特发性肺纤维化合并非小细胞肺癌根治性放疗的初步结果：X 射线与质子治疗的比较。
Preliminary result of definitive radiotherapy in patients with non-small cell lung cancer who have underlying idiopathic pulmonary fibrosis: comparison between X-ray and proton therapy.
机构信息
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
出版信息
Radiat Oncol. 2019 Jan 28;14(1):19. doi: 10.1186/s13014-019-1221-4.
BACKGROUND
Idiopathic pulmonary fibrosis (IPF) is associated with fatal complications after radiotherapy (RT) for lung cancer patients; however, the role of proton therapy to reduce the incidence of life-threatening complications is unclear. Herein, we present the preliminary results of early-stage lung cancer patients having IPF and treated with RT, with a focus on the comparison between X-ray and proton therapy.
METHODS
From January 2010 to October 2017, we retrospectively reviewed the medical records of 264 patients with stage I-II non-small cell lung cancer (NSCLC) treated with definitive RT alone. Ultimately, 30 patients (11.4%) who had underlying IPF were analyzed. Among these, X-ray and proton RT were delivered to 22 and 8 patients, respectively. Treatment-related complications and survival outcomes were compared between X-ray and proton therapy.
RESULTS
The median follow-up duration was 11 months (range, 2 to 51 months). All living patients were followed-up at least 9 months. Treatment-related death occurred in four patients (18.2%) treated with X-ray but none with proton therapy. Most patients died within one month after the onset of pulmonary symptoms in spite of aggressive treatment. In addition, the 1-year overall survival (OS) rate in patients treated with X-ray and proton was 46.4 and 66.7%, respectively, and patients treated with proton therapy showed a tendency of better survival compared to X-ray (p = 0.081). Especially, in GAP stage II and III subgroups, patients treated with proton therapy showed significantly increased survival outcomes compared to X-ray (1-year OS rate; 50.0% versus 26.4%, p = 0.036) in univariate analysis.
CONCLUSIONS
RT is associated with serious treatment-related complications in patients with IPF. Proton therapy may be helpful to reduce these acute and fatal complications.
TRIAL REGISTRATION
retrospectively registered.
背景
特发性肺纤维化（IPF）与肺癌患者放疗（RT）后致命并发症相关；然而，质子治疗降低危及生命的并发症发生率的作用尚不清楚。在此，我们报告了合并特发性肺纤维化的早期肺癌患者接受 RT 治疗的初步结果，重点比较了 X 射线和质子治疗。
方法
从 2010 年 1 月至 2017 年 10 月，我们回顾性分析了 264 例接受单纯根治性 RT 的 I 期和 II 期非小细胞肺癌（NSCLC）患者的病历。最终，分析了 30 例（11.4%）合并特发性肺纤维化的患者。其中，22 例患者接受 X 射线治疗，8 例患者接受质子治疗。比较 X 射线和质子治疗的治疗相关并发症和生存结果。
结果
中位随访时间为 11 个月（范围，2 至 51 个月）。所有存活患者均至少随访 9 个月。X 射线治疗的 4 例患者（18.2%）发生治疗相关死亡，而质子治疗的患者无一例死亡。尽管积极治疗，大多数患者在出现肺部症状后一个月内死亡。此外，X 射线和质子治疗的患者 1 年总生存率（OS）分别为 46.4%和 66.7%，质子治疗组患者的生存结果有优于 X 射线的趋势（p=0.081）。特别是在 GAP 分期 II 期和 III 期亚组中，质子治疗组患者的 1 年 OS 率（50.0%与 26.4%，p=0.036）明显高于 X 射线治疗组。
结论
RT 治疗与 IPF 患者严重的治疗相关并发症相关。质子治疗可能有助于减少这些急性和致命的并发症。
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