Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Radiat Oncol. 2018 Jul 11;13(1):127. doi: 10.1186/s13014-018-1071-5.
Combined stereotactic body radiotherapy (SBRT) for lung lesions and conventional radiotherapy (CRT) for nodal areas may be more effective than CRT alone in patients with locally advanced lung cancer.
This study included 21 patients with small primary lung tumors distant from the regional nodal areas. The SBRT dose was 40-60 Gy in 4 fractions. CRT doses were 66 Gy in 30 fractions for non-small cell lung cancer and 52.5 Gy in 25 fractions for small cell lung cancer.
The median follow-up duration was 12 months, and the median survival was 13 months. The 1 year overall survival, local recurrence-free survival, and distant metastasis-free survival rates were 60.5, 84.8, and 62.1%, respectively. Two patients experienced in-field local recurrence combined with out-field regional recurrence and/or distant failure. The major recurrence pattern was distant failure (crude incidence, 43%). Three patients aged ≥79 years experienced grade ≥ 3 acute radiation pneumonitis, and one also had idiopathic interstitial pneumonia.
The combination of SBRT for the lung lesion and CRT for the nodal region seems to be effective and safe for lung malignancies. However, patients older in age and/or with underlying pulmonary disease require stricter lung dose constraints.
对于局部晚期肺癌患者，联合立体定向体放射治疗（SBRT）治疗肺部病变和常规放射治疗（CRT）治疗区域淋巴结可能比单独 CRT 更有效。
本研究纳入了 21 例原发性肺部肿瘤较小且远离区域淋巴结的患者。SBRT 剂量为 40-60Gy，分 4 次给予。非小细胞肺癌的 CRT 剂量为 66Gy，分 30 次给予；小细胞肺癌的 CRT 剂量为 52.5Gy，分 25 次给予。
中位随访时间为 12 个月，中位生存时间为 13 个月。1 年总生存率、局部无复发生存率和远处无转移生存率分别为 60.5%、84.8%和 62.1%。2 例患者出现了野内局部复发合并野外区域复发和/或远处失败。主要复发模式为远处失败（粗发生率为 43%）。3 名年龄≥79 岁的患者发生了≥3 级急性放射性肺炎，其中 1 名患者还患有特发性间质性肺炎。
对于肺部恶性肿瘤，SBRT 治疗肺部病变联合 CRT 治疗区域淋巴结似乎是有效且安全的。然而，年龄较大和/或存在肺部基础疾病的患者需要更严格的肺剂量限制。
