Department of Radiotherapy, CHU UCL Namur, Site Ste Elisabeth, Place Louise Godin 15, 5000, Namur, Belgium.
NARILIS, Namur, Belgium.
BMC Cancer. 2019 Jun 28;19(1):639. doi: 10.1186/s12885-019-5863-2.
To evaluate the outcome of patients treated with stereotactic ablative body radiotherapy (SABR) with curative intent for stage I non-small cell lung cancer (NSCLC) with regard to local, regional and distant tumor control, disease-free survival (DFS), overall survival (OS) and toxicity.
Data of 300 patients treated with SABR for NSCLC cancer for the period of November 2007 to June 2016 were retrospectively analyzed. Of which, 189 patients had single primary lung lesion and were included in the study. The prescribed dose for the tumor was 48 Gy, given in 12 Gy × 4 fractions for all patients. In 2010, an improved protocol was established in advanced technology for the planning CT, dose calculation and imaging. Cumulative incidence function (CIF) of local, regional, distant or any recurrences were computed using competing risk analysis with death as a competing event. Survivals (DFS and OS) were estimated using the Kaplan-Meier method and Cox proportional regression was used for comparisons. Toxicities were graded according to the common terminology criteria for adverse events version 4.0 (CTCAE v.4).
Diagnosis was histologically confirmed in 42% of the patients (N = 80). At 1, 2 and 4 years, the cumulative incidence function (CIF) of local relapses were 8% [4-13%], 15% [10-21%] and 18% [12-25%], the CIF of regional relapses were 4% [2-8%], 10% [6-16%] and 12% [8-19%], the CIF of distant relapses were 9% [5-14%], 15% [11-22%] and 20% [15-28%] and the CIF of any relapses were 14% [10-20%], 28% [22-36%], 34% [27-43%], respectively. After 1, 2 and 4 years, the OS rates were 83% [95% CI: 78-89%] (N = 128), 65% [95% CI: 57-73%] (N = 78) and 37% [95% CI: 29-47%] (N = 53), respectively. The median survival time was 37 months. The DFS after 1, 2 and 4 years reached 75% [95% CI: 68-81%] (N = 114), 49% [95% CI: 42-58%] (N = 60) and 31% [95% CI: 24-41%] (N = 41), respectively. No grade 4 or 5 toxicity was observed.
We observed a long-term local control and survival after SABR for peripheral stage I NSCLC in this large series of patients with the expected low toxicity.
评估立体定向消融放疗（SABR）治疗具有治愈意图的 I 期非小细胞肺癌（NSCLC）患者的局部、区域和远处肿瘤控制、无病生存（DFS）、总生存（OS）和毒性的结果。
回顾性分析了 2007 年 11 月至 2016 年 6 月期间接受 SABR 治疗的 300 例 NSCLC 患者的数据。其中，189 例患者有单个原发性肺病变，纳入研究。肿瘤的处方剂量为 48Gy，所有患者均接受 12Gy×4 分次。2010 年，为计划 CT、剂量计算和成像制定了改进的先进技术方案。使用竞争风险分析（以死亡为竞争事件）计算局部、区域、远处或任何复发的累积发生率函数（CIF）。使用 Kaplan-Meier 方法估计生存（DFS 和 OS），并使用 Cox 比例风险回归进行比较。毒性根据不良事件通用术语标准 4.0 版（CTCAE v.4）进行分级。
42%（N=80）的患者的诊断经组织学证实。在 1、2 和 4 年时，局部复发的累积发生率（CIF）分别为 8%[4-13%]、15%[10-21%]和 18%[12-25%]，区域复发的 CIF 分别为 4%[2-8%]、10%[6-16%]和 12%[8-19%]，远处复发的 CIF 分别为 9%[5-14%]、15%[11-22%]和 20%[15-28%]，任何复发的 CIF 分别为 14%[10-20%]、28%[22-36%]、34%[27-43%]。在 1、2 和 4 年后，OS 率分别为 83%[95%CI：78-89%]（N=128）、65%[95%CI：57-73%]（N=78）和 37%[95%CI：29-47%]（N=53）。中位生存时间为 37 个月。1、2 和 4 年后的 DFS 分别达到 75%[95%CI：68-81%]（N=114）、49%[95%CI：42-58%]（N=60）和 31%[95%CI：24-41%]（N=41）。未观察到 4 级或 5 级毒性。
在这一系列具有预期低毒性的患者中，我们观察到立体定向消融放疗（SABR）治疗外周性 I 期非小细胞肺癌具有长期的局部控制和生存。
