Giuliani Meredith E, Hope Andrew, Mangona Victor, Guckenberger Matthias, Mantel Frederick, Peulen Heike, Sonke Jan-Jakob, Belderbos José, Werner-Wasik Maria, Ye Hong, Grills Inga S
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.
Clin Lung Cancer. 2017 Mar;18(2):162-168. doi: 10.1016/j.cllc.2016.10.006. Epub 2016 Oct 26.
The objective of this study was to determine the predictors and patterns of regional recurrence (RR) following stereotactic body radiotherapy (SBRT) for primary lung cancers.
Details of patient factors, treatment, and outcome factors were extracted from a multi-institutional (5) database. All events were calculated from the end of radiotherapy. Estimates of local recurrence, RR, and distant metastases (DM) were calculated using the competing risk method. Cause-specific and overall survival were calculated using the Kaplan-Meier method. Details of locations and number of simultaneous RRs were categorized by lymph node anatomic station.
A total of 734 patients were analyzed. The median follow-up was 3.0 years in surviving patients. Four hundred seventy-six (65%) patients had pathologic proof of disease. There were 64 patients with RR. The 2-year local recurrence, RR, and distant metastases rates were 5.6%, 9.0%, and 14.6% respectively. The 2-year cause-specific and overall survival were 89.9% and 63.7%, respectively. There were 136 simultaneous sites of RR. There were 21 recurrences in stations 4R (15.4%), 9 (6.6%) in 4L, 30 (22%) in 7, 19 (13.9%) in 10R, and 14 (10.3%) in 10L. The most common stations for isolated recurrence (n = 19) were station 7 (n = 5; 26.3%) and station 10R (n = 6; 31.6%). The most common RR levels were stations 4 and 7 for right and left upper lobe, stations 5, 7, and 10 for left lower lobe tumors, and stations 7 and 10 for right lower lobe tumors.
Stations 4, 7, and 10 were the most common stations for RR. These patterns of recurrence may guide nodal staging procedures prior to SBRT.
本研究的目的是确定原发性肺癌立体定向体部放疗（SBRT）后区域复发（RR）的预测因素和模式。
从一个多机构（5个）数据库中提取患者因素、治疗和结局因素的详细信息。所有事件均从放疗结束时开始计算。使用竞争风险法计算局部复发、RR和远处转移（DM）的估计值。使用Kaplan-Meier法计算特定病因生存率和总生存率。同时发生RR的部位和数量的详细信息按淋巴结解剖部位分类。
共分析了734例患者。存活患者的中位随访时间为3.0年。476例（65%）患者有疾病的病理证据。有64例患者发生RR。2年局部复发、RR和远处转移率分别为5.6%、9.0%和14.6%。2年特定病因生存率和总生存率分别为89.9%和63.7%。有136个同时发生RR的部位。4R区有21处复发（15.4%），4L区有9处（6.6%），7区有30处（22%），10R区有19处（13.9%），10L区有14处（10.3%）。孤立复发最常见的部位（n = 19）是7区（n = 5；26.3%）和10R区（n = 6；31.6%）。右上叶和左上叶RR最常见的部位是4区和7区，左下叶肿瘤是5区、7区和10区，右下叶肿瘤是7区和10区。
4区、7区和10区是RR最常见的部位。这些复发模式可能指导SBRT前的淋巴结分期程序。
