立体定向体部放疗（SBRT）治疗多发同步及复发性肺结节的疗效
Outcomes of stereotactic body radiotherapy (SBRT) treatment of multiple synchronous and recurrent lung nodules.
作者信息
Owen Dawn, Olivier Kenneth R, Mayo Charles S, Miller Robert C, Nelson Kathryn, Bauer Heather, Brown Paul D, Park Sean S, Ma Daniel J, Garces Yolanda I
机构信息
Department of Radiation Oncology, University of Michigan, 1500 E Medical Drive, Ann Arbor, MI, 48105, USA.
Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA.
出版信息
Radiat Oncol. 2015 Feb 18;10:43. doi: 10.1186/s13014-015-0340-9.
BACKGROUND
Stereotactic body radiotherapy (SBRT) is evolving into a standard of care for unresectable lung nodules. Local control has been shown to be in excess of 90% at 3 years. However, some patients present with synchronous lung nodules in the ipsilateral or contralateral lobe or metasynchronous disease. In these cases, patients may receive multiple courses of lung SBRT or a single course for synchronous nodules. The toxicity of such treatment is currently unknown.
METHODS
Between 2006 and 2012, 63 subjects with 128 metasynchronous and synchronous lung nodules were treated at the Mayo Clinic with SBRT. Demographic patient data and dosimetric data regarding SBRT treatments were collected. Acute toxicity (defined as toxicity < 90 days) and late toxicity (defined as toxicity > = 90 days) were reported and graded as per standardized CTCAE 4.0 criteria. Local control, progression free survival and overall survival were also described.
RESULTS
The median age of patients treated was 73 years. Sixty five percent were primary or recurrent lung cancers with the remainder metastatic lung nodules of varying histologies. Of 63 patients, 18 had prior high dose external beam radiation to the mediastinum or chest. Dose and fractionation varied but the most common prescriptions were 48 Gy/4 fractions, 54 Gy/3 fractions, and 50 Gy/5 fractions. Only 6 patients demonstrated local recurrence. With a median follow up of 12.6 months, median SBRT specific overall survival and progression free survival were 35.7 months and 10.7 months respectively. Fifty one percent (32/63 patients) experienced acute toxicity, predominantly grade 1 and 2 fatigue. One patient developed acute grade 3 radiation pneumonitis at 75 days. Forty six percent (29/63 patients) developed late effects. Most were grade 1 dyspnea. There was one patient with grade 5 pneumonitis.
CONCLUSION
Multiple courses of SBRT and SBRT delivery after external beam radiotherapy appear to be feasible and safe. Most toxicity was grade 1 and 2 but the risk was approximately 50% for both acute and late effects.
背景
立体定向体部放疗（SBRT）正逐渐成为不可切除肺结节的治疗标准。据显示，3年局部控制率超过90%。然而，一些患者存在同侧或对侧肺叶的同步肺结节或异时性疾病。在这些情况下，患者可能接受多疗程的肺部SBRT或对同步结节进行单疗程治疗。目前尚不清楚这种治疗的毒性。
方法
2006年至2012年期间，梅奥诊所对63例患有128个异时性和同步性肺结节的患者进行了SBRT治疗。收集了患者的人口统计学数据和有关SBRT治疗的剂量学数据。报告了急性毒性（定义为90天内的毒性）和晚期毒性（定义为≥90天的毒性），并根据标准化的CTCAE 4.0标准进行分级。还描述了局部控制、无进展生存期和总生存期。
结果
接受治疗患者的中位年龄为73岁。65%为原发性或复发性肺癌，其余为不同组织学类型的转移性肺结节。63例患者中，18例曾接受过纵隔或胸部的高剂量外照射。剂量和分割方式各不相同，但最常见的处方为48 Gy/4次分割、54 Gy/3次分割和50 Gy/5次分割。只有6例出现局部复发。中位随访12.6个月，SBRT特异性总生存期和无进展生存期的中位数分别为35.7个月和10.7个月。51%（32/63例患者）出现急性毒性，主要为1级和2级疲劳。1例患者在75天时发生急性3级放射性肺炎。46%（29/63例患者）出现晚期效应。大多数为1级呼吸困难。有1例5级肺炎患者。
结论
多疗程SBRT以及外照射放疗后进行SBRT似乎是可行且安全的。大多数毒性为1级和2级，但急性和晚期效应的风险约为50%。
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