Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520.
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520.
J Thorac Oncol. 2015 May;10(5):832-837. doi: 10.1097/JTO.0000000000000484.
Stereotactic body radiotherapy (SBRT) has been increasingly utilized for medically inoperable early stage non-small-cell lung cancer. However, a lower biological equivalent dose (BED) is often used for central tumors given toxicity concerns, potentially leading to decreased local control (LC). We compared survival, LC, and toxicity outcomes for SBRT patients with centrally versus peripherally located tumors.
We included patients with primary cT1-2N0M0 non-small-cell lung cancer treated with SBRT at our institution from September 2007 to August 2013 with follow-up through August 2014. Central tumor location was defined as within 2 cm of the proximal bronchial tree, heart, great vessels, trachea, or other mediastinal structures. Kaplan-Meier analysis and multivariable Cox regression modeling were used for overall survival (OS) and LC, and the χ test and multivariable logistic regression modeling were used for toxicity.
We included 251 patients (111 central, 140 peripheral) with median follow-up of 31.2 months. Patients with central tumors were more likely to be older (mean 75.8 versus 73.5 years; p = 0.04), have larger tumors (mean 2.5 cm versus 1.9 cm; p < 0.001), and be treated with a lower BED (mean 120.2 Gy versus 143.5 Gy; p < 0.001). Multivariable analysis revealed that tumor location was not associated with worse OS, LC, or toxicity. Patients with central tumors were less likely to have acute grade greater than or equal to three toxicity than those with peripheral tumors (odds ratio: 0.24; p = 0.02).
Central tumor location did not predict for inferior OS, LC, or toxicity following SBRT when a lower mean BED was utilized.
立体定向体部放疗（SBRT）已越来越多地用于无法手术的早期非小细胞肺癌。然而，由于毒性问题，中央肿瘤的生物等效剂量（BED）往往较低，这可能导致局部控制（LC）降低。我们比较了中央肿瘤和外周肿瘤的 SBRT 患者的生存、LC 和毒性结果。
我们纳入了 2007 年 9 月至 2013 年 8 月在我们机构接受 SBRT 治疗的原发性 cT1-2N0M0 非小细胞肺癌患者，并随访至 2014 年 8 月。中央肿瘤位置定义为近端支气管树、心脏、大血管、气管或其他纵隔结构 2cm 内。采用 Kaplan-Meier 分析和多变量 Cox 回归模型进行总生存（OS）和 LC 分析，采用 χ检验和多变量逻辑回归模型进行毒性分析。
我们纳入了 251 例患者（111 例中央肿瘤，140 例外周肿瘤），中位随访时间为 31.2 个月。中央肿瘤患者年龄更大（平均 75.8 岁比 73.5 岁；p = 0.04），肿瘤更大（平均 2.5cm 比 1.9cm；p < 0.001），接受的 BED 更低（平均 120.2Gy 比 143.5Gy；p < 0.001）。多变量分析显示，肿瘤位置与 OS、LC 或毒性无关。中央肿瘤患者发生急性 3 级以上毒性的可能性低于外周肿瘤患者（比值比：0.24；p = 0.02）。
当使用较低的平均 BED 时，中央肿瘤位置并未预测 SBRT 后 OS、LC 或毒性降低。
