Radiation Physics Laboratory, Sydney University, Camperdown, New South Wales, Australia; Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia.
Sydney Local Health District Clinical Research Centre, Camperdown, New South Wales, Australia.
Clin Lung Cancer. 2018 May;19(3):199-212. doi: 10.1016/j.cllc.2017.11.006. Epub 2017 Dec 15.
Stereotactic ablative body radiotherapy (SABR) is popular because of the high rates of local control with low toxicity seen in lung cancer patients. In this study we compared clinically significant toxicity and overall survival for SABR and non-SABR definitive radiotherapy (conformal radiotherapy) patients. A PUBMED search of all human, English language articles on SABR and non-SABR radically treated early stage lung cancer patients was performed until June 2016. Results of these searches were filtered in accordance with a set of eligibility criteria and analyzed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eighty-seven SABR and 25 non-SABR articles were reviewed. There was no significant difference in pneumonitis rates between patients receiving SABR (11.4%; 95% confidence interval [CI], 9.7-13.3) and non-SABR treatment (14.4%; 95% CI, 10.6-18.8; P = .20). Esophagitis was the most common mediastinal toxicity reported with 15% of all non-SABR patients versus 1% of all SABR patients reporting developing Grade ≥2 toxicity. The proportion of patient surviving at 2 and 3 years was superior for SABR patients (P < .001). Treatment-related deaths were rare (approximately 1% for both treatments). Both radiotherapy approaches had low rates of pneumonitis, mediastinal toxicity, and treatment-related deaths. However, significant heterogeneity in the patient population and study regimens limit the power of direct comparison, showing that further high-quality studies are required to define the role of SABR in higher risk and operable patients.
立体定向消融体放射治疗（SABR）因其在肺癌患者中观察到的高局部控制率和低毒性而受到青睐。在这项研究中，我们比较了 SABR 和非 SABR 根治性放疗（适形放疗）患者的临床显著毒性和总生存情况。我们在 PubMed 上对所有关于 SABR 和非 SABR 根治性治疗早期肺癌患者的人类、英语文章进行了检索，检索时间截至 2016 年 6 月。对这些检索结果按照一套入选标准进行了筛选，并根据系统评价和荟萃分析的首选报告项目进行了分析。共审查了 87 篇 SABR 和 25 篇非 SABR 文章。接受 SABR（11.4%；95%置信区间[CI]，9.7-13.3）和非 SABR 治疗的患者（14.4%；95%CI，10.6-18.8；P=0.20）之间的肺炎发生率没有显著差异。食管炎是报告的最常见纵隔毒性，所有非 SABR 患者中有 15%，而所有 SABR 患者中有 1%报告发生≥2 级毒性。SABR 患者的 2 年和 3 年生存率均较高（P<0.001）。两种放疗方法的肺炎、纵隔毒性和治疗相关死亡率均较低。然而，患者人群和研究方案的显著异质性限制了直接比较的能力，表明需要进一步进行高质量的研究来确定 SABR 在高危和可手术患者中的作用。
