立体定向体部放疗用于复发性或持续性非小细胞肺癌的再照射。

Stereotactic body radiation therapy for re-irradiation of persistent or recurrent non-small cell lung cancer.

机构信息

Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.

出版信息

Int J Radiat Oncol Biol Phys. 2014 Apr 1;88(5):1114-9. doi: 10.1016/j.ijrobp.2014.01.012.

DOI:10.1016/j.ijrobp.2014.01.012

PMID:24661664

Abstract

PURPOSE

To retrospectively assess toxicity and outcome of re-irradiation with stereotactic body radiation therapy (SBRT) in patients with recurrent or persistent non-small cell lung cancer (NSCLC), who were previously treated with radical radiation therapy (50-60 Gy). The secondary endpoint was to investigate whether there are dosimetric parameter predictors of severe radiation toxicity.

METHODS AND MATERIALS

The analysis was conducted in 17 patients with "in-field" recurrent/persistent centrally located NSCLC, who underwent re-irradiation with SBRT. SBRT consisted of 30 Gy in 5 to 6 fractions; these prescriptions would be equivalent for the tumor to 37.5 to 40 Gy, bringing the total 2-Gy-per-fraction cumulative dose to 87 to 100 Gy, considering the primary radiation therapy treatment. Actuarial analyses and survival were calculated by the Kaplan-Meier method, and P values were estimated by the log-rank test, starting from the date of completion of SBRT. Dosimetric parameters from the subgroups with and without grade ≥3 pulmonary toxicity were compared using a 2-tailed Student t test.

RESULTS

The median follow-up was 18 months (range, 4-57 months). Only 2 patients had local failure, corresponding to a local control rate of 86% at 1 year. The Kaplan-Meier estimates of overall survival (OS) rates at 1 and 2 years were 59% and 29%, respectively; the median OS was 19 months. Four patients (23%) experienced grade 3 radiation pneumonitis, and 1 patient developed fatal pneumonitis. One patient died of fatal hemoptysis 2 months after the completion of SBRT. Unexpectedly, heart maximum dose, D5 (minimum dose to at least 5% of the heart volume), and D10 were correlated with risk of radiation pneumonitis (P<.05).

CONCLUSIONS

Re-irradiation with SBRT for recurrent/persistent centrally located NSCLC achieves excellent results in terms of local control. However, the high rate of severe toxicity reported in our study is of concern.

摘要

目的

回顾性评估立体定向体部放射治疗（SBRT）治疗复发或持续性非小细胞肺癌（NSCLC）患者的毒性和结果，这些患者先前接受过根治性放射治疗（50-60Gy）。次要终点是研究是否存在严重放射性毒性的剂量学参数预测因子。

方法和材料

对 17 例“靶内”复发性/持续性中央型 NSCLC 患者进行 SBRT 再照射分析。SBRT 采用 30Gy 分 5-6 次给予；这些处方相当于肿瘤 37.5-40Gy，考虑到初始放射治疗，2-Gy 分次累积剂量为 87-100Gy。通过 Kaplan-Meier 法计算累积生存率和生存分析，通过对数秩检验从 SBRT 完成日期开始估计 P 值。使用双侧学生 t 检验比较有和无 3 级及以上肺毒性亚组的剂量学参数。

结果

中位随访时间为 18 个月（范围，4-57 个月）。仅有 2 例患者发生局部失败，1 年时局部控制率为 86%。1 年和 2 年的总生存率（OS）估计值分别为 59%和 29%；中位 OS 为 19 个月。4 例（23%）患者发生 3 级放射性肺炎，1 例发生致命性肺炎。1 例患者在 SBRT 完成后 2 个月因致命性咯血死亡。出乎意料的是，心脏最大剂量、D5（至少 5%的心脏体积所接受的最小剂量）和 D10 与放射性肺炎的风险相关（P<.05）。