Liu Yuanjun, Zhu Yaoyao, Wu Ran, Hu Min, Zhang Lingnan, Lin Qingren, Weng Denghu, Sun Xiaojiang, Liu Yu, Xu Yaping
First Clinical Medical School, Wenzhou Medical University, Wenzhou, China.
Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Transl Lung Cancer Res. 2020 Dec;9(6):2328-2336. doi: 10.21037/tlcr-20-1050.
For lung cancer patients with subclinical (untreated and asymptomatic) interstitial lung disease (ILD), there is a lack of relatively safe and effective treatment. Stereotactic body radiation therapy (SBRT) can achieve a high level of tumor control with low toxicity in early-stage non-small cell lung cancer (NSCLC). This study aimed to evaluate the efficacy and toxicity of early stage NSCLC patients with subclinical ILD receiving SBRT.
A total of 109 early stage NSCLC patients receiving SBRT treatment between December 2011 and August 2016 were reviewed in our institutions; patients with clinical ILD were excluded. The median dose of SBRT was 50 Gy in 5 fractions. The median biologically effective dose (BED; α/β=10) was 100 Gy (range, 72-119 Gy). An experienced radiation oncologist and an experienced radiologist reviewed the presence of subclinical ILD in the CT findings before SBRT. The relationships among the efficacy, radiation-induced lung injury (RILI) and subclinical ILD were explored.
In all, 38 (34.9%) of 109 patients were recognized with subclinical ILD before SBRT, 48 (44.0%) of 109 patients were recognized with grade 2-5 RILI after SBRT, and 18 (47.4%) of 38 patients with subclinical ILD were observed with grade 2-5 RILI. Subclinical ILD was not a significant factor of grade 2-5 RILI (P=0.608); however, 3 patients had extensive RILI, and they all suffered from subclinical ILD. Dosimetric factor of the lungs, such as mean lung dose (MLD) was significantly related with Grade 2-5 RILI in patients with subclinical ILD (P=0.042). The progression-free survival (PFS) rates at 3 years in the subclinical ILD patients and those without ILD were 61.6% and 66.8%, respectively (P=0.266).
Subclinical ILD was not a significant factor for RILI or PFS in early stage NSCLC patients receiving SBRT; however, patients with subclinical ILD receiving SBRT may experience uncommon extensive RILI.
对于患有亚临床（未经治疗且无症状）间质性肺疾病（ILD）的肺癌患者，缺乏相对安全有效的治疗方法。立体定向体部放射治疗（SBRT）在早期非小细胞肺癌（NSCLC）中可实现高水平的肿瘤控制且毒性较低。本研究旨在评估接受SBRT的伴有亚临床ILD的早期NSCLC患者的疗效和毒性。
回顾了2011年12月至2016年8月期间在我们机构接受SBRT治疗的109例早期NSCLC患者；排除有临床ILD的患者。SBRT的中位剂量为50 Gy，分5次给予。中位生物等效剂量（BED；α/β = 10）为100 Gy（范围72 - 119 Gy）。一位经验丰富的放射肿瘤学家和一位经验丰富的放射科医生在SBRT前审查CT检查结果中是否存在亚临床ILD。探讨了疗效、放射性肺损伤（RILI）与亚临床ILD之间的关系。
总共109例患者中，38例（34.9%）在SBRT前被诊断为亚临床ILD，109例患者中有48例（44.0%）在SBRT后被诊断为2 - 5级RILI，38例亚临床ILD患者中有18例（47.4%）出现2 - 5级RILI。亚临床ILD不是2 - 5级RILI的显著因素（P = 0.608）；然而，有3例患者出现广泛的RILI，他们均患有亚临床ILD。肺部剂量学因素，如平均肺剂量（MLD）与亚临床ILD患者的2 - 5级RILI显著相关（P = 0.042）。亚临床ILD患者和无ILD患者的3年无进展生存期（PFS）率分别为61.6%和66.8%（P = 0.266）。
亚临床ILD不是接受SBRT的早期NSCLC患者发生RILI或PFS的显著因素；然而，接受SBRT的亚临床ILD患者可能会出现罕见的广泛RILI。
