Jumeau Raphaël, Bahig Houda, Filion Édith, Campeau Marie-Pierre, Lambert Louise, Roberge David, Gorgos Andrei-Bogdan, Vu Toni
Department of Radiation Oncology, Centre hospitalier de l'université de Montréal (CHUM).
Radiology, Centre hospitalier de l'université de Montréal (CHUM).
Cureus. 2016 Nov 29;8(11):e901. doi: 10.7759/cureus.901.
Surgery remains the standard treatment for medically operable patients with early-stage non-small cell lung carcinoma (NSCLC). Following surgical resection, adjuvant chemotherapy is recommended for large tumors >4 cm. For unfit patients, stereotactic body radiation therapy (SBRT) has emerged as an excellent alternative to surgery. This study aims to assess patterns of recurrence and discuss the role of chemotherapy after SBRT for NSCLC.
We reviewed patients treated with SBRT for primary early-stage NSCLC between 2009 and 2015. Total target doses were between 50 and 60 Gy administered in three to eight fractions. All patients had a staging fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) scan, and histologic confirmation was obtained whenever possible. Mediastinal staging was performed if lymph node involvement was suspected on CT or PET/CT. Survival outcomes were estimated using the Kaplan-Meier method.
Among the 559 early-stage NSCLC patients treated with SBRT, 121 patients were stage T2N0. The one-year and three-year overall survival rates were 88% and 70%, respectively, for patients with T2 disease, compared to 95% and 81%, respectively, for the T1 patients (p<0.05). The one-year and three-year local control rates were equal in both groups (98% and 91%, respectively). In T2 patients, 25 (21%) presented a relapse, among which 21 (84%) were nodal or distant. The median survival of T2N0 patients following a relapse was 11 months.
Lung SBRT provides high local control rates, even for larger tumors. When patients relapse, the majority of them do so at regional or distant sites. These results raise the question as to whether adjuvant treatment should be considered following SBRT for larger tumors.
手术仍然是早期非小细胞肺癌（NSCLC）可进行医学手术治疗患者的标准治疗方法。手术切除后，对于大于4cm的大肿瘤，建议进行辅助化疗。对于不适合手术的患者，立体定向体部放疗（SBRT）已成为手术的一种极佳替代方案。本研究旨在评估复发模式，并探讨SBRT治疗NSCLC后化疗的作用。
我们回顾了2009年至2015年间接受SBRT治疗的原发性早期NSCLC患者。总靶区剂量在50至60Gy之间，分三至八次给予。所有患者均进行了分期氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）与计算机断层扫描（CT）扫描相结合的检查，并尽可能获得组织学确诊。如果CT或PET/CT怀疑有淋巴结受累，则进行纵隔分期。采用Kaplan-Meier方法估计生存结果。
在559例接受SBRT治疗的早期NSCLC患者中，121例为T2N0期。T2期患者的一年和三年总生存率分别为88%和70%，而T1期患者分别为95%和81%（p<0.05）。两组的一年和三年局部控制率相同（分别为98%和91%）。在T2期患者中，25例（21%）出现复发，其中21例（84%）为淋巴结或远处复发。T2N0期患者复发后的中位生存期为11个月。
肺部SBRT即使对于较大肿瘤也能提供较高的局部控制率。当患者复发时，大多数是在区域或远处部位复发。这些结果提出了一个问题，即对于较大肿瘤，SBRT后是否应考虑辅助治疗。
