Department of Oncology, Odense University Hospital , Odense , Denmark.
Acta Oncol. 2014 Mar;53(3):336-41. doi: 10.3109/0284186X.2013.868035. Epub 2013 Dec 26.
Non-small cell lung cancer (NSCLC) is associated with poor survival even though patients are treated with curatively intended radiotherapy. Survival is affected negatively by lack of loco-regional tumour control, but survival is also influenced by comorbidity caused by age and smoking, and occurrence of distant metastasis. It is challenging to evaluate loco-regional control after definitive radiotherapy for NSCLC since it is difficult to distinguish between radiation-induced damage to the lung tissue and tumour progression/recurrence. In addition it may be useful to distinguish between intrapulmonary failure and mediastinal failure to be able to optimize radiotherapy in order to improve loco-regional control even though it is not easy to discriminate between the two sites of failure.
This study is a retrospective analysis of 331 NSCLC patients treated with definitive radiotherapy from 2002 to 2011. The patients were treated consecutively at the Department of Oncology, Odense University Hospital, Denmark with at least 60 Gy. All patients were followed in a planned follow-up schedule and no patients were lost for follow-up.
At the time of the analysis 93 patients had loco-regional failure only. Of these patients, 68 had intrapulmonary failure only, one patient had failure in mediastinum only, and 24 patients had intrapulmonary failure as well as mediastinal failure. Of the patients which had lung failure only, 78% had mediastinal involvement at treatment start. The only covariate with significant impact on developing intrapulmonary failure only was gross tumour volume. Median survival for the total group of 331 patients was 19 months. The median survival for patients with intrapulmonary failure only was 19 months, and it was 20 months for the patients with mediastinal relapse.
We conclude that focus should be on increasing doses to intrapulmonary tumour volume, when dose escalation is applied to improve local tumour control in NSCLC patients treated with definitive radiotherapy, since most recurrences are located here.
非小细胞肺癌（NSCLC）患者即使接受了以治愈为目的的放疗，其生存预后仍较差。肿瘤局部区域控制不佳会对生存产生负面影响，但生存也受到年龄和吸烟引起的合并症以及远处转移的影响。由于难以区分放射性肺损伤与肿瘤进展/复发，因此评估 NSCLC 根治性放疗后的局部区域控制具有挑战性。此外，区分肺内失败和纵隔失败可能有助于优化放疗，以提高局部区域控制，尽管区分这两个失败部位并不容易。
这是一项对 2002 年至 2011 年期间在丹麦欧登塞大学医院肿瘤科接受根治性放疗的 331 例 NSCLC 患者进行的回顾性分析。所有患者均按计划随访，无失访。
在分析时，93 例患者仅有局部区域失败。这些患者中，68 例仅有肺内失败，1 例仅有纵隔失败，24 例既有肺内失败也有纵隔失败。在仅有肺失败的患者中，78%的患者在治疗开始时存在纵隔受累。唯一对发生单纯肺内失败有显著影响的协变量是大体肿瘤体积。331 例患者的总中位生存期为 19 个月。单纯肺内失败患者的中位生存期为 19 个月，纵隔复发患者的中位生存期为 20 个月。
我们的结论是，当应用剂量升级来提高 NSCLC 根治性放疗患者的局部肿瘤控制时，应重点关注增加肺内肿瘤体积的剂量，因为大多数复发都发生在这里。
