Lee Sung Uk, Moon Sung Ho, Cho Kwan Ho, Pyo Hong Ryull, Kim Joo Young, Kim Dae Yong, Kim Tae Hyun, Suh Yang-Gun, Kim Yeon-Joo
Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
Strahlenther Onkol. 2016 Sep;192(9):649-57. doi: 10.1007/s00066-016-0985-9. Epub 2016 Jun 9.
To evaluate the efficacy and safety of ablative dose hypofractionated proton beam therapy (PBT) for patients with stage I and recurrent non-small cell lung carcinoma (NSCLC).
A total of 55 patients with stage I (n = 42) and recurrent (n = 13) NSCLC underwent hypofractionated PBT and were retrospectively reviewed. A total dose of 50-72 CGE (cobalt gray equivalent) in 5-12 fractions was delivered.
The median follow-up duration was 29 months (range 4-95 months). There were 24 deaths (43.6%) during the follow-up period: 11 died of disease progression and 13 from other causes. Kaplan-Meier overall survival rate (OS) at 3 years was 54.9% and the median OS was 48.6 months (range 4-95 months). Local progression was observed in 7 patients and the median time to local progression was 9.3 months (range 5-14 months). Cumulative actuarial local control rate (LCR), lymph node metastasis-free survival, and distant metastasis-free survival rates at 3 years were 85.4, 78.4, and 76.5%, respectively. Larger tumor diameter was significantly associated with poorer LCR (3-year: 94% for ≤3 cm vs. 65% for >3 cm, p = 0.006) on univariate analysis and also an independent prognostic factor for LCR (HR 6.9, 95% CI = 1.3-37.8, p = 0.026) on multivariate analysis. No grade 3 or 4 treatment-related toxicities developed. One grade 5 treatment-related adverse event occurred in a patient with symptomatic idiopathic pulmonary fibrosis.
Ablative dose hypofractionated PBT was safe and promising for stage I and recurrent NSCLC.
评估大分割剂量质子束治疗（PBT）对Ⅰ期和复发性非小细胞肺癌（NSCLC）患者的疗效和安全性。
共有55例Ⅰ期（n = 42）和复发性（n = 13）NSCLC患者接受了大分割PBT治疗，并进行回顾性分析。总剂量为50 - 72 CGE（钴灰当量），分5 - 12次给予。
中位随访时间为29个月（范围4 - 95个月）。随访期间有24例死亡（43.6%）：11例死于疾病进展，13例死于其他原因。3年时的Kaplan - Meier总生存率（OS）为54.9%，中位OS为48.6个月（范围4 - 95个月）。7例患者出现局部进展，局部进展的中位时间为9.3个月（范围5 - 14个月）。3年时累积精算局部控制率（LCR）、无淋巴结转移生存率和无远处转移生存率分别为85.4%、78.4%和76.5%。单因素分析显示，肿瘤直径较大与LCR较差显著相关（3年时：≤3 cm者为94%，>3 cm者为65%，p = 0.006），多因素分析也是LCR的独立预后因素（HR 6.9，95%CI = 1.3 - 37.8，p = 0.026）。未出现3级或4级治疗相关毒性反应。1例有症状性特发性肺纤维化的患者发生了1例5级治疗相关不良事件。
大分割剂量质子束治疗对Ⅰ期和复发性NSCLC安全且有前景。
