Mathieu Dominique, Campeau Marie-Pierre, Bahig Houda, Larrivée Sandra, Vu Toni, Lambert Louise, Lavoie Caroline, Roberge David, Doucet Robert, Carrier Jean-François, Gorgos Andrei, Fortin Bernard, Filion Edith
Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana.
Pract Radiat Oncol. 2015 Jul-Aug;5(4):e365-73. doi: 10.1016/j.prro.2014.12.002. Epub 2015 Feb 11.
The purpose of this study was to prospectively evaluate the quality of life (QoL) and pulmonary function of patients with early-stage non-small cell lung cancer treated with robotic stereotactic ablative radiation therapy (SABR).
Eligible patients all had histologically confirmed stage I non-small cell lung cancer and were not surgical candidates because of poor pulmonary function, comorbidities, or refusal of surgery. SABR was delivered at a median dose of 60 Gy in 3 fractions for peripheral tumors and 50 Gy in 4 or 5 fractions for central tumors. QoL was scored using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (QLQ-C30) and Lung Cancer-13 questionnaires. Pulmonary function tests (PFTs) included forced expiratory volume in 1 second (FEV1) and lung diffusion capacity. Changes over time in QoL scores and PFTs were tested with nonparametric tests for longitudinal data. Local control, survival, and toxicities are also presented.
From January 2010 to May 2013, 45 patients were enrolled. Median follow-up was 41 months. QLQ-C30 mean baseline scores for global QoL and physical functioning were 66 ± 20% and 73 ± 22%. Multilevel analyses showed no statistically and clinically significant (10-point change) deterioration in any of the QoL scores after SABR. Mean baseline FEV1 was 1.39 ± 0.51 L, and mean lung diffusion capacity was 63 ± 25% of predicted. We saw no significant change in PFTs at any time point. At 3 years, local control, disease-free survival, and overall survival were, respectively, 94%, 67%, and 75%.
In nonsurgical patients with multiple comorbidities, lung SABR achieves long-term local control while maintaining QoL and pulmonary function.
本研究旨在前瞻性评估接受机器人立体定向消融放疗（SABR）治疗的早期非小细胞肺癌患者的生活质量（QoL）和肺功能。
符合条件的患者均经组织学确诊为I期非小细胞肺癌，因肺功能差、合并症或拒绝手术而不适合手术。对于周围型肿瘤，SABR的中位剂量为60 Gy，分3次给予；对于中央型肿瘤，剂量为50 Gy，分4或5次给予。使用欧洲癌症研究与治疗组织生活质量问卷C30（QLQ-C30）和肺癌-13问卷对生活质量进行评分。肺功能测试（PFT）包括1秒用力呼气量（FEV1）和肺弥散量。使用纵向数据的非参数检验来测试生活质量评分和肺功能测试随时间的变化。同时还报告了局部控制、生存率和毒性情况。
从2010年1月至2013年5月，共纳入45例患者。中位随访时间为41个月。QLQ-C30中总体生活质量和身体功能的平均基线评分为66±20%和73±22%。多水平分析显示，SABR后任何生活质量评分均无统计学和临床意义上的显著（10分变化）恶化。平均基线FEV1为1.39±0.51 L，平均肺弥散量为预测值的63±25%。在任何时间点，我们均未观察到肺功能测试有显著变化。3年时，局部控制率、无病生存率和总生存率分别为94%、67%和75%。
在患有多种合并症的非手术患者中，肺部SABR可实现长期局部控制，同时维持生活质量和肺功能。
