Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands.
J Thorac Oncol. 2016 Jul;11(7):1081-9. doi: 10.1016/j.jtho.2016.03.008. Epub 2016 Mar 21.
We defined "ultracentral" lung tumors as centrally located non-small cell lung cancers with planning target volumes overlapping the trachea or main bronchi. Increased toxicity has been reported after both conventional and stereotactic radiotherapy for such lesions. We studied outcomes after 12 fractions of 5 Gy (BED10 = 90 Gy, heterogeneous dose distribution) to ultracentral tumors in patients unfit for surgery or conventional chemoradiotherapy.
Clinical outcomes and dosimetric details were analyzed in 47 consecutive patients with single primary or recurrent ultracentral non-small cell lung cancer treated between 2010 and 2015. Those irradiated previously or with metastasis to sites other than the brain and adrenal glands were excluded. Treatments were delivered using volumetric modulated arc therapy.
The median age was 77.5 years, 49% of patients had a World Health Organization performance score of 2 or higher, and the median planning target volume was 104.5cm(3) (range 17.7-508.5). At a median follow-up of 29.3 months, median overall survival was 15.9 months, and 3-year survival was 20.1%. No isolated local recurrences were observed. Grade 3 or higher toxicity was recorded in 38% of patients, with 21% scored as having a "possible" (n = 2) or "likely" (n = 8) treatment-related death between 5.2 and 18.2 months after treatment. Fatal pulmonary hemorrhage was observed in 15% of patients.
Unfit patients with ultracentral tumors who were treated using this scheme had a high local control and a median survival of 15.9 months. Despite manifestation of rates of a fatal lung bleeding comparable to those seen with conventional radiotherapy for endobronchial tumors, the overall rate of G5 toxicity is of potential concern. Additional work is needed to identify tumor and treatment factors related to hemorrhage.
我们将“超中心”肺部肿瘤定义为位于中央的非小细胞肺癌，其计划靶区与气管或主支气管重叠。对于此类病变，常规放疗和立体定向放疗后均有报道毒性增加。我们研究了不能手术或常规放化疗的患者接受 12 次 5 Gy（BED10=90 Gy，不均匀剂量分布）治疗超中心肿瘤的结果。
分析了 2010 年至 2015 年间接受单次原发性或复发性超中心非小细胞肺癌治疗的 47 例连续患者的临床结果和剂量学细节。排除了之前接受过放疗或有脑和肾上腺以外部位转移的患者。治疗采用容积旋转调强弧形治疗。
中位年龄为 77.5 岁，49%的患者有 2 分或更高的世界卫生组织表现评分，中位计划靶区体积为 104.5cm3（范围 17.7-508.5）。在中位随访 29.3 个月时，中位总生存期为 15.9 个月，3 年生存率为 20.1%。未观察到孤立的局部复发。38%的患者出现 3 级或更高毒性，21%的患者被评为在治疗后 5.2-18.2 个月“可能”（n=2）或“可能”（n=8）与治疗相关的死亡。15%的患者发生致命性肺出血。
采用该方案治疗超中心肿瘤的不适合患者具有较高的局部控制率和 15.9 个月的中位生存期。尽管致命性肺出血的发生率与常规放疗治疗支气管内肿瘤相似，但 5 级毒性的总体发生率值得关注。需要进一步研究以确定与出血相关的肿瘤和治疗因素。
