Aibe Norihiro, Yamazaki Hideya, Nakamura Satoaki, Tsubokura Takuji, Kobayashi Kana, Kodani Naohiro, Nishimura Takuya, Okabe Haruumi, Yamada Kei
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
J Radiat Res. 2014 May;55(3):575-82. doi: 10.1093/jrr/rrt146. Epub 2014 Jan 23.
To analyze outcomes and toxicities of stereotactic body radiotherapy with helical tomotherapy (HT-SBRT) for inoperable lung tumors, the medical records of 30 patients with 31 lung tumors treated with HT-SBRT were reviewed. The 3-year local control, cause-specific survival and overall survival rates (LC, CCS and OS, respectively) were analyzed using the Kaplan-Meier method. Toxicities were graded using Common Terminology Criteria for Adverse Events ver. 4. To investigate the factors associated with Grade 5 radiation pneumonitis (G5 RP), several parameters were analyzed: (i) patient-specific factors (age, gross tumor volume and PTV, and the interstitial pulmonary shadow on pretreatment CT); and (ii) dosimetry-specific factors (conformity index, homogeneity index, mean lung dose, and V5, V10, V15, V20 and V25 of the total lungs). The median duration of observation for all patients was 36.5 months (range, 4-67 months). The 3-year LC, CCS and OS were 82, 84 and 77%, respectively. Regarding Grade 3 or higher toxicities, two patients (6.7%) developed G5 RP. GTV was significantly associated with G5 RP (P = 0.025), and there were non-significant but slight associations with developing G5 RP for V5 (P = 0.067) and PTV (P = 0.096). HT-SBRT led to standard values of LC, CCS and OS, but also caused a markedly higher incidence of G5 RP. It is essential to optimize patient selection so as to avoid severe radiation pneumonitis in HT-SBRT.
为分析螺旋断层放疗立体定向体部放疗（HT-SBRT）治疗不可手术切除的肺肿瘤的疗效和毒性，回顾了30例接受HT-SBRT治疗的31个肺肿瘤患者的病历。采用Kaplan-Meier法分析3年局部控制率、病因特异性生存率和总生存率（分别为LC、CCS和OS）。使用《不良事件通用术语标准》第4版对毒性进行分级。为研究与5级放射性肺炎（G5 RP）相关的因素，分析了几个参数：（i）患者特异性因素（年龄、肿瘤总体积和计划靶体积，以及治疗前CT上的肺间质阴影）；（ii）剂量学特异性因素（适形指数、均匀性指数、平均肺剂量，以及全肺的V5、V10、V15、V20和V25）。所有患者的中位观察时间为36.5个月（范围4 - 67个月）。3年LC、CCS和OS分别为82%、84%和77%。关于3级或更高等级的毒性，2例患者（6.7%）发生了G5 RP。GTV与G5 RP显著相关（P = 0.025），V5（P = 0.067）和PTV与发生G5 RP有非显著但轻微的关联。HT-SBRT导致了LC、CCS和OS的标准值，但也导致了G5 RP的发生率明显更高。优化患者选择对于避免HT-SBRT中严重的放射性肺炎至关重要。
