Chiang Yun, Yang James Chih-Hsin, Hsu Feng-Ming, Chen Yu-Hsuan, Shih Jin-Yuan, Lin Zhong-Zhe, Lan Keng-Hsueh, Cheng Ann-Lii, Kuo Sung-Hsin
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Cancer Research Center, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan.
PLoS One. 2015 Dec 31;10(12):e0145936. doi: 10.1371/journal.pone.0145936. eCollection 2015.
For metastatic non-small cell lung cancer (NSCLC) patients with controlled extrathoracic disease after systemic treatment, stable or progressive primary lung lesions may cause respiratory symptoms and increase comorbidities. In the present study, we sought to investigate whether aggressive palliative thoracic radiotherapy (RT) can enhance local control and improve the survival for this subgroup of patients.
Between March 2006 and December 2014, 56 patients with metastatic NSCLC who had responsive or stable extrathoracic diseases after chemotherapy and/or molecular targets, and received thoracic RT for stable and progressive primary lung lesions were included. RT with a median dose of 55 Gy (range, 40-62 Gy) was administered in 1.8-2.5 Gy fractions to primary lung tumor and regional mediastinal lymph nodes using modern RT technique. Overall survival (OS) from diagnosis, and locoregional progression-free survival (LRPFS), and survival calculated from radiotherapy (OS-RT) were estimated using the Kaplan-Meier method.
There were 37 men and 19 women with a median age of 60 years at diagnosis. The median interval from the diagnosis of metastatic disease to thoracic RT was 8 months. Following thoracic RT, 26 patients (46%) achieved complete or partial response (overall response rate, ORR). Patients with squamous cell carcinoma or poorly-differentiated carcinoma had a higher ORR than those with adenocarcinoma (63% vs. 34%, P = 0.034). EGFR mutations was closely associated with a better ORR (45% vs. 29%, P = 0.284). At a median follow-up time of 44 months, the median OS, LRPFS after RT, and OS-RT were 50 months, 15 months, and 18 months.
Radical palliative throractic RT is safe and might be beneficial for primary lung lesions of metastatic NSCLC patients with controlled extrathoracic diseases.
对于全身治疗后胸外疾病得到控制的转移性非小细胞肺癌（NSCLC）患者，原发性肺病灶稳定或进展可能会引起呼吸道症状并增加合并症。在本研究中，我们试图探究积极的姑息性胸部放疗（RT）是否能增强局部控制并改善该亚组患者的生存情况。
2006年3月至2014年12月期间，纳入了56例转移性NSCLC患者，这些患者在化疗和/或分子靶向治疗后胸外疾病有反应或稳定，并因原发性肺病灶稳定或进展而接受了胸部放疗。使用现代放疗技术，以1.8 - 2.5 Gy的分割剂量对原发性肺肿瘤和区域纵隔淋巴结给予中位剂量为55 Gy（范围40 - 62 Gy）的放疗。采用Kaplan-Meier法估计从诊断开始的总生存期（OS）、局部区域无进展生存期（LRPFS）以及从放疗开始计算的生存期（OS-RT）。
共有37例男性和19例女性，诊断时的中位年龄为60岁。从转移性疾病诊断到胸部放疗的中位间隔时间为8个月。胸部放疗后，26例患者（46%）达到完全或部分缓解（总缓解率，ORR）。鳞状细胞癌或低分化癌患者的ORR高于腺癌患者（63%对34%，P = 0.034）。表皮生长因子受体（EGFR）突变与更好的ORR密切相关（45%对29%，P = 0.284）。在中位随访时间44个月时，中位OS、放疗后的LRPFS以及OS-RT分别为50个月、15个月和18个月。
根治性姑息性胸部放疗是安全的，可能对胸外疾病得到控制的转移性NSCLC患者的原发性肺病灶有益。
