Shioyama Yoshiyuki, Onishi Hiroshi, Takayama Kenji, Matsuo Yukinori, Takeda Atsuya, Yamashita Hideomi, Miyakawa Akifumi, Murakami Naoya, Aoki Masahiko, Matsushita Haruo, Matsumoto Yasuo, Shibamoto Yuta
1 Department of Radiation Oncology, Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan.
2 Department of Radiology, Graduate School of Medicine, Yamanashi University, Yamanashi, Japan.
Technol Cancer Res Treat. 2018 Jan 1;17:1533033818783904. doi: 10.1177/1533033818783904.
Stereotactic body radiotherapy (SBRT) is widely used as a curative treatment option for stage I non-small-cell lung cancer, but for patients with stage I small-cell lung cancer, the role of stereotactic body radiotherapy is unclear. In this study, we retrospectively analyzed the outcomes of a subset of patients with stage I small-cell lung cancer treated with stereotactic body radiotherapy in the database of the Japanese Radiological Society-Multi-Institutional stereotactic body radiotherapy Study Group. The 43 patients treated with stereotactic body radiotherapy for stage I small-cell lung cancer between 2004 and 2012 at 11 Japanese institutions were studied: median age = 77 years; 32 (74%) males and 11 females; and 80% were medically inoperable. The clinical stage was IA in 31 and IB in 12. In all patients, the lung tumors were pathologically proven as small-cell lung cancer. A total dose of 48 to 60 Gy was administered in 4 to 8 fractions. The median biologically effective dose (α/β = 10 Gy) was 105.6 Gy. Chemotherapy and prophylactic cranial irradiation were administered in only 8 patients, respectively. The median follow-up time was 23.2 months. The 2-year overall survival, progression-free survival, and distant metastasis-free survival rates were 72.3%, 44.6%, and 47.2%, respectively. The 2-year local control was 80.2%. Regarding the patterns of failure, distant metastasis, lymph node metastasis, and local recurrence were observed in 47%, 28%, and 16% of patients, respectively. No ≥grade 3 stereotactic body radiotherapy-related toxicities were observed. Although stereotactic body radiotherapy was thus revealed to be effective for the local control of stage I small-cell lung cancer, the incidence of distant metastases was high. Further investigations of larger cohorts are needed, including analyses of the effects of combined chemotherapy.
立体定向体部放疗（SBRT）被广泛用作I期非小细胞肺癌的根治性治疗选择，但对于I期小细胞肺癌患者，立体定向体部放疗的作用尚不清楚。在本研究中，我们在日本放射学会-多机构立体定向体部放疗研究组的数据库中，回顾性分析了接受立体定向体部放疗的I期小细胞肺癌患者亚组的治疗结果。研究了2004年至2012年期间在日本11家机构接受立体定向体部放疗的43例I期小细胞肺癌患者：中位年龄 = 77岁；男性32例（74%），女性11例；80%为医学上无法手术切除。临床分期为IA期31例，IB期12例。所有患者的肺肿瘤经病理证实为小细胞肺癌。总剂量48至60 Gy分4至8次给予。中位生物等效剂量（α/β = 10 Gy）为105.6 Gy。仅分别有8例患者接受了化疗和预防性颅脑照射。中位随访时间为23.2个月。2年总生存率、无进展生存率和无远处转移生存率分别为72.3%、44.6%和47.2%。2年局部控制率为80.2%。关于失败模式，分别有47%、28%和16%的患者出现远处转移、淋巴结转移和局部复发。未观察到≥3级的与立体定向体部放疗相关的毒性反应。虽然立体定向体部放疗对I期小细胞肺癌的局部控制有效，但远处转移的发生率较高。需要对更大的队列进行进一步研究，包括分析联合化疗的效果。
