Kim Eunji, Song Changhoon, Kim Mi Young, Kim Jae-Sung
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Kyungpook National University Medical Center, Daegu, Korea.
Radiat Oncol J. 2017 Mar;35(1):55-64. doi: 10.3857/roj.2016.01928. Epub 2017 Feb 13.
The outcomes and toxicities of locoregionally recurrent non-small-cell lung cancer (NSCLC) patients treated with curative radiotherapy were evaluated in the modern era.
Fifty-seven patients receiving radical radiotherapy for locoregionally recurrent NSCLC without distant metastasis after surgery from 2004 to 2014 were reviewed. Forty-two patients were treated with concurrent chemoradiotherapy (CCRT), and 15 patients with radiotherapy alone. The median radiation dose was 66 Gy (range, 45 to 70 Gy). Lung function change after radiotherapy was evaluated by comparing pulmonary function tests before and at 1, 6, and 12 months after radiotherapy.
Median follow-up was 53.6 months (range, 12.0 to 107.5 months) among the survivors. The median overall survival (OS) and progression-free survival (PFS) were 54.8 months (range, 3.0 to 116.9 months) and 12.2 months (range, 0.8 to 100.2 months), respectively. Multivariate analyses revealed that single locoregional recurrence focus and use of concurrent chemotherapy were significant prognostic factors for OS (p = 0.048 and p = 0.001, respectively) and PFS (p = 0.002 and p = 0.026, respectively). There was no significant change in predicted forced expiratory volume in one second after radiotherapy. Although diffusing lung capacity for carbon monoxide decreased significantly at 1 month after radiotherapy (p < 0.001), it recovered to pretreatment levels within 12 months. Acute grade 3 radiation pneumonitis and esophagitis were observed in 3 and 2 patients, respectively. There was no chronic complication observed in all patients.
Salvage radiotherapy showed good survival outcomes without severe complications in postoperative locoregionally recurrent NSCLC patients. A single locoregional recurrent focus and the use of CCRT chemotherapy were associated with improved survival. CCRT should be considered as a salvage treatment in patients with good prognostic factors.
评估现代时期接受根治性放疗的局部区域复发性非小细胞肺癌（NSCLC）患者的治疗结果和毒性反应。
回顾性分析2004年至2014年间57例接受根治性放疗的局部区域复发性NSCLC患者，这些患者均在术后无远处转移。42例患者接受同步放化疗（CCRT），15例患者仅接受放疗。中位放疗剂量为66 Gy（范围45至70 Gy）。通过比较放疗前、放疗后1个月、6个月和12个月的肺功能测试来评估放疗后肺功能的变化。
幸存者的中位随访时间为53.6个月（范围12.0至107.5个月）。中位总生存期（OS）和无进展生存期（PFS）分别为54.8个月（范围3.0至丨16.9个月）和12.2个月（范围0.8至100.2个月）。多因素分析显示，单一局部区域复发灶和同步化疗的使用分别是OS（p = 0.048和p = 0.001）和PFS（p = 0.002和p = 0.026）的显著预后因素。放疗后预计1秒用力呼气量无显著变化。尽管放疗后1个月一氧化碳弥散肺容量显著下降（p < 0.001），但在12个月内恢复到治疗前水平。分别有3例和2例患者出现急性3级放射性肺炎和食管炎。所有患者均未观察到慢性并发症。
挽救性放疗在术后局部区域复发性NSCLC患者中显示出良好的生存结果且无严重并发症。单一局部区域复发灶和CCRT化疗的使用与生存改善相关。对于具有良好预后因素的患者，CCRT应被视为一种挽救性治疗方法。
