Kharod Shivam M, Nichols R Charles, Henderson Randal H, Morris Christopher G, Pham Dat C, Seeram Vandana K, Jones Lisa M, Antonio-Miranda Maria, Siragusa Daniel A, Li Zuofeng, Flampouri Stella, Hoppe Bradford S
Department of Radiation Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA.
Department of Medicine, Division of Hematology and Medical Oncology, University of Florida, College of Medicine, Jacksonville, FL, USA.
Int J Part Ther. 2020 Nov 6;7(2):1-10. doi: 10.14338/IJPT-20-00013.1. eCollection 2020 Fall.
Due to the excellent outcomes with image-guided stereotactic body radiotherapy for patients with early-stage non-small cell lung cancer (NSCLC) and the low treatment-related toxicities using proton therapy (PT), we investigated treatment outcomes and toxicities when delivering hypofractionated PT.
Between 2009 and 2018, 22 patients with T1 to T2 N0M0 NSCLC (45% T1, 55% T2) received image-guided hypofractionated PT. The median age at diagnosis was 72 years (range, 58-90). Patients underwent 4-dimensional computed tomography simulation following fiducial marker placement, and daily image guidance was performed. Nine patients (41%) were treated with 48 GyRBE in 4 fractions for peripheral lesions, and 13 patients (59%) were treated with 60 GyRBE in 10 fractions for central lesions. Patients were assessed for CTCAEv4 toxicities with computed tomography imaging for tumor assessment. The primary endpoint was grade 3 to 5 toxicity at 1 year.
The median follow-up for all patients was 3.5 years (range, 0.2-8.8 years). The overall survival rates at 3 and 5 years were 81% and 49%, respectively. Cause-specific survival rates at 3 and 5 years were 100% and 75%, respectively. The 3-year local, regional, and distant control rates were 86%, 85%, and 95%, respectively. Four patients experienced in-field recurrences between 18 and 45 months after treatment. One patient (5%) developed a late grade 3 bronchial stricture requiring hospitalization and stent.
Image-guided hypofractionated PT for early-stage NSCLC provides promising local control and long-term survival with a low likelihood of toxicity. Regional nodal and distant relapses remain a problem.
鉴于图像引导的立体定向体部放射治疗对早期非小细胞肺癌（NSCLC）患者疗效优异，且质子治疗（PT）相关毒性较低，我们研究了大分割PT的治疗效果和毒性。
2009年至2018年期间，22例T1至T2 N0M0 NSCLC患者（45%为T1，55%为T2）接受了图像引导的大分割PT。诊断时的中位年龄为72岁（范围58 - 90岁）。患者在放置基准标记后进行4维计算机断层扫描模拟，并进行每日图像引导。9例（41%）外周病变患者接受48 GyRBE分4次照射，13例（59%）中央病变患者接受60 GyRBE分10次照射。通过计算机断层扫描成像评估患者的CTCAEv4毒性以进行肿瘤评估。主要终点是1年时3至5级毒性。
所有患者的中位随访时间为3.5年（范围0.2 - 8.8年）。3年和5年的总生存率分别为81%和49%。3年和5年的病因特异性生存率分别为100%和7�%。3年的局部、区域和远处控制率分别为86%、85%和95%。4例患者在治疗后18至45个月出现野内复发。1例患者（5%）出现3级晚期支气管狭窄，需要住院并置入支架。
图像引导的大分割PT治疗早期NSCLC可提供良好的局部控制和长期生存，且毒性可能性较低。区域淋巴结和远处复发仍是一个问题。
