Aridgides Paul, Nsouli Tamara, Chaudhari Rishabh, Kincaid Russell, Rosenbaum Paula F, Tanny Sean, Mix Michael, Bogart Jeffrey
Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Lung Cancer (Auckl). 2018 Nov 5;9:103-110. doi: 10.2147/LCTT.S175168. eCollection 2018.
To report the outcomes of stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) according to respiratory motion management method.
Patients with stage I NSCLC who received SBRT from 2007 to 2015 were reviewed. Computed tomography (CT) simulation with four-dimensional CT was performed for respiratory motion assessment. Tumor motion >1 cm in the craniocaudal direction was selectively treated with advanced respiratory management: either respiratory gating to a pre-specified portion of the respiratory cycle or dynamic tracking of an implanted fiducial marker. Comparisons were made with internal target volume approach, which treated all phases of respiratory motion.
Of 297 patients treated with SBRT at our institution, 51 underwent advanced respiratory management (48 with respiratory gating and three with tumor tracking) and 246 underwent all-phase treatment. Groups were similarly balanced with regard to mean age (=0.242), tumor size (=0.315), and histology (=0.715). Tumor location in the lower lung lobes, as compared to middle or upper lobes, was more common in those treated with advanced respiratory management (78.4%) compared to all-phase treatment (25.6%, <.0001). There were 17 local recurrences in the treated lesions. Kaplan-Meier analyses showed that there were no differences with regard to mean time to local failure (91.5 vs 98.8 months, =0.56), mean time to any failure (73.2 vs 78.7 months, =0.73), or median overall survival (43.3 vs 45.5 months, =0.56) between patients who underwent advanced respiratory motion management and all-phase treatment.
SBRT with advanced respiratory management (the majority with respiratory gating) showed similar efficacy to all-phase treatment approach for stage I NSCLC.
根据呼吸运动管理方法报告立体定向体部放射治疗（SBRT）用于I期非小细胞肺癌（NSCLC）的疗效。
回顾2007年至2015年接受SBRT的I期NSCLC患者。采用四维CT进行CT模拟以评估呼吸运动。对于头脚方向肿瘤运动>1 cm的患者，选择性地采用先进的呼吸管理方法：要么对呼吸周期的预先指定部分进行呼吸门控，要么对植入的基准标记进行动态跟踪。与治疗呼吸运动所有阶段的内靶区方法进行比较。
在我们机构接受SBRT治疗的297例患者中，51例采用了先进的呼吸管理方法（48例采用呼吸门控，3例采用肿瘤跟踪），246例采用全阶段治疗。两组在平均年龄（P=0.242）、肿瘤大小（P=0.315）和组织学（P=0.715）方面平衡相似。与中、上叶相比，下肺叶的肿瘤位置在采用先进呼吸管理方法治疗的患者中更常见（78.4%），而在全阶段治疗患者中为25.6%（P<0.0001）。治疗的病变中有17例局部复发。Kaplan-Meier分析显示，采用先进呼吸运动管理方法的患者与全阶段治疗患者在局部失败的平均时间（91.5对98.8个月，P=0.56）、任何失败的平均时间（73.2对78.7个月，P=0.73）或中位总生存期（43.3对45.5个月，P=0.56）方面均无差异。
对于I期NSCLC，采用先进呼吸管理方法（大多数采用呼吸门控）的SBRT与全阶段治疗方法显示出相似的疗效。
