Rahn Douglas A, Thakur Siddarth, Makani Samir, Sandhu Ajay
Department of Radiation Oncology, University of California - San Diego, USA.
Crittenton Hospital Medical Center, Wayne State University Medical School, Detroit, Michigan, USA.
J Radiosurg SBRT. 2013;2(2):135-140.
To review the literature and report our experience with the use of stereotactic body radiation therapy (SBRT) to treat multiple primary lung cancers (MPLCs).
A retrospective review of 18 patients with 36 separate MPLC lesions (6 synchronous pairs and 12 metachronous pairs) was performed. Of these 18 patients, 16 were not surgical candidates and 2 declined to have surgery. Of the 36 lesions treated, 27 received SBRT, 6 had received prior fractionated RT, and 3 had prior surgical resection. Radiotherapy doses for SBRT ranged from 48 to 56 Gy (Median = 50 Gy) in 4 to 13 fractions (Median = 5 fractions) and treatment plans used 4D-CT simulation scans in all patients.
The median follow-up was 20 months after initial SBRT. We observed local control in 22 of 27 (81.5%) of the lesions treated with SBRT. The actuarial overall survival at 2 years from completion of initial SBRT course was 62%. Metastatic disease occurred in 3 of the 6 deceased patients. Clinically evident pneumonitis was observed in 3 of the 18 pts (17%), which resolved completely with steroid therapy.
SBRT appears to be a safe and effective treatment for MPLC both solely or after prior fractionated RT or surgical resection. SBRT for MPLC is a reasonable treatment option for patients who are not optimal candidates for surgery or who decline surgery.
回顾文献并报告我们使用立体定向体部放射治疗（SBRT）治疗多原发性肺癌（MPLC）的经验。
对18例患者的36个独立MPLC病灶（6对同步病灶和12对异时病灶）进行回顾性分析。这18例患者中，16例不适合手术，2例拒绝手术。在接受治疗的36个病灶中，27个接受了SBRT，6个曾接受过常规分割放疗，3个曾接受过手术切除。SBRT的放疗剂量为48至56 Gy（中位数 = 50 Gy），分4至13次（中位数 = 5次）给予，所有患者的治疗计划均采用4D-CT模拟扫描。
首次SBRT后中位随访时间为20个月。我们观察到，接受SBRT治疗的27个病灶中有22个（81.5%）实现了局部控制。从首次SBRT疗程结束起算，2年时的精算总生存率为62%。6例死亡患者中有3例发生了转移。18例患者中有3例（17%）出现了临床明显的肺炎，经类固醇治疗后完全缓解。
SBRT无论是单独使用，还是在常规分割放疗或手术切除后使用，似乎都是治疗MPLC的一种安全有效的方法。对于不适合手术或拒绝手术的患者，SBRT治疗MPLC是一种合理的选择。
