Agolli Linda, Valeriani Maurizio, Bracci Stefano, Nicosia Luca, DE Sanctis Vitaliana, Enrici Riccardo Maurizi, Osti Mattia Falchetto
Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
Anticancer Res. 2015 Oct;35(10):5693-700.
We conducted long-term follow-up analysis of the outcomes for patients affected by advanced-stage non-small cell lung cancer (NSCLC) treated with hypofractionated radiotherapy (RT).
Sixty patients with advanced-stage NSCLC (IIIA-IV) treated with hypofractionated radiotherapy (60Gy/20 fractions) were analyzed. Radiation was delivered using an image-guided RT technique to verify the correct position. Toxicities were graded according to the Common Toxicity Criteria for Adverse Effects v4.0 scale.
Overall, six patients achieved a complete response and 46 patients had a partial response (tumor response rate 86%). After a median follow-up of 30 months, locoregional progression occurred in 23 patients and distant progression occurred in 38. The 1-year and 2-years overall survival were 57% and 40%, respectively. The 1-year and 2-years progression-free survival (PFS) were 47.1% and 33.5%, respectively. The median duration of OS and PFS was 13 months and 12 months, respectively. The 2-year local PFS and metastases-free survival (MFS) were 53% and 40.3%, respectively. On univariate analysis, the T-size (≥5 cm), and type of response to RT (non-response/progressive disease) were significantly associated with worse OS. Type of response was identified as significant prognostic factors for PFS (p<0.01) local PFS (p=0.015) and MFS (p<0.01). Acute grade 3 esophagitis and pneumonitis occurred in three patients (5%) and four patients (6%), respectively. Late grade 3 esophagitis and pneumonitis occurred in 2% (one patient) and 3% (two patients), respectively. No patient experienced grade 4 acute or late RT-related toxicities.
Hypofractionated RT offers good disease control for patients with advanced-stage NSCLC with acceptable toxicity rates. Phase III randomized trials are necessary to compare hypofractionated RT with conventional RT.
我们对接受大分割放疗（RT）治疗的晚期非小细胞肺癌（NSCLC）患者的预后进行了长期随访分析。
分析了60例接受大分割放疗（60Gy/20次分割）的晚期NSCLC（IIIA-IV期）患者。使用图像引导放疗技术进行放疗以验证正确位置。毒性根据《不良反应通用毒性标准》第4.0版进行分级。
总体而言，6例患者达到完全缓解，46例患者部分缓解（肿瘤缓解率86%）。中位随访30个月后，23例患者出现局部区域进展，38例患者出现远处进展。1年和2年总生存率分别为57%和40%。1年和2年无进展生存率（PFS）分别为47.1%和33.5%。总生存期（OS）和无进展生存期（PFS）的中位持续时间分别为13个月和12个月。2年局部无进展生存率和无转移生存率（MFS）分别为53%和40.3%。单因素分析显示，肿瘤大小（≥5cm）以及放疗反应类型（无反应/疾病进展）与较差的总生存期显著相关。放疗反应类型被确定为无进展生存期（p<0.01）、局部无进展生存期（p=0.015）和无转移生存期（p<0.01）的重要预后因素。3例患者（5%）发生急性3级食管炎，4例患者（6%）发生急性3级肺炎。2%（1例患者）发生晚期3级食管炎，3%（2例患者）发生晚期3级肺炎。没有患者出现4级急性或晚期放疗相关毒性。
大分割放疗可为晚期NSCLC患者提供良好的疾病控制，且毒性率可接受。有必要进行III期随机试验以比较大分割放疗与传统放疗。
