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局限期小细胞肺癌质子束放射治疗的前瞻性研究。

Prospective study of proton-beam radiation therapy for limited-stage small cell lung cancer.

作者信息

Rwigema Jean-Claude M, Verma Vivek, Lin Liyong, Berman Abigail T, Levin William P, Evans Tracey L, Aggarwal Charu, Rengan Ramesh, Langer Corey, Cohen Roger B, Simone Charles B

机构信息

Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona.

出版信息

Cancer. 2017 Nov 1;123(21):4244-4251. doi: 10.1002/cncr.30870. Epub 2017 Jul 5.

Abstract

BACKGROUND

Existing data supporting the use of proton-beam therapy (PBT) for limited-stage small cell lung cancer (LS-SCLC) are limited to a single 6-patient case series. This is the first prospective study to evaluate clinical outcomes and toxicities of PBT for LS-SCLC.

METHODS

This study prospectively analyzed patients with primary, nonrecurrent LS-SCLC definitively treated with PBT and concurrent chemotherapy from 2011 to 2016. Clinical backup intensity-modulated radiotherapy (IMRT) plans were generated for each patient and were compared with PBT plans. Outcome measures included local control (LC), recurrence-free survival (RFS), and overall survival (OS) rates and toxicities.

RESULTS

Thirty consecutive patients were enrolled and evaluated. The median dose was 63.9 cobalt gray equivalents (range, 45-66.6 cobalt gray equivalents) in 33 to 37 fractions delivered daily (n = 18 [60.0%]) or twice daily (n = 12 [40.0%]). The concurrent chemotherapy was cisplatin/etoposide (n = 21 [70.0%]) or carboplatin/etoposide (n = 9 [30.0%]). In comparison with the backup IMRT plans, PBT allowed statistically significant reductions in the cord, heart, and lung mean doses and the volume receiving at least 5 Gy but not in the esophagus mean dose or the lung volume receiving at least 20 Gy. At a median follow-up of 14 months, the 1-/2-year LC and RFS rates were 85%/69% and 63%/42%, respectively. The median OS was 28.2 months, and the 1-/2-year OS rates were 72%/58%. There was 1 case each (3.3%) of grade 3 or higher esophagitis, pneumonitis, anorexia, and pericardial effusion. Grade 2 pneumonitis and esophagitis were seen in 10.0% and 43.3% of patients, respectively.

CONCLUSIONS

In the first prospective registry study and largest analysis to date of PBT for LS-SCLC, PBT was found to be safe with a limited incidence of high-grade toxicities. Cancer 2017;123:4244-4251. © 2017 American Cancer Society.

摘要

背景

现有支持质子束治疗(PBT)用于局限期小细胞肺癌(LS-SCLC)的数据仅限于一个6例患者的病例系列。这是第一项评估PBT用于LS-SCLC的临床疗效和毒性的前瞻性研究。

方法

本研究前瞻性分析了2011年至2016年期间接受PBT联合同步化疗的原发性、非复发性LS-SCLC患者。为每位患者制定了临床备用调强放射治疗(IMRT)计划,并与PBT计划进行比较。观察指标包括局部控制(LC)、无复发生存期(RFS)、总生存期(OS)率及毒性。

结果

连续纳入并评估了30例患者。中位剂量为63.9钴灰当量(范围45 - 66.6钴灰当量),分33至37次每日(n = 18 [60.0%])或每日2次(n = 12 [40.0%])给予。同步化疗方案为顺铂/依托泊苷(n = 21 [70.0%])或卡铂/依托泊苷(n = 9 [30.0%])。与备用IMRT计划相比,PBT在统计学上显著降低了脊髓、心脏和肺的平均剂量以及接受至少5 Gy照射的体积,但未降低食管平均剂量或接受至少20 Gy照射的肺体积。中位随访14个月时,1年/2年的LC和RFS率分别为85%/69%和63%/42%。中位OS为28.2个月,1年/2年的OS率分别为72%/58%。3级或更高等级的食管炎、肺炎、厌食和心包积液各有1例(3.3%)。2级肺炎和食管炎分别见于10.0%和43.3%的患者。

结论

在第一项关于PBT用于LS-SCLC的前瞻性注册研究及迄今为止最大规模的分析中,发现PBT是安全的,高等级毒性的发生率有限。《癌症》2017;123:4244 - 4251。© 2017美国癌症协会

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