Shirai Katsuyuki, Kubota Yoshiki, Ohno Tatsuya, Saitoh Jun-Ichi, Abe Takanori, Mizukami Tatsuji, Mori Yasumasa, Kawamura Hidemasa, Akahane Keiko, Nakano Takashi
Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Gunma University Heavy Ion Medical Center, Maebashi, Japan.
Front Oncol. 2019 Aug 7;9:731. doi: 10.3389/fonc.2019.00731. eCollection 2019.
Mediastinal and hilar lymph node metastasis is one of the recurrence patterns after definitive treatment of lung cancer. Salvage radiotherapy (RT) can be a treatment option for lymph node metastasis. However, the usefulness of additional RT remains unclear after surgery or RT for the primary lung tumor. We retrospectively evaluated the efficacy and safety of hypofractionated carbon-ion RT for isolated lymph node metastasis. Between April 2013 and August 2016, 15 consecutive patients with isolated lymph node metastasis underwent carbon-ion RT. The pretreatment evaluations confirmed the isolated lymph node metastasis and the absence of local recurrence or distant metastasis, which was oligometastatic disease. The median age was 72 (range, 51-83) years, with 11 male patients. The first treatments for primary lung tumors were carbon-ion RT for 8 patients and surgery for 7 patients. There were 9 adenocarcinomas, 4 squamous cell carcinomas, 1 adenosquamous cell carcinoma, and 1 mucoepidermoid carcinoma. Most patients (93%) were irradiated with 52.8 Gy relative biological effectiveness in 12 fractions for 3 weeks. There were no patients treated with concurrent or adjuvant therapy such as chemotherapy, molecular-targeted therapy, or immunotherapy. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events (version 4.0). The median follow-up for surviving patients was 28 months. One patient experienced local lymph node recurrence, and the 2-year local control rate was 92% for all patients. Distant metastasis was observed in 7 patients, and 2-year progression-free survival rate was 47%. During follow-up, there were 4 deaths from lung cancer, and the 2-year overall survival rate was 75%. There were 2 patients with acute grade 2 esophagitis and 2 with late grade 2 cough, which were improved by conservative therapy. There were no other grade 2 or higher adverse events. Hypofractionated carbon-ion RT showed excellent local control and overall survival without severe toxicities in lung cancer patients with isolated lymph node metastasis after surgery or carbon-ion RT for primary lung tumors. A multi-institutional prospective study is required to establish the efficacy and safety of carbon-ion RT.
纵隔和肺门淋巴结转移是肺癌根治性治疗后的复发模式之一。挽救性放疗（RT）可作为淋巴结转移的一种治疗选择。然而，在对原发性肺肿瘤进行手术或放疗后，追加放疗的有效性仍不明确。我们回顾性评估了大分割碳离子放疗对孤立性淋巴结转移的疗效和安全性。2013年4月至2016年8月，15例连续的孤立性淋巴结转移患者接受了碳离子放疗。预处理评估证实为孤立性淋巴结转移且无局部复发或远处转移，即寡转移疾病。中位年龄为72岁（范围51 - 83岁），男性患者11例。原发性肺肿瘤的首次治疗，8例患者为碳离子放疗，7例患者为手术。其中腺癌9例，鳞状细胞癌4例，腺鳞癌1例，黏液表皮样癌1例。大多数患者（93%）接受了相对生物效应为52.8 Gy、分12次、为期3周的照射。没有患者接受化疗、分子靶向治疗或免疫治疗等同步或辅助治疗。根据不良事件通用术语标准（第4.0版）评估不良事件。存活患者的中位随访时间为28个月。1例患者出现局部淋巴结复发，所有患者的2年局部控制率为92%。7例患者出现远处转移，2年无进展生存率为47%。随访期间，4例患者死于肺癌，2年总生存率为75%。2例患者出现急性2级食管炎，2例出现晚期2级咳嗽，经保守治疗后好转。没有其他2级或更高级别的不良事件。大分割碳离子放疗在原发性肺肿瘤接受手术或碳离子放疗后出现孤立性淋巴结转移的肺癌患者中显示出良好的局部控制和总生存率，且无严重毒性。需要进行多机构前瞻性研究以确定碳离子放疗的疗效和安全性。
