Cai Shuhua, Shi Anhui, Yu Rong, Zhu Guangying
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, 52# Fucheng Road, Beijing 100142, People's Republic of China.
Radiat Oncol. 2014 Jan 10;9:17. doi: 10.1186/1748-717X-9-17.
To analyze the feasibility of omitting clinical target volume (CTV) for limited small cell lung cancer treated with chemotherapy and intensity modulated radiotherapy.
89 patients were treated from January 1, 2008 to August 31, 2011, 54 cases were irradiated with target volume without CTV, and 35 cases were irradiated with CTV. Both arms were irradiated post chemotherapy tumor extent and omitted elective nodal irradiation; dose prescription was 95% PTV56-63 Gy/28-35 F/5.6-7 weeks.
In the arm without CTV and arm with CTV, the local relapse rates were 16.7% and 17.1% (p = 0.586) respectively. In the arm without CTV, of the 9 patients with local relapse, 6 recurred in-field, 2 recurred in margin, 1 recurred out of field. In the arm with CTV, of the 6 patients with local relapse, 4 recurred in-field, 1 recurred in margin, 1 recurred out of field. The distant metastases rates were 42.6% and 51.4% (p = 0.274) respectively. Grade 3-4 hematological toxicity and radiation esophagitis had no statistically significant, but grade 3-4 radiation pneumonia was observed in only 7.4% in the arm without CTV, compared 22.9% in the arm with CTV (p = 0.040). The median survival in the arm without CTV had not reached, compared with 38 months in the with CTV arm. The l- years, 2- years, 3- years survival rates of the arm without CTV and the arm with CTV were 81.0%, 66.2%, 61.5% and 88.6%, 61.7%, 56.6% (p = 0.517). The multivariate analysis indicated that the distant metastases (p = 0.000) and PCI factor (p = 0.004) were significantly related to overall survival.
Target delineation omitting CTV for limited-disease small cell lung cancer received IMRT was feasible. The distant metastases and PCI factor were significantly related to overall survival.
分析对于接受化疗和调强放疗的局限性小细胞肺癌省略临床靶区（CTV）的可行性。
2008年1月1日至2011年8月31日期间治疗了89例患者，54例患者照射时靶区未包括CTV，35例患者照射时靶区包括CTV。两组均在化疗后根据肿瘤范围进行照射，省略选择性淋巴结照射；剂量处方为95%计划靶区（PTV）56 - 63 Gy/28 - 35次/5.6 - 7周。
在未设CTV组和设CTV组中，局部复发率分别为16.7%和17.1%（p = 0.586）。在未设CTV组的9例局部复发患者中，6例在靶区内复发，2例在边缘复发，1例在靶区外复发。在设CTV组的6例局部复发患者中，4例在靶区内复发，1例在边缘复发，1例在靶区外复发。远处转移率分别为42.6%和51.4%（p = 0.274）。3 - 4级血液学毒性和放射性食管炎无统计学差异，但未设CTV组3 - 4级放射性肺炎仅为7.4%，而设CTV组为22.9%（p = 0.040）。未设CTV组的中位生存期未达到，而设CTV组为38个月。未设CTV组和设CTV组的1年、2年、3年生存率分别为8l.0%、66.2%、61.5%和88.6%、61.7%、56.6%（p = 0.517）。多因素分析表明远处转移（p = 0.000）和预防性颅脑照射（PCI）因素（p = 0.004）与总生存期显著相关。
对于接受调强放疗的局限性小细胞肺癌省略CTV进行靶区勾画是可行的。远处转移和PCI因素与总生存期显著相关。
