Rosen Lane R, Fischer-Valuck Benjamin W, Katz Sanford R, Durci Michael, Wu Hsinshun Terry, Syh Joseph, Syh Jarron, Patel Bijal
Tumori. 2014 Jan-Feb;100(1):42-8. doi: 10.1700/1430.15814.
Our aim is to report on the clinical methods and outcomes of helical intensity-modulated stereotactic body radiotherapy (SBRT) for the treatment of early-stage non-small cell lung cancer (NSCLC).
Seventy-nine patients with stage I NSCLC underwent helical SBRT with 48 Gy in 4 fractions or 60 Gy in 5 fractions. All patients underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) or FDG-PET/computed tomography (CT) scanning in the immobilized treatment position for planned fusion with a separate kilovoltage (KV) CT simulation prior to treatment. Megavoltage CT images were obtained on the treatment unit prior to therapy and repeated at mid-fraction with comparison and fusion to the KV CT simulation planning images to assure setup accuracy. Serial follow-up with FDG-PET or FDG-PET/CT was performed at 3-4 months and every 6 months thereafter.
Median follow-up was 27 months (range, 4-82 months). Overall local control rate (LCR) was 93.6% (95% confidence interval [CI], 86.0-97.3%) and 3-year overall survival (OS) was 58.4% (95% CI, 47.2-69.5%). For patients with T1N0M0 disease (n = 59) the LCR was 94.9% (95% CI, 86.1-98.3%) and the 3-year OS was 62.8% (95% CI, 49.9-73.9%). Patients treated with 60 Gy had longer 3-year OS than patients treated with 48 Gy (65.2% vs 37.5%; P = 0.044). SBRT-related toxicity was modest, with 10 patients developing grade 1/2 chest wall toxicity based on the Common Terminology Criteria for Adverse Events (CTCAE).
Image-guided SBRT with helical IMRT delivered in 4 or 5 fractions of 12 Gy with rigid immobilization, FDG-PET-assisted targeting, and repeat mid-fraction CT scan is an effective treatment for early NSCLC.
我们的目的是报告螺旋调强立体定向体部放射治疗（SBRT）用于治疗早期非小细胞肺癌（NSCLC）的临床方法及结果。
79例I期NSCLC患者接受了螺旋SBRT，剂量为48 Gy分4次或60 Gy分5次。所有患者在固定治疗体位下进行18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）或FDG-PET/计算机断层扫描（CT），以便在治疗前与单独的千伏（KV）CT模拟进行计划融合。在治疗前在治疗单元上获取兆伏级CT图像，并在疗程中间重复获取，与KV CT模拟计划图像进行比较和融合，以确保摆位准确性。在3至4个月时进行FDG-PET或FDG-PET/CT的系列随访，此后每6个月进行一次。
中位随访时间为27个月（范围4至82个月）。总体局部控制率（LCR）为93.6%（95%置信区间[CI]，86.0 - 97.3%），3年总生存率（OS）为58.4%（95% CI，47.2 - 69.5%）。对于T1N0M0期疾病患者（n = 59），LCR为94.9%（95% CI，86.1 - 98.3%），3年OS为62.8%（95% CI，49.9 - 73.9%）。接受60 Gy治疗的患者3年OS长于接受48 Gy治疗的患者（65.2%对37.5%；P = 0.044）。SBRT相关毒性较轻，根据不良事件通用术语标准（CTCAE），有10例患者出现1/2级胸壁毒性。
采用螺旋调强放疗（IMRT）、以12 Gy分4或5次进行、刚性固定、FDG-PET辅助定位及疗程中间重复CT扫描的图像引导SBRT是早期NSCLC的有效治疗方法。
