中心型和周围型I期非小细胞肺癌大剂量质子束治疗后复发的结局及预后因素

Outcomes and prognostic factors for recurrence after high-dose proton beam therapy for centrally and peripherally located stage I non--small-cell lung cancer.

作者信息

Kanemoto Ayae, Okumura Toshiyuki, Ishikawa Hitoshi, Mizumoto Masashi, Oshiro Yoshiko, Kurishima Koichi, Homma Shinsuke, Hashimoto Takayuki, Ohkawa Ayako, Numajiri Haruko, Ohno Toshiki, Moritake Takashi, Tsuboi Koji, Sakae Takeji, Sakurai Hideyuki

机构信息

Proton Medical Research Center and Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan.

出版信息

Clin Lung Cancer. 2014 Mar;15(2):e7-12. doi: 10.1016/j.cllc.2013.11.002. Epub 2013 Nov 13.

DOI:10.1016/j.cllc.2013.11.002

PMID:24365049

Abstract

INTRODUCTION

This study was conducted to determine disease control rates and prognostic factors associated with recurrence of centrally and peripherally located stage I NSCLC treated using high-dose PBT.

PATIENTS AND METHODS

Seventy-four patients with 80 centrally or peripherally located stage I NSCLCs were treated with PBT. A protocol using 72.6 Gy (RBE) in 22 fractions was used for centrally located tumors, and 66 Gy (RBE) in 10 or 12 fractions was used for peripherally located tumors. Data were collected and control rates and prognostic factors for recurrence were evaluated retrospectively.

RESULTS

The median follow-up period was 31.0 months. The overall survival, disease-specific survival, and progression-free survival rates were 76.7%, 83.0%, and 58.6% at 3 years, respectively. Disease recurrence was noted in 30 patients and local recurrence of 11 tumors occurred. The 3-year local control rate was 86.2% for stage IA tumors and 67.0% for stage IB tumors. Radiation dose was identified as a significant prognostic factor for disease recurrence and local recurrence. Tumor diameter and age were only significantly associated with disease recurrence. The 3-year local control rate was 63.9% for centrally located tumors irradiated with 72.6 Gy (RBE) and 88.4% for peripherally located tumors irradiated with 66 Gy (RBE).

CONCLUSION

Radiation dose was shown to be the most significant prognostic factor for tumor control in stage I NSCLC treated using high-dose PBT. Tumor diameter was not significant for local control. Further evaluation of PBT for centrally located tumors is warranted.

摘要

引言

本研究旨在确定使用高剂量质子束治疗（PBT）的中心型和外周型Ⅰ期非小细胞肺癌（NSCLC）的疾病控制率及与复发相关的预后因素。

患者与方法

74例患者的80处中心型或外周型Ⅰ期NSCLC接受了PBT治疗。对于中心型肿瘤，采用22次分割给予72.6 Gy（相对生物效应剂量，RBE）的方案；对于外周型肿瘤，采用10或12次分割给予66 Gy（RBE）的方案。收集数据并回顾性评估疾病控制率和复发的预后因素。

结果

中位随访期为31.0个月。3年时的总生存率、疾病特异性生存率和无进展生存率分别为76.7%、83.0%和58.6%。30例患者出现疾病复发，11处肿瘤发生局部复发。ⅠA期肿瘤的3年局部控制率为86.2%，ⅠB期肿瘤为67.0%。放射剂量被确定为疾病复发和局部复发的重要预后因素。肿瘤直径和年龄仅与疾病复发显著相关。接受72.6 Gy（RBE）照射的中心型肿瘤3年局部控制率为63.9%，接受66 Gy（RBE）照射的外周型肿瘤为88.4%。