Franceschini D, De Rose F, Cozzi L, Navarria P, Clerici E, Franzese C, Comito T, Tozzi A, Iftode C, D'Agostino G, Sorsetti M
Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
Istituto Clinico Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano (Milan), Italy.
Strahlenther Onkol. 2017 May;193(5):385-391. doi: 10.1007/s00066-017-1103-3. Epub 2017 Feb 6.
This study aimed to analyse the feasibility and acute toxicity of radical hypo-fractionated radiotherapy (RT) for elderly patients with non-small-cell lung cancer (NSCLC).
We conducted a retrospective evaluation of treatment with volumetric modulated arc therapy (VMAT) of elderly patients affected by stage III inoperable NSCLC. The dose prescription was 56 Gy in 20 fractions, 55 Gy in 22 fractions, or 50 Gy in 20 fractions. Target volume included only the primary lesion and the infiltrated lymph nodes. The primary end point was acute and late toxicity, while secondary end points were progression-free survival (PFS), and overall survival (OS).
In all, 41 patients were included in this analysis. The mean age of the patients was 78.6 years, and 22 patients had staged IIIA while 19 patients had stage IIIB disease. All but one patient had pathological nodal involvement; 15 patients received chemotherapy before RT. Acute grade 1-2 toxicity was recorded in 25 (61%) patients. Late toxicity was recorded in 13 (32%) patients. No cases of G3 or G4 toxicity were recorded. Complete response was obtained in two (5%) patients, 26 (63%) showed a partial response, and two (5%) experience disease progression. At a mean follow-up of 9.9 months (range, 1.1-25.4), 17 patients had died from disease progression, one died from other causes, and 23 were alive. Median OS was 13.7 ± 1.5 months (95% CI: 10.7-16.7), OS at 12 and 18 months was 51.3 ± 9.5% and 35.1 ± 10.1%, respectively. Median PFS was 13.7 ± 2.3 months (95% CI: 9.1-18.2), and PFS at 12 and 18 months was 50.1 ± 9.9% and 38.9 ± 10.4%, respectively.
Radical hypo-fractionated VMAT is a promising treatment for locally advanced NSCLC in the elderly. The use of hypo-fractionated radiotherapy for lung cancer in older patients can be considered a valuable approach, particularly for patients with poor performance status or refusing other treatment approaches.
本研究旨在分析根治性大分割放疗（RT）用于老年非小细胞肺癌（NSCLC）患者的可行性和急性毒性。
我们对接受容积调强弧形放疗（VMAT）治疗的Ⅲ期不可手术NSCLC老年患者进行了回顾性评估。剂量处方为20次分割给予56 Gy、22次分割给予55 Gy或20次分割给予50 Gy。靶区仅包括原发灶和受累淋巴结。主要终点为急性和晚期毒性，次要终点为无进展生存期（PFS）和总生存期（OS）。
本分析共纳入41例患者。患者的平均年龄为78.6岁，22例为ⅢA期，19例为ⅢB期。除1例患者外，所有患者均有病理淋巴结受累；15例患者在放疗前接受了化疗。25例（61%）患者记录有1 - 2级急性毒性。13例（32%）患者记录有晚期毒性。未记录到3级或4级毒性病例。2例（5%）患者获得完全缓解，26例（63%）显示部分缓解，2例（5%）疾病进展。平均随访9.9个月（范围1.1 - 25.4个月），17例患者死于疾病进展，1例死于其他原因，23例存活。中位OS为13.7 ± 1.5个月（95%CI：10.7 - 16.7），12个月和18个月时的OS分别为51.3 ± 9.5%和35.1 ± 10.1%。中位PFS为13.7 ± 2.3个月（95%CI：9.1 - 18.2），12个月和18个月时的PFS分别为50.1 ± 9.9%和38.9 ± 10.4%。
根治性大分割VMAT是老年局部晚期NSCLC的一种有前景的治疗方法。对于老年肺癌患者使用大分割放疗可被视为一种有价值的方法，特别是对于身体状况较差或拒绝其他治疗方法的患者。
