Lischalk Jonathan W, Malik Ryan M, Collins Sean P, Collins Brian T, Matus Ismael A, Anderson Eric D
Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Lower Level Bles, 3800 Reservoir Road, NW, Washington, DC, 20007, USA.
Division of Pulmonary, Critical Care, and Sleep Medicine, Pasquerilla Healthcare Center, Georgetown University Hospital, 5th floor, 3800 Reservoir Road, NW, Washington, DC, 20007, USA.
Radiat Oncol. 2016 Feb 27;11:28. doi: 10.1186/s13014-016-0608-8.
Radiotherapy of central lung tumors carries a higher risk of treatment-related toxicity and local failure. In the era of aggressive oligometastic management the exploration of the proper dose-fractionation for metastatic central lung tumors is essential.
Patients diagnosed with high-risk metastatic lesions of the central pulmonary tree comprised this single-institutional retrospective analysis. "High-risk" central pulmonary lesions were defined as those with abutment and/or invasion of the mainstem bronchus. All patients were treated using the CyberKnife SBRT system in 5 fractions to a total dose of 35 or 40 Gy.
Twenty patients were treated from 2008 to 2011 at Georgetown University Hospital. At a median follow up of 19 months, 1-year Kaplan-Meier local control and overall survival was 70 and 75 %, respectively. Late grade 2 or higher atelectasis was the most common treatment-related toxicity and was significantly associated with maximum dose to the mainstem bronchus. Gross endobronchial involvement was associated with significantly lower overall survival.
Five-fraction SBRT to a total dose of 35 or 40 Gy appears to be a safe and effective management strategy for high-risk central pulmonary metastatic lesions, though care should be taken to limit the maximum point dose to the mainstem bronchus.
中央型肺肿瘤的放射治疗具有较高的治疗相关毒性和局部失败风险。在积极的寡转移瘤治疗时代，探索转移性中央型肺肿瘤的合适剂量分割至关重要。
本单机构回顾性分析纳入了被诊断为中央肺树高风险转移病灶的患者。“高风险”中央肺病灶定义为那些紧邻和/或侵犯主支气管的病灶。所有患者均使用射波刀立体定向体部放疗系统分5次治疗，总剂量为35或40 Gy。
2008年至2011年期间，乔治敦大学医院共治疗了20例患者。中位随访19个月时，1年的Kaplan-Meier局部控制率和总生存率分别为70%和75%。2级或更高等级的晚期肺不张是最常见的治疗相关毒性，且与主支气管的最大剂量显著相关。支气管内明显受累与总生存率显著降低相关。
总剂量为35或40 Gy的5分次立体定向体部放疗似乎是治疗高风险中央肺转移病灶的一种安全有效的管理策略，不过应注意限制主支气管的最大点剂量。
