Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Pract Radiat Oncol. 2017 Nov-Dec;7(6):e543-e549. doi: 10.1016/j.prro.2017.06.011. Epub 2017 Jun 29.
To report on the patient, tumor, and treatment characteristics of patients aged 90 years or older who were treated with lung stereotactic body radiation therapy (SBRT) for early stage lung cancer and the resulting clinical outcomes.
We surveyed our institutional review board-approved prospective lung SBRT data registry for patients aged 90 years or older who were treated for early stage lung cancer to determine the rates of local failure, progression-free survival, and overall survival as well as treatment-related toxicity.
For the 2004 to 2016 time period, 19 patients (of a total of 1268 lung SBRT cases) were identified. The median age at treatment was 91.6 years (range, 90-97 years). Most patients were female (52.6%) and former smokers (78.9%). The median tumor size was 2.1 cm (range, 1.5-5.4 cm). Tissue was obtained for diagnosis in 68.4% of patients, with the predominant histology being adenocarcinoma (42.2%). Six patients (31.6%) had central lesions. The median follow-up for all patients was 17.3 months. The median SBRT schedule was 50 Gy in 5 fractions over 5 consecutive days and was used in 9 cases (47.4%). The median pre-SBRT and 6-month post-SBRT pulmonary testing showed that the forced expiratory volume in one second, as the percent predicted, was 81.9 and 84.5 and the diffusing capacity of the lungs for carbon monoxide, as the percent predicted, was 66.5 and 67, respectively. No grade 3 or higher toxicities were observed. The 2-year rates of local failure, progression-free survival, and overall survival were 5.6%, 48.6%, and 47.8%, respectively.
Lung SBRT appears to be safe and effective in nonagenarians with stage I lung cancer. The absence of high-grade toxicities and mortality warrants its consideration as the primary curative modality in this population.
报告 90 岁及以上接受立体定向体部放疗（SBRT）治疗早期肺癌患者的患者、肿瘤和治疗特征，以及由此产生的临床结果。
我们调查了机构审查委员会批准的前瞻性肺 SBRT 数据登记处，以确定 90 岁及以上接受早期肺癌治疗的患者的局部失败、无进展生存率和总生存率以及与治疗相关的毒性发生率。
在 2004 年至 2016 年期间，共确定了 19 名患者（共 1268 例肺 SBRT 病例）。治疗时的中位年龄为 91.6 岁（范围为 90-97 岁）。大多数患者为女性（52.6%）和既往吸烟者（78.9%）。肿瘤大小中位数为 2.1 厘米（范围为 1.5-5.4 厘米）。68.4%的患者获得了组织学诊断，主要组织学类型为腺癌（42.2%）。6 名患者（31.6%）有中央病变。所有患者的中位随访时间为 17.3 个月。中位 SBRT 方案为 50Gy，5 次分割，连续 5 天，9 例（47.4%）采用该方案。中位 SBRT 前和 6 个月后肺功能检查显示，用力呼气量占预计值的百分比分别为 81.9%和 84.5%，一氧化碳弥散量占预计值的百分比分别为 66.5%和 67%。未观察到 3 级或更高级别的毒性。2 年局部失败、无进展生存率和总生存率分别为 5.6%、48.6%和 47.8%。
SBRT 似乎对 1 期肺癌的 90 岁以上患者安全有效。无高级别毒性和死亡率，这使其成为该人群的主要治疗方式。
