Arcangeli Stefano, Falcinelli Lorenzo, Bracci Stefano, Greco Alessandro, Monaco Alessia, Dognini Jessica, Chiostrini Cinzia, Bellavita Rita, Aristei Cynthia, Donato Vittorio
1 Department of Radiation Oncology, San Camillo-Forlanini Hospitals, Rome, Italy.
2 Department of Radiation Oncology, S. Maria della Misericordia University Hospital, Perugia, Italy.
Br J Radiol. 2017 Mar;90(1071):20160853. doi: 10.1259/bjr.20160853.
To evaluate treatment outcomes and patterns of CT lung injury after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) in a series of inoperable lung lesions.
68 patients who were medically inoperable (69 lesions) without evidence of viable extrathoracic disease were included. Dose prescription was driven by tumour location (hilar/pericentral vs peripheral) and/or target volume. 52% of the lesions received a biological equivalent dose (BED) ≥100 Gy. Assessment of tumour response was based on the Response Evaluation Criteria in Solid Tumours 1.1 criteria coupled with fluorine-18 fludeoxyglucose/positron emission tomography-CT. Toxicity monitoring was focused on treatment-related pulmonary adverse events according to the Common Terminology Criteria for Adverse Events v. 4.0. Acute and late events were classified as radiation pneumonitis (RP) and radiation fibrosis (RF), respectively. Survival curves were calculated using the Kaplan-Meier method. Univariate and multivariate analyses of survival were performed using the Cox proportional hazards model.
After a median follow-up of 12 months (range, 3-31 months), no instances of ≥Grade 4 RP was documented, and clinically severe (Grade 3) RP occurred in 5.8% of the patients. 2 (3%) patients developed a late severe (≥Grade 3) symptomatic RF. No specific pattern of CT lung injury was demonstrated, in both acute and late settings. Median overall survival (OS) and progression-free survival (PFS) for the entire population were 30.8 and 14.1 months, respectively. At multivariate analysis (MVA), BED ≥ 100 Gy and KPS ≥ 90 emerged as significant prognostic factors for OS (p = 0.01 and p = 0.001, respectively), and BED ≥ 100 Gy for PFS (p = 0.02).
Our findings show that HHT adjusted for tumour location and/or target volume is an effective treatment with an acceptable toxicity profile in patients who are medically inoperable with lung tumours and is not associated with a specific pattern of lung injury. Therefore, it can represent a viable option when conventional stereotactic ablative radiotherapy facilities are not available. Advances in knowledge: The present study is among the largest series addressing the role of HHT for inoperable lung tumours. This technique is safe and effective and is not associated with a specific pattern of lung injury, at least at early and average time points.
评估在一系列不可手术切除的肺部病变中，采用螺旋断层放射治疗（HHT）进行大分割图像引导放射治疗后的肺部CT损伤治疗效果及模式。
纳入68例因医学原因无法手术（69个病灶）且无胸外疾病存活证据的患者。剂量处方根据肿瘤位置（肺门/中央周围型与周围型）和/或靶体积确定。52%的病灶接受了生物等效剂量（BED）≥100 Gy。根据实体瘤疗效评价标准1.1标准结合氟-18氟脱氧葡萄糖/正电子发射断层扫描-CT评估肿瘤反应。毒性监测重点关注根据不良事件通用术语标准第4.0版的治疗相关肺部不良事件。急性和晚期事件分别分类为放射性肺炎（RP）和放射性肺纤维化（RF）。采用Kaplan-Meier法计算生存曲线。使用Cox比例风险模型进行生存的单因素和多因素分析。
中位随访12个月（范围3 - 31个月），未记录到≥4级RP病例，5.8%的患者发生临床严重（3级）RP。2例（3%）患者出现晚期严重（≥3级）有症状的RF。在急性和晚期情况下，均未显示出特定的CT肺损伤模式。整个人群的中位总生存期（OS）和无进展生存期（PFS）分别为30.8个月和14.1个月。在多因素分析（MVA）中，BED≥100 Gy和KPS≥90是OS的显著预后因素（分别为p = 0.01和p = 0.001），BED≥100 Gy是PFS的显著预后因素（p = 0.02）。
我们的研究结果表明，针对肿瘤位置和/或靶体积进行调整的HHT对因医学原因无法手术的肺部肿瘤患者是一种有效的治疗方法，毒性可接受，且与特定的肺损伤模式无关。因此，当没有传统立体定向消融放疗设备时，它是一种可行的选择。知识进展：本研究是探讨HHT对不可手术切除肺部肿瘤作用的最大系列研究之一。该技术安全有效，至少在早期和中期时间点与特定的肺损伤模式无关。
