立体定向消融放疗治疗Ⅰ期小细胞肺癌的多机构经验
Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer.
作者信息
Verma Vivek, Simone Charles B, Allen Pamela K, Gajjar Sameer R, Shah Chirag, Zhen Weining, Harkenrider Matthew M, Hallemeier Christopher L, Jabbour Salma K, Matthiesen Chance L, Braunstein Steve E, Lee Percy, Dilling Thomas J, Allen Bryan G, Nichols Elizabeth M, Attia Albert, Zeng Jing, Biswas Tithi, Paximadis Peter, Wang Fen, Walker Joshua M, Stahl John M, Daly Megan E, Decker Roy H, Hales Russell K, Willers Henning, Videtic Gregory M M, Mehta Minesh P, Lin Steven H
机构信息
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
出版信息
Int J Radiat Oncol Biol Phys. 2017 Feb 1;97(2):362-371. doi: 10.1016/j.ijrobp.2016.10.041. Epub 2016 Nov 2.
PURPOSE
For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population.
METHODS AND MATERIALS
The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes.
RESULTS
From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3% and 53.2% at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P=.02) and OS (31.4 vs 14.3 months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and "elsewhere lung" (20.8%). The median time to each was 5 to 7 months.
CONCLUSIONS
From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50 Gy) with chemotherapy should be considered a standard option.
目的
对于无法手术的I期（T1-T2N0）小细胞肺癌（SCLC），国家指南推荐进行化疗，可联合或不联合常规分割放射治疗。本多机构队列研究调查了立体定向消融放疗（SABR）在该人群中的作用。
方法和材料
对组织学确诊为T1-T2N0M0期SCLC的患者的临床和治疗特征、毒性、结局及失败模式进行评估。采用Kaplan-Meier分析评估生存结局。单因素和多因素分析确定结局的预测因素。
结果
来自24家机构的74例患者共治疗了76个病灶（中位随访时间18个月）。中位年龄和肿瘤大小分别为72岁和2.5 cm。分别有56%和23%的病例接受了化疗和预防性颅脑照射。SABR的中位剂量和分割次数分别为50 Gy和5次。1年和3年的局部控制率分别为97.4%和96.1%。中位无病生存期（DFS）为49.7个月。1年和3年的DFS率分别为58.3%和53.2%。中位、1年和3年的疾病特异性生存率分别为52.3个月、84.5%和64.4%。中位、1年和3年的总生存期（OS）分别为17.8个月、69.9%和34.0%。接受化疗的患者中位DFS（61.3对9.0个月；P = 0.02）和OS（31.4对14.3个月；P = 0.02）增加。多因素分析显示，接受化疗可独立预测DFS/OS的更好结局（P = 0.01）。毒性反应不常见；5.2%的患者发生≥2级肺炎。治疗后失败最常见于远处转移（45.8%的复发），其次是淋巴结转移（25.0%）和“肺部其他部位”（20.8%）。每种情况的中位时间为5至7个月。
结论
根据迄今为止关于T1-T2N0期SCLC的SABR最大规模报告的结果，SABR（≥50 Gy）联合化疗应被视为一种标准选择。
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