School of Medicine, Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA.
Ther Adv Respir Dis. 2014 Feb;8(1):3-12. doi: 10.1177/1753465813512545. Epub 2013 Dec 10.
PURPOSE/OBJECTIVE: Treatment of presumed early-stage lung cancer with definitive radiation therapy in the absence of a pathologically confirmed specimen frequently occurs. However, it is not well described in the literature, and there are few North American series reporting on this patient population. We report outcomes in patients treated with stereotactic body radiotherapy (SBRT) for presumed lung cancer and compare them to outcomes in patients treated with SBRT with pathologically confirmed non-small cell lung cancer (NSCLC).
MATERIALS/METHODS: This study is based on a retrospective review of 55 patients with presumed or confirmed lung cancer: 23 patients had nondiagnostic or absent pathologic specimens while 32 patients had pathologically confirmed NSCLC. All patients had hypermetabolic primary lesions on a positron emission tomography (PET) or PET/computed tomography (CT) scan. SBRT was delivered as 48-56 Gy in four to five fractions via a four-dimensional CT treatment plan.
Of the patients without pathological confirmation, the mean age was 78 (range 63-89 years) and 17 (74%) were men. The mean tumor size was 2.5 cm (range 1.0-5.1). Reasons for not having confirmed pathologic diagnosis included indeterminate biopsy specimen or an inability to tolerate a biopsy procedure due to poor respiratory status. SBRT was chosen due to noncandidacy for surgery in 17 patients (74%) or patient refusal of surgery in six (26%). Median follow up was 24.2 months (range 1.9-64.6): 2 of the 23 patients (8.7%) had local failure at the site of SBRT and 3 (13%) had regional failure. The actuarial 12-month overall survival was 83%. The median overall survival was 30.2 months. At last follow up, 12 patients (52%) were alive up to 64.6 months after treatment. SBRT was tolerated well in this series. Acute toxicity was noted in two patients (8.7%) and chronic toxicity in three (13%). These patient characteristics and results were shown to be similar to the 32 patients with pathologically confirmed NSCLC. On Kaplan-Meier analysis, there was no significant difference (p = 0.27) in overall survival between patients with pathologically confirmed NSCLC and those with presumed lung cancer (which was deemed most likely NSCLC).
While biopsy confirmation remains a goal in the workup of suspected NSCLC, SBRT without pathologic confirmation may represent a safe and effective option for the treatment of presumed NSCLC among patients who cannot tolerate or refuse surgery.
目的/目标：在没有病理证实标本的情况下，常采用根治性放射治疗治疗疑似早期肺癌。然而，文献中对此描述并不充分，北美也鲜有系列报道此类患者人群。我们报告了采用立体定向体部放射治疗（SBRT）治疗疑似肺癌患者的结果，并将其与采用 SBRT 治疗经病理证实的非小细胞肺癌（NSCLC）患者的结果进行了比较。
材料/方法：本研究基于对 55 例疑似或确诊肺癌患者的回顾性分析：23 例患者无诊断性或无病理标本，32 例患者有经病理证实的 NSCLC。所有患者的正电子发射断层扫描（PET）或 PET/计算机断层扫描（CT）上均显示原发性病变代谢活跃。SBRT 通过四维 CT 治疗计划以 48-56Gy 分 4-5 次给予。
在无病理证实的患者中，平均年龄为 78 岁（63-89 岁），17 例（74%）为男性。肿瘤平均大小为 2.5cm（1.0-5.1cm）。无病理诊断的确切原因包括活检标本不确定或由于呼吸状态不佳而无法耐受活检。由于 17 例（74%）患者不适合手术或 6 例（26%）患者拒绝手术，选择了 SBRT。中位随访时间为 24.2 个月（1.9-64.6 个月）：23 例患者中有 2 例（8.7%）在 SBRT 部位发生局部失败，3 例（13%）发生区域失败。12 个月的总生存率为 83%。中位总生存时间为 30.2 个月。最后一次随访时，12 例（52%）患者在治疗后 64.6 个月仍存活。本系列中 SBRT 耐受性良好。两名患者（8.7%）出现急性毒性，三名患者（13%）出现慢性毒性。这些患者特征和结果与 32 例经病理证实的 NSCLC 患者相似。在 Kaplan-Meier 分析中，经病理证实的 NSCLC 患者和疑似肺癌患者的总生存率无显著差异（p=0.27）。
虽然在疑似 NSCLC 的检查中仍应将活检确认为目标，但对于不能耐受或拒绝手术的疑似 NSCLC 患者，SBRT 治疗在无病理证实的情况下可能是一种安全有效的选择。
