Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands.
Institute of Radiooncology - OncoRay, Helmholtz Zentrum Dresden - Rossendorf, Dresden, Germany; OncoRay, National Center for Radiation Research in Oncology, Dresden, Germany; Department of Radiation Oncology, University Hospital Carl Gustav Carus of Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partnersite Dresden, Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
Radiother Oncol. 2019 Feb;131:120-126. doi: 10.1016/j.radonc.2018.11.024. Epub 2018 Dec 31.
The aim was to investigate the incidence of isolated regional failure following stereotactic ablative radiotherapy (SABR) and risk factors for recurrence.
Early stage non-small cell lung cancer (NSCLC) patients treated with SABR were included in this retrospective cohort study, with isolated regional recurrence (IRR) as primary endpoint, distant recurrence (DR) and overall survival (OS) as secondary endpoints. Survival analyses were performed using the cumulative incidence function (IRR and DR) or the Kaplan-Meier method (OS) and Cox proportional hazards modelling for univariate and multivariate analyses. The prognostic effect of contact between the tumour and the pleura was investigated using the CT scans used for SABR planning.
A total of 554 patients were included, of whom 494 could be analysed for IRR. The median follow-up for surviving patients was 48.1 months. Twenty-one patients developed an IRR (4%). The cumulative incidence of IRR and DR after 1-, 2-, and 5 years was 2%, 3%, 7% and 8%, 15% and 21%, respectively. Two year OS was 71%. The presence and type of pleural contact was not associated with any of the studied outcomes.
The presence, type and length of pleural contact as surrogate for visceral pleural invasion were not predictive for outcome. Further studies focussing on risk factors for occult nodal involvement, (I)RR, distant metastases and mortality in early stage NSCLC are warranted for the development of risk adapted diagnostic, treatment and follow-up strategies as more younger, operable and fitter patients receive SABR.
本研究旨在探讨立体定向消融放疗（SABR）后孤立区域性失败的发生率和复发的危险因素。
本回顾性队列研究纳入了接受 SABR 治疗的早期非小细胞肺癌（NSCLC）患者，以孤立区域性复发（IRR）为主要终点，远处复发（DR）和总生存（OS）为次要终点。使用累积发生率函数（IRR 和 DR）或 Kaplan-Meier 方法（OS）进行生存分析，并进行单因素和多因素 Cox 比例风险模型分析。使用用于 SABR 计划的 CT 扫描来研究肿瘤与胸膜接触对预后的影响。
共纳入 554 例患者，其中 494 例可分析 IRR。生存患者的中位随访时间为 48.1 个月。21 例患者发生 IRR（4%）。IRR 和 DR 在 1、2 和 5 年后的累积发生率分别为 2%、3%、7%和 8%、8%、15%和 21%。2 年 OS 为 71%。胸膜接触的存在和类型与研究结果均无关。
胸膜接触的存在、类型和长度作为内脏胸膜侵犯的替代指标，与任何研究结果均无关。需要进一步研究早期 NSCLC 隐匿性淋巴结受累、IRR、远处转移和死亡率的危险因素，以制定风险适应的诊断、治疗和随访策略，因为更多年轻、可手术和身体状况较好的患者接受 SABR。
