*Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; and †Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Thorac Oncol. 2015 Dec;10(12):1762-9. doi: 10.1097/JTO.0000000000000670.
To determine changes in pulmonary function brought about by lung stereotactic body radiation therapy (SBRT).
One hundred and twenty-seven patients were treated with lung SBRT using 48 to 60Gy in four to five fractions on a prospective trial. We obtained pulmonary function tests (PFTs) at baseline, 6 weeks, 3 months, 6 months, 9 months, 12 months, and 24 months after SBRT. Group mean PFT parameter values are reported.
At baseline forced expiratory volume in 1 second (FEV1) was 1.5 l (67% predicted, range: 0.4-3.4 l), corrected diffusing capacity for carbon monoxide was 12.2 ml/min/mmHg (50.8% predicted, range: 3.3-27.2 ml/min/mmHg), and total lung capacity was 5.7 l (102.4% predicted, range: 3.1-9.1 l). At 12 months, there was decline in FEV1 (-4.1%; p = 0.01), corrected diffusing capacity for carbon monoxide (-5.2%; p = 0.027), forced vital capacity (-5.7%; p = 0.004), and total lung capacity (-3.6%; p = 0.039). Declines in FEV1 (-7.6%; p = 0.001) and forced vital capacity (-8.9%; p = 0.001) persisted at 24 months. Rates of pneumonitis were 3.1% and 0.8% for grades 2 and 3, respectively. There were no grade 3 PFT toxicities at 12 months. Lower PFTs at baseline and 1 year after SBRT did not predict for worse overall survival.
As the largest cohort of patients with prospective follow-up PFT evaluation after lung SBRT, this supports the safety of SBRT in this population of predominantly medically inoperable patients. While statistically significant, nearly all declines in PFTs would be rated as a grade 1 on the Radiation Therapy Oncology Group scale, demonstrating safety. PFT declines were not associated with worse overall survival.
确定立体定向体部放射治疗（SBRT）引起的肺功能变化。
在一项前瞻性试验中，127 例患者采用 48 至 60Gy 的 4 至 5 个分次接受肺部 SBRT。我们在 SBRT 后 6 周、3 个月、6 个月、9 个月、12 个月和 24 个月时获得了肺功能检查（PFT）。报告组平均 PFT 参数值。
在基线时，1 秒用力呼气量（FEV1）为 1.5l（预测值的 67%，范围：0.4-3.4l），一氧化碳校正弥散量为 12.2ml/min/mmHg（预测值的 50.8%，范围：3.3-27.2ml/min/mmHg），总肺容量为 5.7l（预测值的 102.4%，范围：3.1-9.1l）。12 个月时，FEV1 下降（-4.1%；p=0.01），一氧化碳校正弥散量下降（-5.2%；p=0.027），用力肺活量下降（-5.7%；p=0.004），总肺容量下降（-3.6%；p=0.039）。24 个月时，FEV1（-7.6%；p=0.001）和用力肺活量（-8.9%；p=0.001）持续下降。2 级和 3 级肺炎发生率分别为 3.1%和 0.8%。12 个月时无 3 级 PFT 毒性。SBRT 后基线和 1 年时较低的 PFT 值并不能预测总体生存率更差。
作为最大的前瞻性随访 PFT 评估队列，这支持 SBRT 在以主要不能手术的患者为主的这部分人群中的安全性。虽然具有统计学意义，但几乎所有 PFT 的下降都将在放射治疗肿瘤学组量表上被评为 1 级，证明了安全性。PFT 下降与总体生存率无相关性。
