采用笔形束扫描粒子治疗的早期非小细胞肺癌：早期疗效和安全性的回顾性分析。
Early stage non-small cell lung cancer treated with pencil beam scanning particle therapy: retrospective analysis of early results on safety and efficacy.
机构信息
Department of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton and Heavy Ion Center, Shanghai, China.
Department of Medical Physics, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Fudan University, Shanghai, China.
出版信息
Radiat Oncol. 2019 Jan 25;14(1):16. doi: 10.1186/s13014-019-1216-1.
BACKGROUND
To evaluate the safety and efficacy of particle therapy (PT) using pencil beam scanning (PBS) technique for early stage non-small cell lung cancer (NSCLC).
METHODS
From 08/2014 to 03/2018, 31 consecutive patients with sum of the longest diameters of primary tumor and hilar lymph node < 5 cm, N0-1, M0 NSCLC treated with PT were retrospectively analyzed. Gating/active breathing control techniques were used to control tumor motion in 20 and 7 patients. PBS-based proton radiotherapy (PRT) or carbon ion radiotherapy (CIRT) plans were designed via Syngo® planning system. PRT, PRT + CIRT boost, and CIRT were used in 6, 6 and 19 patients, respectively. Prescriptions were categorized to 3 levels: 5-7.5 GyE * 8-10 Fx, 4-5 GyE * 15-16 Fx and 2.25-3.5 GyE * 20-31 Fx.
RESULTS
Thirty-one patients (20 males and 11 females) with a median age of 71 (50-80) years were enrolled with a median follow-up time of 12.1 (2.9-45.2) months. Fourteen were adenocarcinomas, 7 squamous cell carcinomas, 4 non-specified NSCLC and 6 had no histological diagnosis (4/6 had previous resected lung cancer). The median tumor size was 3.1 (1.1-4.7) cm. No grade 4-5 toxicities were observed. One patient experienced grade 3 (per the Common Terminology Criteria for Adverse Events version 4.03) radiation-induced lung injury (RILI) at 6.7 months from radiation started. Grade 2 acute toxicities included hematological toxicities (5 cases), RILI (2), plural pain (1) and dermatitis (1). Grade 2 late toxicities included RILI (3) and asymptomatic rib fracture (1). Three patients had progressed disease at 4.0~10.6 months after the initiation of PT. One experienced local failure with simultaneous distant failure and died of brain metastasis at 10.8 months; one developed regional and distant failure and died of lung infection at 8.7 months; the other experienced isolated distant failure only and his disease was well controlled after salvage systemic therapy. The estimated rates of progression-free survival, local control, cause-specific survival and overall survival at 1, 2 years were 85.5% and 85.5%, 95.2% and 95.2%, 95.0% and 95.0%, 90.7% and 90.7%, respectively.
CONCLUSIONS
PBS-based PT appears safe and effective for early stage NSCLC. Further follow-up and investigation is warranted.
TRIAL REGISTRATION
ISRCTN, ISRCTN78973763. Registered 14 August 2018- Retrospectively registered, http://www.isrctn.com/ISRCTN78973763 .
背景
评估使用铅笔束扫描 (PBS) 技术治疗早期非小细胞肺癌 (NSCLC) 的安全性和疗效。
方法
从 2014 年 8 月至 2018 年 3 月，回顾性分析了 31 例接受 PT 治疗的肿瘤最大直径和肺门淋巴结总和 < 5cm、N0-1、M0 NSCLC 的连续患者。20 例和 7 例患者分别使用门控/主动呼吸控制技术控制肿瘤运动。通过 Syngo® 规划系统设计基于 PBS 的质子放射治疗 (PRT) 或碳离子放射治疗 (CIRT) 计划。分别有 6、6 和 19 例患者接受 PRT、PRT+CIRT 推量和 CIRT 治疗。处方分为 3 个等级：5-7.5GyE8-10Fx、4-5GyE15-16Fx 和 2.25-3.5GyE*20-31Fx。
结果
共纳入 31 例患者（20 例男性和 11 例女性），中位年龄为 71（50-80）岁，中位随访时间为 12.1（2.9-45.2）个月。14 例为腺癌，7 例为鳞状细胞癌，4 例为非特定 NSCLC，6 例无组织学诊断（6 例中有 4 例有既往切除的肺癌）。肿瘤大小中位数为 3.1（1.1-4.7）cm。未观察到 4-5 级毒性。1 例患者在放疗开始后 6.7 个月发生 3 级（根据通用不良事件术语标准 4.03 版）放射性肺损伤 (RILI)。2 级急性毒性包括血液学毒性（5 例）、RILI（2 例）、胸膜痛（1 例）和皮炎（1 例）。2 级迟发性毒性包括 RILI（3 例）和无症状肋骨骨折（1 例）。3 例患者在 PT 开始后 4.0-10.6 个月疾病进展。1 例发生局部失败伴同时远处失败，并于 10.8 个月死于脑转移；1 例发生局部和远处复发，并于 8.7 个月死于肺部感染；另 1 例仅发生孤立性远处失败，疾病经挽救性全身治疗后得到很好控制。1、2 年时无进展生存率、局部控制率、疾病特异性生存率和总生存率的估计值分别为 85.5%和 85.5%、95.2%和 95.2%、95.0%和 95.0%、90.7%和 90.7%。
结论
基于 PBS 的 PT 治疗早期 NSCLC 似乎是安全有效的。需要进一步的随访和研究。
试验注册
ISRCTN，ISRCTN78973763。2018 年 8 月 14 日注册-回顾性注册，http://www.isrctn.com/ISRCTN78973763。
Zotero 插件