Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Pract Radiat Oncol. 2013 Oct-Dec;3(4):301-6. doi: 10.1016/j.prro.2012.10.003. Epub 2012 Nov 2.
To report on medically inoperable stage I small cell lung cancer (SCLC) patients for whom stereotactic body radiation therapy (SBRT) was employed to manage the primary tumor.
Review of our institutional review board approved SBRT registry revealed 6 cases of stage I SCLC out of 430 patients over a 6-year interval (2004-2010). All patients had biopsy proven disease and deemed medically inoperable by a thoracic surgeon. Our institutional approach was to treat with a combination of SBRT, platinum-etoposide chemotherapy (CHT) and prophylactic cranial irradiation (PCI). SBRT was delivered using a Novalis/BrainLAB platform and ExacTrac (BrainLab, Westchester, IL) for image guidance.
Patient characteristics included a median Karnofsky performance scale of 80, a median age of 68 years, 4 females, and 1 patient still smoking at presentation. Impaired pulmonary function caused inoperability in 50% of cases. Tumor characteristics included median tumor size of 2.6 cm and median positron emission tomography-standard uptake valuemax of 9. The SBRT was 60 Gy/3 fractions (3 patients), 50 Gy/5 fractions (2 patients), 30 Gy/1 fraction (1 patient). Median follow-up was 11.9 months. There was no grade 3 or higher, and 1 grade 2, toxicity. Three patients were alive at analysis and 3 patients had died of non-cancer causes. At 1 year, local control was 100%, there was no regional nodal failure, and 1 patient had distant failure (liver). Overall and disease-free survivals at 1 year were 63% and 75%, respectively.
Employing SBRT for stage I medically inoperable SCLC is rational, with excellent local control and encouraging disease-specific survival. The absence of regional nodal failure supports positron emission tomography for mediastinal staging. Platinum-based CHT may be feasible in vulnerable populations.
报告无法进行手术的 I 期小细胞肺癌（SCLC）患者，这些患者采用立体定向体部放射治疗（SBRT）来治疗原发肿瘤。
对本机构审查委员会批准的 SBRT 注册处进行了回顾，发现 6 例 I 期 SCLC 患者，他们来自 430 例患者，随访时间为 6 年（2004 年至 2010 年）。所有患者均经活检证实患有疾病，并被胸外科医生判定为无法进行手术。我们的机构治疗方法是将 SBRT、铂类依托泊苷化疗（CHT）和预防性颅照射（PCI）相结合。SBRT 使用 Novalis/BrainLAB 平台和 ExacTrac（BrainLab，Westchester，IL）进行图像引导。
患者特征包括 Karnofsky 表现量表评分为 80 分的中位数、68 岁的中位数年龄、4 名女性和 1 名就诊时仍在吸烟的患者。50%的病例因肺功能受损导致无法手术。肿瘤特征包括肿瘤大小中位数为 2.6 厘米和正电子发射断层扫描标准摄取值最大值中位数为 9。SBRT 为 60 Gy/3 个剂量（3 例）、50 Gy/5 个剂量（2 例）、30 Gy/1 个剂量（1 例）。中位随访时间为 11.9 个月。无 3 级或更高，1 例 2 级毒性。分析时，3 例患者存活，3 例患者死于非癌症原因。1 年时，局部控制率为 100%，无区域淋巴结失败，1 例患者发生远处失败（肝脏）。1 年时的总生存率和无病生存率分别为 63%和 75%。
对无法进行手术的 I 期 SCLC 患者采用 SBRT 是合理的，局部控制率高，疾病特异性生存率高。无区域淋巴结失败支持正电子发射断层扫描进行纵隔分期。基于铂的 CHT 在脆弱人群中可能是可行的。
