Kowalchuk Roman O, Waters Michael R, Baliga Sujith, Richardson K Martin, Spencer Kelly M, Larner James M, Kersh Charles R
University of Virginia/Riverside, Radiosurgery Center, Newport News, VA, USA.
Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA.
Transl Lung Cancer Res. 2020 Oct;9(5):1862-1872. doi: 10.21037/tlcr-20-469.
Though pathologic evidence for non-small cell lung cancer (NSCLC) is preferred, many patients do not receive a biopsy prior to treatment with stereotactic body radiation therapy (SBRT). This study seeks to analyze the overall survival (OS), local control, and toxicity rates for such patients.
This retrospective review included patients empirically treated with SBRT for presumed non-metastatic NSCLC at a single institution. Inclusion criteria included a hypermetabolic pulmonary lesion noted on positron emission tomography (PET) imaging but no pathological evidence of NSCLC. Patients with another known metastatic tumor were excluded. Statistical analysis was conducted with Cox proportional hazards analysis, univariate analysis, and the Kaplan-Meier method.
Ninety-one treatments in 90 unique patients met inclusion criteria. Patients were a median 77.9 years at the start of treatment and had a median Charlson score of 7. Pre-treatment standardized uptake value (SUV) was a median 4.5 and 1.5 after treatment. At a median follow-up of 12.9 months, 36-month local control of 91.3% was achieved. Twenty-four-month OS and progression-free survival were 65.4% and 44.8%, respectively. On univariate analysis, biologically effective dose (BED) ≥120 Gy was predictive of improved OS (P=0.001), with 36-month OS of 50.5% for patients with BED ≥120 Gy and only 31.6% for patients with BED <120 Gy. On Kaplan-Meier analysis, Charlson score ≥9 was predictive of decreased OS (P=0.04), and BED ≥120 Gy trended towards improved OS (P=0.08). Thirty-two cases of grade <3 toxicity were reported, and only two cases of grade 3 morbidity (fatigue) were noted.
Local control rates for empiric SBRT treatment for hypermetabolic, non-metastatic NSCLC are similar to those for biopsied NSCLC. OS is primarily dependent on a patient's overall health status, which can be accurately assessed with the Charlson score. BED ≥120 Gy may also contribute to improved OS.
尽管非小细胞肺癌（NSCLC）的病理证据更为可取，但许多患者在接受立体定向体部放射治疗（SBRT）之前并未进行活检。本研究旨在分析此类患者的总生存期（OS）、局部控制率和毒性发生率。
这项回顾性研究纳入了在单一机构接受经验性SBRT治疗的疑似非转移性NSCLC患者。纳入标准包括正电子发射断层扫描（PET）成像显示肺部有高代谢病灶，但无NSCLC的病理证据。排除有其他已知转移性肿瘤的患者。采用Cox比例风险分析、单因素分析和Kaplan-Meier方法进行统计分析。
90例独特患者中的91次治疗符合纳入标准。患者开始治疗时的中位年龄为77.9岁，查尔森评分中位数为7分。治疗前标准化摄取值（SUV）中位数为4.5，治疗后为1.5。中位随访12.9个月时，36个月局部控制率达到91.3%。24个月总生存期和无进展生存期分别为65.4%和44.8%。单因素分析显示，生物等效剂量（BED）≥120 Gy可预测总生存期改善（P=0.001），BED≥120 Gy的患者3个月总生存期为50.5%，而BED<120 Gy的患者仅为31.6%。根据Kaplan-Meier分析，查尔森评分≥9可预测总生存期降低（P=0.04），BED≥120 Gy有总生存期改善的趋势（P=0.08）。报告了32例<3级毒性病例，仅记录到2例3级并发症（疲劳）。
对高代谢、非转移性NSCLC进行经验性SBRT治疗的局部控制率与经活检的NSCLC相似。总生存期主要取决于患者的整体健康状况，可通过查尔森评分准确评估。BED≥120 Gy也可能有助于改善总生存期。
