Rochet Nathalie, Hauswald Henrik, Stoiber Eva Maria, Hensley Frank W, Becker Heinrich D, Debus Juergen, Lindel Katja
Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
Tumori. 2013 Mar-Apr;99(2):183-90. doi: 10.1177/030089161309900211.
To retrospectively evaluate the outcome of patients with inoperable non-small-cell lung cancer treated with primary external beam radiotherapy combined with high-dose-rate endobronchial brachytherapy boost.
Between 1988 and 2005, 35 patients with non-small-cell lung cancer (stage I-III) ineligible for surgical resection and/or chemotherapy, were primarily treated with external beam radiotherapy with a median total dose of 50 Gy (range, 46-60). A median of 3 fractions high-dose-rate endobronchial brachytherapy was applied as a boost after external beam radiotherapy, the median total dose was 15 Gy (range, 8-20). High-dose-rate endobronchial brachytherapy was carried out with iridium-192 sources (370 GBq) and prescribed to 1 cm distance from the source axis.
With a median follow-up of 26 months from the first fraction of high-dose-rate endobronchial brachytherapy, the 1-, 2- and 5-year overall (local progression-free) survival rates were 76% (76%), 61% (57%) and 28% (42%), respectively. Complete or partial remission rates 6 to 8 weeks after treatment were 57% and 17%, respectively. Significant prognostic favorable factors were a complete remission 6-8 weeks after treatment and a negative nodal status. In patients without mediastinal node involvement, a long-term local control could be achieved with 56% 5-year local progression-free survival. Common Toxicity Criteria grade 3 toxicities were hemoptysis (n = 2) and necrosis (n = 1). One fatal hemoptysis occurred in combination with a local tumor recurrence.
The combination of external beam radiotherapy with high-dose-rate endobronchial brachytherapy boost is an effective primary treatment with acceptable toxicity in patients with non-small-cell lung cancer ineligible for surgical resection and/or chemotherapy.
回顾性评估无法手术的非小细胞肺癌患者接受外照射放疗联合高剂量率支气管内近距离放疗增敏的疗效。
1988年至2005年间，35例无法进行手术切除和/或化疗的非小细胞肺癌（I - III期）患者，首先接受外照射放疗，中位总剂量为50 Gy（范围46 - 60 Gy）。外照射放疗后，中位给予3次高剂量率支气管内近距离放疗作为增敏，中位总剂量为15 Gy（范围8 - 20 Gy）。采用铱 - 192源（370 GBq）进行高剂量率支气管内近距离放疗，处方剂量为距源轴1 cm处。
从首次高剂量率支气管内近距离放疗开始，中位随访26个月，1年、2年和5年的总（局部无进展）生存率分别为76%（76%）、61%（57%）和28%（42%）。治疗后6至8周的完全缓解率和部分缓解率分别为57%和17%。显著的预后有利因素是治疗后6 - 8周完全缓解和无淋巴结转移。在无纵隔淋巴结受累的患者中，5年局部无进展生存率为56%，可实现长期局部控制。常见毒性标准3级毒性反应为咯血（n = 2）和坏死（n = 1）。1例致命咯血与局部肿瘤复发相关。
外照射放疗联合高剂量率支气管内近距离放疗增敏是无法进行手术切除和/或化疗的非小细胞肺癌患者的一种有效的初始治疗方法，毒性可接受。
