinary thoracic oncology team meeting, and approved by the technical committee of the Department of Radiotherapy. After the realization of a dosimetric CT Scan (4DCT or three phases-free breathing and deep breath-hold inspiration and expiration) and after performing a ((18)F)-FDG PET scan in the treatment position, all patients were treated on Novalis Tx(®) linear accelerator, with arctherapy or modulated intensity radiotherapy (IMRT). A protocol has been defined for the prescribed dose, depending on the size and location of the tumor, central or peripheral. The patients underwent follow-up during treatment and at 1 month, 3-4 months, 6 and 9 months to assess outcomes and toxicities.
The mean age was 72.6 years (52-89). Seventeen patients had one or more pulmonary comorbidities. The mean delivered dose was 59.9 Gy (40-70) in 4 Gy to 17.5 Gy fractions. The mean gross tumour volume was 14.9 mL (median 7.2, 0.9 to 73.5) and the mean planning target volume was 77.8 mL (median 49.5; 17-300). The mean initial SUV max was 7.7 (1.8 to 16.7). Dose constraints and planning target volume coverage recommended by the protocol were achieved in the majority of cases. The mean lung V20 was 7.63% (1.2 to 17.7) and the mean dose delivered to the planning target volume was 94.6% (88-99). The duration of treatment was 21 days (median: 23; 8-27), and no change or interruption of prescribed treatment has occurred. Median follow-up was 6.6 months, and crude rates of objective response for patients evaluated were 85% (11/13 patients) at 3 months and 100% at 6 and 9 months. The complete response rate at 3 and 6 months were 0 (0/13 patients) and 50% (5/10 patients). Two patients had metastatic disease in the 6 months following treatment. Concerning pulmonary toxicity at 3 months, 6 patients developed G2 radiation pneumonitis and three patients G3, with positive evolution.
The analysis of the results of this series, comparable with those described in literature, shows that lung stereotactic radiotherapy is an effective and well-tolerated treatment for inoperable patients. The extension of the indications could be envisaged based on the results of ongoing trials.
对于拒绝手术或因医学原因无法手术的I期非小细胞肺癌患者，立体定向体部放射治疗剂量递增以提高局部肿瘤控制率的近期临床结果使其成为这种情况下的标准治疗方法。2010年，这种治疗技术在斯特拉斯堡的保罗 - 施特劳斯中心得以应用。本研究的目的是描述和分析首批20例接受治疗患者的数据。
2010年10月至2012年5月，20例T1N0M0或T2N0M0肺肿瘤患者接受了该技术治疗。治疗指征由多学科胸肿瘤学团队会议提出，并经放疗科技术委员会批准。在完成剂量学CT扫描（4DCT或三期自由呼吸及深吸气屏气和呼气扫描）并在治疗体位进行（18）F - FDG PET扫描后，所有患者均在Novalis Tx（®）直线加速器上接受治疗，采用弧形治疗或调强放射治疗（IMRT）。根据肿瘤的大小和位置（中央或周边），已为规定剂量制定了方案。患者在治疗期间以及治疗后1个月、3 - 4个月、6个月和9个月接受随访，以评估疗效和毒性。
平均年龄为72.6岁（52 - 89岁）。17例患者有一种或多种肺部合并症。平均给予剂量为59.9 Gy（40 - 70），分4 Gy至17.5 Gy的分次剂量。平均肿瘤总体积为14.9 mL（中位数7.2，0.9至73.5），平均计划靶体积为77.8 mL（中位数49.5；17 - 300）。平均初始SUV最大值为7.7（1.8至16.7）。在大多数情况下达到了方案推荐的剂量限制和计划靶体积覆盖。平均肺V20为7.63%（1.2至17.7），给予计划靶体积的平均剂量为94.6%（88 - 99）。治疗持续时间为21天（中位数：23；8 - 27），且未发生规定治疗的改变或中断。中位随访时间为6.6个月，评估患者的客观缓解粗率在3个月时为85%（11/13例患者），在6个月和9个月时为100%。3个月和6个月时的完全缓解率分别为0（0/13例患者）和50%（5/10例患者）。2例患者在治疗后6个月出现转移疾病。关于3个月时的肺部毒性，6例患者发生2级放射性肺炎，3例患者发生3级，病情呈好转趋势。
本系列结果分析与文献报道结果相当，表明肺部立体定向放射治疗对于无法手术的患者是一种有效且耐受性良好的治疗方法。可根据正在进行的试验结果设想扩大适应证。
