Arifin Andrew J, Al-Shafa Faiez, Chen Hanbo, Boldt R Gabriel, Warner Andrew, Rodrigues George B, Palma David A, Louie Alexander V
Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada.
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Transl Lung Cancer Res. 2020 Apr;9(2):348-353. doi: 10.21037/tlcr.2020.01.18.
Patients treated with surgery for lung cancer are at risk of second primary lung cancers (SPLCs), which when localized, may be amenable to radical treatment. Treatment options, however, are limited due to reduced cardiopulmonary reserve and competing mortality risks. The aim of this study was to perform a systematic review of publications examining treatment planning considerations, clinical outcomes, and toxicity rates of stereotactic ablative radiotherapy (SABR) in patients who have previously undergone pneumonectomy. A systematic review of the literature was conducted in accordance with PRISMA guidelines using PubMed and EMBASE from inception to July 2018. Articles were limited to those published in the English language. Non-review articles with patients who received exclusively lung SABR post-pneumonectomy were included. Two reviewers independently performed abstract and full-text review, with discrepancies settled by a third reviewer. Of the 215 articles identified by the initial search, 6 articles comprising 53 patients who received lung SABR post-pneumonectomy met inclusion criteria. The mean age was 68, and most patients were male (73.7%). The mean time to pneumonectomy was 6.5 years. The mean biologically effective dose was 115 Gy, and the most common dose fractionation schemes were 54 Gy in 3 fractions, 48 Gy in 4 fractions, and 50 Gy in 5 fractions. The mean follow-up was 25.4 months. The mean 1-year overall survival and 2-year local control rates were 80.6% and 89.4%. Grade 3 or higher toxicity was reported in 13.2% of patients. SABR appears to be a safe and feasible option for SPLCs in patients with prior pneumonectomy. Multi-institutional and/or prospective studies would be helpful to determine the true risk and appropriateness of SABR in this high-risk patient population.
接受肺癌手术治疗的患者有患第二原发性肺癌（SPLC）的风险，当SPLC局限时，可能适合进行根治性治疗。然而，由于心肺储备功能下降和相互竞争的死亡风险，治疗选择有限。本研究的目的是对有关立体定向消融放疗（SABR）在先前接受肺叶切除术患者中的治疗计划考虑因素、临床结果和毒性率的出版物进行系统评价。根据PRISMA指南，使用PubMed和EMBASE对从创刊到2018年7月的文献进行了系统评价。文章仅限于英文发表的文章。纳入了仅在肺叶切除术后接受肺部SABR治疗患者的非综述文章。两名审稿人独立进行摘要和全文评审，如有分歧由第三名审稿人解决。在初步检索中确定的215篇文章中，有6篇文章共53例在肺叶切除术后接受肺部SABR治疗的患者符合纳入标准。平均年龄为68岁，大多数患者为男性（73.7%）。肺叶切除的平均时间为6.5年。平均生物有效剂量为115 Gy，最常见的剂量分割方案为3次分割54 Gy、4次分割48 Gy和5次分割50 Gy。平均随访时间为25.4个月。1年总生存率和2年局部控制率分别为80.6%和89.4%。13.2%的患者报告有3级或更高毒性。对于先前接受肺叶切除术的患者，SABR似乎是治疗SPLC的一种安全可行的选择。多机构和/或前瞻性研究将有助于确定SABR在这一高危患者群体中的真正风险和适用性。
