Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Clin Lung Cancer. 2018 Sep;19(5):e803-e810. doi: 10.1016/j.cllc.2018.06.001. Epub 2018 Jun 18.
Patients with ultracentral lung tumors, whose planning target volume directly contacts or overlaps the proximal bronchial tree, trachea, esophagus, pulmonary vein, or pulmonary artery, may be at higher risk of toxicity when treated with stereotactic body radiotherapy (SBRT). We reviewed the outcomes and toxicities of ultracentral lung tumors and compared the results with central lung tumors.
A review of our institutional prospective database of patients treated with lung SBRT from January 2006 to December 2015 was conducted. Patients with central tumors (RTOG 0813 definition) and ultracentral tumors were included.
In total, 180 central and 26 ultracentral tumors were analyzed. The majority of patients received 60 Gy in 8 fractions (53.9%) or 48 Gy in 4 fractions (29.1%). The rates of any grade 2 or higher toxicity were 8.4% (n = 16) in the central group and 7.9% (n = 2) in the ultracentral group (P = .88). There were no observed grade 4 or 5 toxicities. In the nonmetastatic primary lung cancer cohort (n = 182), the median overall survival was 39.4 months versus 23.8 months (P = .40) and cause-specific survival was 55.5 months versus 28.2 months (P = .34) for central and ultracentral tumors, respectively. The 2-year cumulative local, regional, and distant failure rates were 3.3% versus 0 (P = .36), 9.1% versus 5.0% (P = .5), and 17.7% versus 18.7% (P = .63) in the central and ultracentral groups, respectively.
In our experience, with strict adherence to planning parameters, SBRT to ultracentral tumors resulted in effective local control and no excessive risk of toxicity compared to central tumors.
计划靶区直接接触或重叠近端支气管树、气管、食管、肺静脉或肺动脉的超中央肺部肿瘤患者，在接受立体定向体部放疗（SBRT）治疗时，可能面临更高的毒性风险。我们回顾了超中央肺部肿瘤的结果和毒性，并将结果与中央肺部肿瘤进行了比较。
对我们机构 2006 年 1 月至 2015 年 12 月期间接受肺部 SBRT 治疗的患者的前瞻性数据库进行了回顾。包括中央肿瘤（RTOG 0813 定义）和超中央肿瘤患者。
共分析了 180 个中央肿瘤和 26 个超中央肿瘤。大多数患者接受 60 Gy/8 次分割（53.9%）或 48 Gy/4 次分割（29.1%）。中央组任何 2 级或更高毒性的发生率为 8.4%（n=16），超中央组为 7.9%（n=2）（P=0.88）。没有观察到 4 级或 5 级毒性。在非转移性原发性肺癌队列（n=182）中，中央肿瘤和超中央肿瘤的中位总生存期分别为 39.4 个月和 23.8 个月（P=0.40），中位特异性生存期分别为 55.5 个月和 28.2 个月（P=0.34）。中央组和超中央组的 2 年累积局部、区域和远处失败率分别为 3.3%和 0（P=0.36）、9.1%和 5.0%（P=0.5）和 17.7%和 18.7%（P=0.63）。
根据我们的经验，严格遵守计划参数，与中央肿瘤相比，SBRT 治疗超中央肿瘤可有效控制局部肿瘤，且毒性风险无显著增加。
