Radiation Oncology Section, Perugia General Hospital, Perugia, Italia.
Radiation Oncology Unit, University of Perugia, Perugia, Italia.
Radiol Med. 2021 Jan;126(1):163-169. doi: 10.1007/s11547-020-01223-w. Epub 2020 May 15.
This retrospective study reports outcomes after stereotactic body radiation therapy (SBRT) as delivered by helical tomotherapy (HT) for lung lesions. It promotes a dose escalation program.
Histological and/or radiological findings and/or case histories identified 41 primary and 15 metastatic lesions. Thirty patients received 40 Gy in 5 fractions (BED 72 Gy) and 26 50 Gy in 5 fractions (BED 100Gy). Primary end point was lung toxicity. Secondary end points were respiratory function, local control and local progression-free survival.
Acute toxicity developed in 18/56 patients and late toxicity in 8/54. Median FEV-1 variations versus baseline were - 0.5% (range - 16 to + 43%) at 6 months and - 4.00% (range - 42 to + 18%) at 24 months. Median DLCO variations versus baseline were - 1% (range - 38 to + 36%) at 6 months and - 12.2% (range - 48 to + 11%) at 24 months. At 6 months, a significant positive correlation emerged between FEV-1 change and KPS (p = 0.047). At 24 months, a significant negative correlation emerged between FEV-1 change and the ipsilateral lung V5 (p = 0.006). A low baseline DLCO correlated with more marked DLCO worsening at 6 months (p = 0.012). At 24 months, DLCO worsening correlated significantly with the median contralateral lung dose (p = 0.003). At the last checkup, 23 patients were in complete remission, 16 were in partial remission, 5 had stable disease, and 7 were in relapse. Median follow-up was 12 months (range 5-56).
In patients with lung disease, SBRT, as delivered by HT, was well tolerated and provided good local control.
本回顾性研究报告了螺旋断层放疗（HT）治疗肺部病变的立体定向体部放疗（SBRT）的结果。它促进了剂量递增计划。
通过组织学和/或影像学发现和/或病史，确定了 41 个原发性和 15 个转移性病变。30 名患者接受了 40Gy 分 5 次（BED72Gy）和 26 个 50Gy 分 5 次（BED100Gy）的治疗。主要终点是肺部毒性。次要终点是呼吸功能、局部控制和局部无进展生存期。
56 例患者中有 18 例发生急性毒性，54 例中有 8 例发生晚期毒性。6 个月时与基线相比，FEV-1 变化的中位数为 -0.5%（范围 -16 至 +43%），24 个月时为 -4.00%（范围 -42 至 +18%）。6 个月时与基线相比，DLCO 变化的中位数为 -1%（范围 -38 至 +36%），24 个月时为 -12.2%（范围 -48 至 +11%）。6 个月时，FEV-1 变化与 KPS 之间存在显著正相关（p=0.047）。24 个月时，FEV-1 变化与同侧肺 V5 之间存在显著负相关（p=0.006）。基线时 DLCO 较低与 6 个月时 DLCO 恶化更明显相关（p=0.012）。24 个月时，DLCO 恶化与中位数对侧肺剂量显著相关（p=0.003）。最后一次检查时，23 例患者完全缓解，16 例部分缓解，5 例病情稳定，7 例复发。中位随访时间为 12 个月（范围 5-56 个月）。
在患有肺部疾病的患者中，HT 提供的 SBRT 耐受性良好，并提供了良好的局部控制。
