Department of Radiation Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of Oncology, Beijing Fengtai You Anmen Hospital, Beijing, China.
Thorac Cancer. 2019 Jul;10(7):1567-1575. doi: 10.1111/1759-7714.13105. Epub 2019 Jun 11.
Previous studies have documented a high incidence of toxicity in patients with ultra-central non-small cell lung cancer (UC-NSCLC) treated with stereotactic body radiation therapy (SBRT). However, these studies mainly focused on early stage patients and included small sample populations. We reviewed the outcomes and toxicity of SBRT in patients with advanced stage UC-NSCLC treated at our institution.
Fifty-one consecutive patients with advanced UC-NSCLC treated with SBRT using a regular regimen of 35 Gy administered in five fractions between December 2014 and August 2017 were reviewed. UC was defined as tumors abutting or overlapping the trachea or the proximal bronchial tree. We included locally advanced patients who were unfit or unwilling to receive conventional chemoradiotherapy and patients with metastatic or postoperative recurrent disease. Clinical outcomes, dosimetric parameters, and SBRT toxicity were analyzed.
The median age was 63 years (range: 35-82), and the median tumor diameter was 6.8 cm (range: 2.1-12.4). The overall median follow-up duration was 17 months (25.5 months for surviving patients). The median local control was 17 months for stage III patients and 11 months for stage IV or recurrent patients. Grade 3 or higher toxicity was observed in 9.8% of patients: G3 radiation pneumonitis (5.9%) and possible treatment-related death (3.9%).
SBRT with a moderate dose in 4-6 fractions is effective and tolerable for patients with advanced stage UC-NSCLC. However, caution should be taken considering possible treatment-related death. Further studies are warranted.
之前的研究记录了接受立体定向体部放射治疗（SBRT）的超中心非小细胞肺癌（UC-NSCLC）患者毒性发生率较高。然而，这些研究主要集中在早期患者，且纳入的样本量较小。我们回顾了我们机构治疗的晚期 UC-NSCLC 患者接受 SBRT 的结果和毒性。
回顾了 2014 年 12 月至 2017 年 8 月期间，51 例连续接受 SBRT 治疗的晚期 UC-NSCLC 患者。UC 定义为肿瘤紧邻或重叠气管或近端支气管树。我们纳入了局部晚期患者，他们不适合或不愿意接受常规放化疗以及转移性或术后复发性疾病的患者。分析了临床结果、剂量学参数和 SBRT 毒性。
中位年龄为 63 岁（范围：35-82 岁），中位肿瘤直径为 6.8cm（范围：2.1-12.4cm）。总的中位随访时间为 17 个月（生存患者为 25.5 个月）。III 期患者的中位局部控制时间为 17 个月，IV 期或复发性患者为 11 个月。9.8%的患者出现 3 级或以上毒性：3 级放射性肺炎（5.9%）和可能与治疗相关的死亡（3.9%）。
4-6 个分次给予中等剂量的 SBRT 对晚期 UC-NSCLC 患者是有效且可耐受的。然而，应考虑可能与治疗相关的死亡，故需进一步研究。
