Parks Jason, Kloecker Goetz, Woo Shiao, Dunlap Neal E
*School of Medicine Departments of †Internal Medicine, Division of Hematology Oncology ‡Radiation Oncology, University of Louisville, Louisville, KY.
Am J Clin Oncol. 2016 Apr;39(2):147-53. doi: 10.1097/COC.0000000000000039.
The purpose of this study is to provide data on the outcomes of using stereotactic body radiotherapy (SBRT) as a means of salvage for non-small cell lung cancer (NSCLC) relapses previously treated with radiation.
The records of 128 consecutive patients treated with thoracic SBRT from 2009 through 2012 were retrospectively reviewed. Twenty-seven patients (29 lesions) treated with prior thoracic radiation for stage IIB-IIIB NSCLC with subsequent recurrences and retreated with SBRT were identified.
The median prior radiation dose was 64.8 Gy (range, 45 to 74 Gy) with a median retreatment dose of 50 Gy (range, 30 to 54 Gy), corresponding to a biological equivalent dose of 100 Gy (range, 48 to 151 Gy), at a median time of 13.4 months from prior radiation. The mean follow-up after salvage SBRT was 22 months. Local failure following salvage was 11%, nodal failure was 37%, and distant failure was 30%. The local recurrence-free survival at 2 years was 72%. Out-of-field failure was predictive for worse local control (hazard ratio, 47.38; 95% confidence interval, 5.795-64.899). Progression-free survival at 1 year was 55% and 38% at 2 years. Overall survival at 2 years from SBRT salvage was 79%. Salvage biological equivalent dose ≥100 Gy was predictive of improved progression-free survival (48% vs. 18%, P=0.021) and overall survival (91% vs. 52%, P=0.004) at 2 years. The rate of symptomatic pneumonitis was 63% and chest wall pain reported was 26%.
We observed improved outcomes following SBRT as a means of salvage for locally advanced recurrent NSCLC over traditional radiation therapy options. The toxicities were greater than expected from naive lung irradiation, but the adverse effects remained controlled with medications.
本研究的目的是提供关于使用立体定向体部放疗（SBRT）作为先前接受过放疗的非小细胞肺癌（NSCLC）复发后的挽救治疗手段的疗效数据。
回顾性分析了2009年至2012年期间连续接受胸部SBRT治疗的128例患者的记录。确定了27例（29个病灶）先前因IIB-IIIB期NSCLC接受胸部放疗且随后复发并接受SBRT挽救治疗的患者。
先前放疗的中位剂量为64.8 Gy（范围45至74 Gy），再次治疗的中位剂量为50 Gy（范围30至54 Gy），相当于生物等效剂量100 Gy（范围48至151 Gy），距先前放疗的中位时间为13.4个月。挽救性SBRT后的平均随访时间为22个月。挽救治疗后的局部失败率为11%，淋巴结失败率为37%，远处失败率为30%。2年时的局部无复发生存率为72%。野外失败预示着局部控制更差（风险比，47.38；95%置信区间，5.795 - 64.899）。1年时的无进展生存率为55%，2年时为38%。SBRT挽救治疗后2年的总生存率为79%。挽救性生物等效剂量≥100 Gy预示着2年时无进展生存率（48%对18%，P = 0.021）和总生存率（91%对52%，P = 0.004）提高。症状性肺炎的发生率为63%，报告的胸壁疼痛发生率为26%。
我们观察到，作为局部晚期复发性NSCLC的挽救治疗手段，SBRT的疗效优于传统放疗方案。毒性大于初次肺部照射的预期，但通过药物治疗不良反应仍可得到控制。
