来自RSSearch(®)患者登记处的关于中心型早期非小细胞肺癌或肺转移瘤的立体定向体部放射治疗
Stereotactic body radiotherapy for centrally located early-stage non-small cell lung cancer or lung metastases from the RSSearch(®) patient registry.
作者信息
Davis Joanne N, Medbery Clinton, Sharma Sanjeev, Pablo John, Kimsey Frank, Perry David, Muacevic Alexander, Mahadevan Anand
机构信息
The Radiosurgery Society®, 1350 Dell, Suite 105, Campbell, CA, 95008, USA.
Department of Radiation Oncology, St. Anthony Hospital, Oklahoma City, OK, USA.
出版信息
Radiat Oncol. 2015 May 15;10:113. doi: 10.1186/s13014-015-0417-5.
BACKGROUND
The purpose of this study was to evaluate treatment patterns and outcomes of stereotactic body radiotherapy (SBRT) for centrally located primary non-small cell lung cancer (NSCLC) or lung metastases from the RSSearch(®) Patient Registry, an international, multi-center patient registry dedicated to radiosurgery and SBRT.
METHODS
Eligible patients included those with centrally located lung tumors clinically staged T1-T2 N0, M0, biopsy-confirmed NSCLC or lung metastases treated with SBRT between November 2004 and January 2014. Descriptive analysis was used to report patient demographics and treatment patterns. Overall survival (OS) and local control (LC) were determined using Kaplan-Meier method. Toxicity was reported using the Common Terminology Criteria for Adverse Events version 3.0.
RESULTS
In total, 111 patients with 114 centrally located lung tumors (48 T1-T2,N0,M0 NSCLC and 66 lung metastases) were treated with SBRT at 19 academic and community-based radiotherapy centers in the US and Germany. Median follow-up was 17 months (range, 1-72). Median age was 74 years for primary NSCLC patients and 65 years for lung metastases patients (p < 0.001). SBRT dose varied from 16 - 60 Gy (median 48 Gy) delivered in 1-5 fractions (median 4 fractions). Median dose to centrally located primary NSCLC was 48 Gy compared to 37.5 Gy for lung metastases (p = 0.0001) and median BED10 was 105.6 Gy for primary NSCLC and 93.6 Gy for lung metastases (p = 0.0005). Two-year OS for T1N0M0 and T2N0M0 NSCLC was 79 and 32.1 %, respectively (p = 0.009) and 2-year OS for lung metastases was 49.6 %. Two-year LC was 76.4 and 69.8 % for primary NSCLC and lung metastases, respectively. Toxicity was low with no Grade 3 or higher acute or late toxicities.
CONCLUSION
Overall, patients with centrally located primary NSCLC were older and received higher doses of SBRT than those with lung metastases. Despite these differences, LC and OS was favorable for patients with central lung tumors treated with SBRT. Reported toxicity was low, although low grade toxicities were observed in patients where dose tolerances approached or exceeded published guidelines. Prospective studies are needed to further define the optimal SBRT dose for this cohort of patients.
TRIAL REGISTRATION
Clinicaltrials.gov Identifier: NCT01885299.
背景
本研究旨在通过RSSearch®患者登记系统评估立体定向体部放疗（SBRT）治疗中央型原发性非小细胞肺癌（NSCLC）或肺转移瘤的治疗模式及疗效，该登记系统是一个致力于放射外科和SBRT的国际多中心患者登记系统。
方法
符合条件的患者包括2004年11月至2014年1月期间接受SBRT治疗的中央型肺肿瘤患者，这些患者临床分期为T1-T2 N0、M0，经活检确诊为NSCLC或肺转移瘤。采用描述性分析报告患者人口统计学特征和治疗模式。采用Kaplan-Meier法确定总生存期（OS）和局部控制率（LC）。使用不良事件通用术语标准3.0版报告毒性反应。
结果
在美国和德国的19个学术及社区放疗中心，共有111例患者的114个中央型肺肿瘤（48例T1-T2、N0、M0 NSCLC和66例肺转移瘤）接受了SBRT治疗。中位随访时间为17个月（范围1-72个月）。原发性NSCLC患者的中位年龄为74岁，肺转移瘤患者为65岁（p<0.001）。SBRT剂量为16-60 Gy（中位剂量48 Gy），分1-5次给予（中位次数4次）。中央型原发性NSCLC的中位剂量为48 Gy，肺转移瘤为37.5 Gy（p=0.0001），原发性NSCLC的中位生物等效剂量10（BED10）为105. Gy，肺转移瘤为93.6 Gy（p=0.0005）。T1N0M0和T2N0M0 NSCLC的2年总生存率分别为79%和32.1%（p=0.009），肺转移瘤的2年总生存率为49.6%。原发性NSCLC和肺转移瘤的2年局部控制率分别为76.4%和69.8%。毒性反应较低，无3级或更高等级的急性或晚期毒性反应。
结论
总体而言，中央型原发性NSCLC患者比肺转移瘤患者年龄更大，接受的SBRT剂量更高。尽管存在这些差异，但SBRT治疗中央型肺肿瘤患者的局部控制率和总生存率良好。报告的毒性反应较低，尽管在剂量耐受性接近或超过已发表指南的患者中观察到了低等级毒性反应。需要进行前瞻性研究以进一步确定该队列患者的最佳SBRT剂量。
试验注册
Clinicaltrials.gov标识符：NCT01885299。
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