Kumar Aryavarta M S, Woody Neil M, Djemil Toufik, Videtic Gregory M M, Stephans Kevin L
Cleveland Clinic, Department of Radiation Oncology, Cleveland OH 44195, USA.
J Radiosurg SBRT. 2014;3(1):81-88.
We compare our institutional outcomes of synchronous primary (SP) lung lesion patients with non-SP patients.Materials and Methods: From an IRB approved prospective registry of 445 NSCLC patients treated with SBRT (8/2005 8/2012), 26 (5.8%) had SPs by biopsy or PET/CT. SBRT was delivered on a Novalis/BrainLAB platform with daily Exactrac set-up.
There were no significant differences comparing SP vs non-SP groups for age, Charlson score, smoking pack years, and PET SUV (p=ns). 18 (69%) SP patients had at least one lesion biopsied. Ipsilateral and bilateral SPs were seen in 10 (38.4%) and 16 (61.6%) respectively. 77% received 50 Gy / 5 fx. SP vs non-SP median follow up was 12 (range 1.5-49.8) vs 15.2 months. Median survival for SP vs non-SP groups was 20.7 vs 28.4 months (p=0.3). In SP vs non-SP groups, local failure was 4% vs 7.6% (p=ns) and nodal/distant failure was 23% vs 24.6% (p=ns). Patients with ipsilateral and bilateral SPs had a 50% vs 14% distant failure respectively (p=0.037).
After SBRT, there were no differences in survival and patterns of failure for SP vs non-SP patients. Ipsilateral SPs had significantly worse distant failure compared to bilateral SPs.
我们比较了我院同步原发性（SP）肺部病变患者与非SP患者的治疗结果。
从经机构审查委员会批准的、对2005年8月至2012年8月期间接受立体定向体部放疗（SBRT）的445例非小细胞肺癌（NSCLC）患者的前瞻性登记研究中，发现26例（5.8%）经活检或PET/CT检查为SP。SBRT在Novalis/BrainLAB平台上进行，采用每日在线影像引导系统进行摆位。
在年龄、查尔森评分、吸烟包年数和PET标准化摄取值（SUV）方面，SP组与非SP组之间无显著差异（p值无统计学意义）。18例（69%）SP患者至少有一个病变进行了活检。同侧和双侧SP分别见于10例（38.4%）和16例（61.6%）。77%的患者接受了50 Gy / 5次分割的放疗。SP组与非SP组的中位随访时间分别为12个月（范围1.5 - 49.8个月）和15.2个月。SP组与非SP组的中位生存期分别为20.7个月和28.4个月（p = 0.3）。在SP组与非SP组中，局部失败率分别为4%和7.6%（p值无统计学意义），区域/远处失败率分别为23%和24.6%（p值无统计学意义）。同侧和双侧SP患者的远处失败率分别为50%和14%（p = 0.037）。
SBRT治疗后，SP患者与非SP患者在生存率和失败模式方面无差异。与双侧SP相比，同侧SP的远处失败情况明显更差。
