Hörner-Rieber Juliane, Bernhardt Denise, Dern Julian, König Laila, Adeberg Sebastian, Paul Angela, Heussel Claus Peter, Kappes Jutta, Hoffmann Hans, Herth Felix J P, Debus Jürgen, Warth Arne, Rieken Stefan
University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.
Translational Research Unit, Thoraxklinik, Heidelberg University, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University-Hospital, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University-Hospital, Heidelberg, Germany.
Radiother Oncol. 2017 Nov;125(2):317-324. doi: 10.1016/j.radonc.2017.08.029. Epub 2017 Sep 14.
To investigate the prognostic impact of different histological subtypes of non-small cell lung cancer (NSCLC) on outcome following stereotactic body radiotherapy (SBRT) for NSCLC patients.
We analyzed 126 consecutive patients with early-stage adenocarcinoma or squamous cell carcinoma treated with SBRT from 2004 to 2016. Adenocarcinoma patients were further sub-classified as high-risk or low-risk tumors.
With a median follow-up time of 22months, 2-year overall survival (OS), local (LC), and distant control (DC) were 68%, 90% and 79%, respectively. For LC, histologic subtype was identified as major independent prognostic factor (p=0.033): while LC was 81% for squamous cell carcinoma patients, LC was significantly improved for high-risk and even more non-high-risk adenocarcinoma patients with 96% and 100%, respectively (p=0.026). The negative prognostic impact of the histologic subtype "squamous cell carcinoma" was not evident when patients received SBRT with higher total doses in EQD2 (2Gy equivalent dose): if patients were treated with a total dose in EQD2≥150Gy, no significant difference in LC for histologic subtypes was detected anymore (p=0.355).
In the current study, histologic subtypes of NSCLC predicted local control probabilities following SBRT. Prospective, multi-center studies are needed to evaluate the prognostic impact of histology and consecutively the need for SBRT dose adaptation.
探讨非小细胞肺癌（NSCLC）不同组织学亚型对NSCLC患者立体定向体部放疗（SBRT）后预后的影响。
我们分析了2004年至2016年期间连续接受SBRT治疗的126例早期腺癌或鳞癌患者。腺癌患者进一步分为高危或低危肿瘤。
中位随访时间为22个月，2年总生存率（OS）、局部控制率（LC）和远处控制率（DC）分别为68%、90%和79%。对于LC，组织学亚型被确定为主要独立预后因素（p = 0.033）：鳞癌患者的LC为81%，高危腺癌患者的LC显著提高至96%，非高危腺癌患者的LC甚至更高，为100%（p = 0.026）。当患者接受等效剂量（EQD2）较高的SBRT时，组织学亚型“鳞癌”的负面预后影响不明显：如果患者接受EQD2≥150Gy的总剂量治疗，则组织学亚型之间的LC不再有显著差异（p = 0.355）。
在本研究中，NSCLC的组织学亚型可预测SBRT后的局部控制概率。需要进行前瞻性、多中心研究来评估组织学的预后影响以及连续评估SBRT剂量调整的必要性。
