Scorsetti Marta, Navarria Piera, De Rose Fiorenza, Ascolese AnnaMaria, Clerici Elena, Franzese Ciro, Lobefalo Francesca, Reggiori Giacomo, Mancosu Pietro, Tomatis Stefano, Fogliata Antonella, Cozzi Luca
Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, MI, Italy,
J Cancer Res Clin Oncol. 2014 Nov;140(11):1937-45. doi: 10.1007/s00432-014-1739-7. Epub 2014 Jun 17.
To report about the outcome of radiation treatment of advanced lung cancer patients with volumetric modulated arcs [RapidArc (RA)].
Seventy-five consecutive patients (all stages IIIA and IIIB) were treated with RA. Among them 71 % were men; 25.4 % presented unspecified non-small cell lung cancer, 41.3% adenocarcinoma and 33.3 % squamous cell carcinoma. Of them, 54.7 % received sequential chemotherapy while 45.3% were treated with concomitant regimen. Dose prescription ranged from 54 to 72 Gy. Analysis included survival, local control (LC) and toxicity profiles.
Median follow-up was 21.2 months (range 6-75). One- two- and five-year actuarial LC was 91.9 ± 3.2, 79.5 ± 5.7 and 67.4 ± 9.5 %, respectively. Median survival was 19.0 ± 1.1 months. Actuarial survival at 1-2-5 years was 80.0 ± 4.6, 38.5 ± 5.9 and 15.2 ± 4.9 %, respectively. Acute toxicity of G2 was reported in 24, 25.3 and 4.0 % of patients for lung, esophageal and hematological profiles. A total of 2.7 % of patients reported G3 toxicity in the esophagus and 5.3 % of the patients experienced G3-G4 hematological toxicity. Significant differences were observed in all cases between concomitant and sequential chemotherapy regiments. Only 1.3 % (1 patient) showed G2 lung late toxicity. No significant correlation was found between toxicity and organ's irradiation levels.
RA proved to be a safe and advantageous treatment modality for advanced lung cancer with results in line with expectations from earlier literature.
报告容积调强弧形放疗（快速弧形放疗，RA）用于晚期肺癌患者的治疗结果。
连续75例患者（均为ⅢA期和ⅢB期）接受了RA治疗。其中71%为男性；25.4%为未明确类型的非小细胞肺癌，41.3%为腺癌，33.3%为鳞状细胞癌。其中，54.7%接受序贯化疗，45.3%接受同步化疗方案。剂量处方范围为54至72 Gy。分析内容包括生存率、局部控制率（LC）和毒性反应情况。
中位随访时间为21.2个月（范围6 - 75个月）。1年、2年和5年精算局部控制率分别为91.9±3.2%、79.5±5.7%和67.4±9.5%。中位生存期为19.0±1.1个月。1年、2年和5年精算生存率分别为80.0±4.6%、38.5±5.9%和15.2±4.9%。肺部、食管和血液学方面分别有24%、25.3%和4.0%的患者报告有2级急性毒性反应。共有2.7%的患者报告有3级食管毒性反应，5.3%的患者出现3 - 4级血液学毒性反应。同步和序贯化疗方案在所有情况下均观察到显著差异。仅1.3%（1例患者）出现2级肺部迟发性毒性反应。未发现毒性反应与器官照射剂量水平之间存在显著相关性。
RA被证明是一种安全且有效的晚期肺癌治疗方式，其结果与早期文献的预期相符。
