*Department of Thoracic Surgery, and †Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Thorac Oncol. 2015 Nov;10(11):1616-24. doi: 10.1097/JTO.0000000000000662.
Many efforts have been made to detect local relapse (LR) in the follow-up after stereotactic body radiotherapy (SBRT) for non-small-cell lung cancer (NSCLC) although limited data are available on its treatment and prognosis. We aimed to characterize treatment options and clarify long-term outcomes of isolated LR after SBRT for patients with clinical stage I NSCLC.
We reviewed our institutional database in search of patients with isolated LR after SBRT for clinical stage I NSCLC at our institution between 1999 and 2013. Patient characteristics were compared with Mann-Whitney U test, χ2 test, or Fisher's exact test as appropriate. Survival outcomes were estimated with Kaplan-Meier method. Potential prognostic factors were investigated using Cox proportional hazard model.
Of 308 patients undergoing SBRT for clinical stage I NSCLC, 49 patients were identified to have isolated LR. Twelve patients underwent salvage surgery, none underwent radiotherapy, and eight patients received chemotherapy, whereas 29 patients received best supportive care. No patient characteristic except operability was significantly related with patient selection for LR treatments. Five-year overall survival (OS) rate of the whole cohort was 47.9% from SBRT and 25.7% from LR. Salvage surgery was associated with improved OS after LR (p = 0.014), and 5-year OS for patients undergoing salvage surgery was 79.5% from LR.
It was confirmed that our patient selection for salvage surgery for isolated LR was associated with favorable survival outcomes. Operability based on multidisciplinary conferences, rather than measurable patient characteristics, is essential for appropriate patient selection for salvage surgery.
尽管针对非小细胞肺癌（NSCLC）立体定向体部放疗（SBRT）后局部复发（LR）的治疗和预后的相关数据有限，但已经做出了许多努力来进行检测。我们旨在描述 SBRT 治疗临床 I 期 NSCLC 后孤立性 LR 的治疗选择，并阐明其长期结果。
我们回顾了机构数据库，寻找了 1999 年至 2013 年期间在我们机构接受 SBRT 治疗的临床 I 期 NSCLC 后孤立性 LR 的患者。使用 Mann-Whitney U 检验、χ2 检验或 Fisher 确切检验比较患者特征。使用 Kaplan-Meier 法估计生存结果。使用 Cox 比例风险模型调查潜在的预后因素。
在 308 例接受 SBRT 治疗的临床 I 期 NSCLC 患者中，有 49 例患者被确定为孤立性 LR。12 例患者接受了挽救性手术，没有患者接受放疗，8 例患者接受了化疗，而 29 例患者接受了最佳支持治疗。除了可操作性外，没有患者特征与 LR 治疗的患者选择显著相关。从 SBRT 和 LR 来看，整个队列的 5 年总生存率（OS）率分别为 47.9%和 25.7%。LR 后接受挽救性手术与 OS 改善相关（p=0.014），接受挽救性手术的患者从 LR 开始的 5 年 OS 率为 79.5%。
证实了我们对孤立性 LR 进行挽救性手术的患者选择与有利的生存结果相关。基于多学科会议的可操作性，而不是可测量的患者特征，对于适当选择挽救性手术的患者至关重要。
