Pöttgen Christoph, Abu Jawad Jehad, Gkika Eleni, Freitag Lutz, Lübcke Wolfgang, Welter Stefan, Gauler Thomas, Schuler Martin, Eberhardt Wilfried Ernst Erich, Stamatis Georgios, Stuschke Martin
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
J Thorac Dis. 2015 Mar;7(3):264-72. doi: 10.3978/j.issn.2072-1439.2015.01.59.
Treatment options are very limited for patients with lung cancer who experience contralateral central or mediastinal relapse following pneumonectomy. We present results of an accelerated salvage chemoradiotherapy regimen.
Patients with localized contralateral central intrapulmonary or mediastinal relapse after pneumonectomy were offered combined chemoradiotherapy including concurrent weekly cisplatin (25 mg/m(2)) and accelerated radiotherapy [accelerated fractionated (AF), 60 Gy, 8×2 Gy per week] to reduce time for repopulation. Based on 4D-CT-planning, patients were irradiated using multifield intensity-modulated radiotherapy (IMRT) or helical tomotherapy.
Between 10/2011 and 12/2012, seven patients were treated. Initial stages were IIB/IIIA/IIIB: 3/1/3; histopathological subtypes scc/adeno/large cell: 4/1/2. Tumour relapses were located in mediastinal nodal stations in five patients with endobronchial tumour in three patients. The remaining patients had contralateral central tumour relapses. All patients received 60 Gy (AF), six patients received concurrent chemotherapy. Median dose to the remaining contralateral lung, esophagus, and spinal cord was 6.8 (3.3-11.4), 8.0 (5.1-15.5), and 7.6 (2.8-31.2) Gy, respectively. With a median follow-up of 29 [17-32] months, no esophageal or pulmonary toxicity exceeding grade 2 [Common terminology criteria for adverse events (CTC-AE) v. 3] was observed. Median survival was 17.2 months, local in-field control at 12 months 80%. Only two local recurrences were observed, both in combination with out-field metastases.
This intensified accelerated chemoradiotherapy schedule was safely applicable and offers a curative chance in these pretreated frail lung cancer patients.
对于肺叶切除术后出现对侧中央或纵隔复发的肺癌患者，治疗选择非常有限。我们展示了一种加速挽救性放化疗方案的结果。
为肺叶切除术后出现局限性对侧中央肺内或纵隔复发的患者提供联合放化疗，包括每周一次顺铂（25mg/m²）同步化疗和加速放疗[加速分割放疗（AF），60Gy，每周8次，每次2Gy]，以减少肿瘤再增殖时间。基于4D-CT规划，患者采用多野调强放疗（IMRT）或螺旋断层放疗。
2011年10月至2012年12月期间，7例患者接受了治疗。初始分期为IIB/IIIA/IIIB：3/1/3；组织病理学亚型为鳞状细胞癌/腺癌/大细胞癌：4/1/2。5例患者肿瘤复发位于纵隔淋巴结站，3例患者肿瘤复发位于支气管内。其余患者出现对侧中央肿瘤复发。所有患者均接受了60Gy（AF）放疗，6例患者接受了同步化疗。对侧剩余肺、食管和脊髓的中位剂量分别为6.8（3.3-11.4）Gy、8.0（5.1-15.5）Gy和7.6（2.8-31.2）Gy。中位随访时间为29[17-32]个月，未观察到超过2级的食管或肺部毒性[不良事件通用术语标准（CTC-AE）第3版]。中位生存期为17.2个月，12个月时局部野内控制率为80%。仅观察到2例局部复发，均合并野外转移。
这种强化的加速放化疗方案安全可行，为这些经过预处理的体弱肺癌患者提供了治愈机会。
