Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Departement of Surgery, Erasmus MC, Rotterdam, The Netherlands.
Clin Lung Cancer. 2017 Nov;18(6):e403-e409. doi: 10.1016/j.cllc.2017.05.002. Epub 2017 May 10.
Inoperable patients with early stage lung cancer are referred late. The purpose was to calculate the referral time and the volume doubling time (VDT), and to investigate its consequence with regard to staging and survival in 117 inoperable patients with early stage lung cancer treated with stereotactic body radiotherapy.
Tumor VDT was calculated using the modified Schwartz formula of exponential growth model and was on the basis of volumes measured on initial diagnostic computed tomography (CT) scans and the planning CT scan. VDT was defined as fast (<100 days), moderate (100-249 days), slow (250-399 days), and no growth (≥400 days). The referral time is the time between the diagnostic CT scan and the radiotherapy planning CT scan.
The median referral time was 86 days. The VDT was fast in 53 patients [45%] of tumors. No significant difference in VDT was found between different tumor or patient characteristics. Patients with T1 tumors that progressed to T2 had a significant worse median survival (P = .01). The overall survival at 5 years according to VDT was 21% for fast-growing tumors, 19% for moderate growth, 31% for slow, and 46% for no growth.
The median referral time was almost 3 months. VDT was considered as fast in almost half of tumors examined. This resulted in significant growth and upstaging in 35% of the tumors, with a significant worse survival if T1 tumors progressed to T2 tumors. Therefore, medically inoperable patients should also be offered a fast workup and referral.
无法手术的早期肺癌患者就诊较晚。目的是计算无法手术的早期肺癌患者的转诊时间和倍增时间（VDT），并研究其对 117 例接受立体定向体部放疗的早期肺癌患者分期和生存的影响。
使用指数增长模型的修正 Schwartz 公式计算肿瘤 VDT，并基于初始诊断 CT（计算机断层扫描）扫描和计划 CT 扫描上测量的体积。VDT 定义为快速（<100 天）、中度（100-249 天）、缓慢（250-399 天）和无生长（≥400 天）。转诊时间是从诊断 CT 扫描到放疗计划 CT 扫描的时间。
中位转诊时间为 86 天。53 例肿瘤[45%]的 VDT 较快。不同肿瘤或患者特征之间的 VDT 无显著差异。T1 肿瘤进展为 T2 的患者中位生存期明显更差（P=.01）。根据 VDT，5 年总生存率分别为快速生长肿瘤 21%、中度生长肿瘤 19%、缓慢生长肿瘤 31%和无生长肿瘤 46%。
中位转诊时间近 3 个月。近一半的检查肿瘤被认为是快速生长的。这导致 35%的肿瘤出现明显生长和分期升高，如果 T1 肿瘤进展为 T2 肿瘤，则生存显著恶化。因此，对于无法手术的患者也应提供快速的检查和转诊。
