Boda-Heggemann Judit, Frauenfeld Anian, Weiss Christel, Simeonova Anna, Neumaier Christian, Siebenlist Kerstin, Attenberger Ulrike, Heußel Claus Peter, Schneider Frank, Wenz Frederik, Lohr Frank
Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Radiat Oncol. 2014 Jan 8;9:10. doi: 10.1186/1748-717X-9-10.
Stereotactic Ablative RadioTherapy (SABR) of lung tumors/metastases has been shown to be an effective treatment modality with low toxicity. Outcome and toxicity were retrospectively evaluated in a unique single-institution cohort treated with intensity-modulated image-guided breath-hold SABR (igSABR) without external immobilization. The dose-response relationship is analyzed based on Biologically Equivalent Dose (BED).
50 lesions in 43 patients with primary NSCLC (n = 27) or lung-metastases of various primaries (n = 16) were consecutively treated with igSABR with Active-Breathing-Coordinator (ABC®) and repeat-breath-hold cone-beam-CT. After an initial dose-finding/-escalation period, 5 x 12 Gy for peripheral lesions and single doses of 5 Gy to varying dose levels for central lesions were applied. Overall-survival (OS), progression-free-survival (PFS), progression pattern, local control (LC) and toxicity were analyzed.
The median BED2 was 83 Gy. 12 lesions were treated with a BED2 of <80 Gy, and 38 lesions with a BED2 of >80 Gy. Median follow-up was 15 months. Actuarial 1- and 2-year OS were 67% and 43%; respectively. Cause of death was non-disease-related in 27%. Actuarial 1- and 2-year PFS was 42% and 28%. Progression site was predominantly distant. Actuarial 1- and 2 year LC was 90% and 85%. LC showed a trend for a correlation to BED2 (p = 0.1167). Pneumonitis requiring conservative treatment occurred in 23%.
Intensity-modulated breath-hold igSABR results in high LC-rates and low toxicity in this unfavorable patient cohort with inoperable lung tumors or metastases. A BED2 of <80 Gy was associated with reduced local control.
立体定向消融放疗（SABR）已被证明是一种治疗肺肿瘤/转移瘤的有效方法，毒性较低。本研究对一个独特的单机构队列进行回顾性分析，该队列接受了强度调制图像引导屏气SABR（igSABR）治疗，且未使用外部固定装置。基于生物等效剂量（BED）分析剂量反应关系。
43例原发性非小细胞肺癌（n = 27）或各种原发性肺转移瘤（n = 16）患者的50个病灶连续接受igSABR治疗，采用主动呼吸协调器（ABC®）及重复屏气锥形束CT。在初始剂量探索/递增期后，外周病灶给予5×12 Gy，中央病灶给予单剂量5 Gy至不同剂量水平。分析总生存期（OS）、无进展生存期（PFS）、进展模式、局部控制率（LC）及毒性。
BED2中位数为83 Gy。12个病灶接受BED2<80 Gy治疗，38个病灶接受BED2>80 Gy治疗。中位随访时间为15个月。1年和2年总生存率分别为67%和43%；27%的死亡原因与疾病无关。1年和2年无进展生存率分别为42%和28%。进展部位主要为远处。1年和2年局部控制率分别为90%和85%。局部控制率与BED2呈相关趋势（p = 0.1167）。23%的患者发生需要保守治疗的肺炎。
在这个患有无法手术的肺肿瘤或转移瘤的不良患者队列中，强度调制屏气igSABR导致高局部控制率和低毒性。BED2<80 Gy与局部控制率降低相关。
