Li Wen-Cai, Wang Zhen, Gao Jie, Zhou Han, Li Jing, Zhu Xi-Xu
Department of Radiation Oncology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
Department of Medical Radiation Oncology, Jinling Hospital, Nanjing, Jiangsu, 210002, People's Republic of China.
Cancer Manag Res. 2021 Feb 23;13:1887-1896. doi: 10.2147/CMAR.S287993. eCollection 2021.
The study aimed to assess the efficacy and safety of stereotactic body radiotherapy (SBRT) using CyberKnife (CK) in patients with postoperative thoracic oligo-recurrence/metastasis of non-small-cell lung cancer (NLCLC), and to analyze the prognostic factors affecting overall survival after SBRT.
A total of 44 patients with postoperative thoracic oligo-recurrence/metastatic of NLCLC treated with SBRT were reviewed. Thoracic oligo-recurrence/was defined as 1-3 loco-regional confined to lung lobe, hilar/mediastinal lymph nodes, bronchial stump, or chest wall. Primary endpoints included local control (LC), overall survival (OS), progression-free survival (PFS) and toxicity. Prognostic factors that affected these patients were analyzed by the univariate and multivariate analysis by Kaplan-Meier methods and Cox regression models, respectively.
The median follow-up time after salvage SBRT was 48.5 months. Measuring from the date of salvage SBRT, the median OS of the 44 patients was 52.60 (95% CI: 29.59-75.60) months. 1-,3-and 5-year OS rates were 97.7%, 65.3% and 47.7%, respectively. The 1-,3-year and 5-year LC rates were 97.7%, 85.1% and 80.1%, respectively. At 1, 3 and 5 years, the PFS rates were 77.1%, 28.8% and 5.3%, respectively. Multivariate analysis demonstrated that pre-SBRT neutrophil-to-lymphocyte ratio (NLR) and Charlson comorbidity index (CCI) were independent prognostic factors (p < 0.05). The treatment-related side-effects were well tolerated. No patients developed grade 3 or greater pulmonary toxicity.
SBRT is a promising salvage therapeutic option for postoperative thoracic oligo-recurrence/metastasis of non-small-cell lung cancer with acceptable toxicity. Low pre-SBRT neutrophil-to-lymphocyte ratio (NLR) and low Charlson comorbidity index (CCI) were associated with a better prognosis and longer survival and might be considered as reliable and independent prognostic factors in these patients treated with SBRT.
本研究旨在评估使用射波刀（CK）进行立体定向体部放疗（SBRT）对非小细胞肺癌（NLCLC）术后胸部寡复发/转移患者的疗效和安全性，并分析影响SBRT后总生存的预后因素。
回顾性分析44例接受SBRT治疗的NLCLC术后胸部寡复发/转移患者。胸部寡复发/转移定义为局限于肺叶、肺门/纵隔淋巴结、支气管残端或胸壁的1 - 3个局部区域。主要终点包括局部控制（LC）、总生存（OS）、无进展生存（PFS）和毒性。分别采用Kaplan - Meier法和Cox回归模型对影响这些患者的预后因素进行单因素和多因素分析。
挽救性SBRT后的中位随访时间为48.5个月。从挽救性SBRT日期开始计算，44例患者的中位OS为52.60（95%CI：29.59 - 75.60）个月。1年、3年和5年的OS率分别为97.7%、65.3%和47.7%。1年、3年和5年的LC率分别为97.7%、85.1%和80.1%。1年、3年和5年的PFS率分别为77.1%、28.8%和5.3%。多因素分析表明，SBRT前中性粒细胞与淋巴细胞比值（NLR）和Charlson合并症指数（CCI）是独立的预后因素（p < 0.05）。治疗相关的副作用耐受性良好。无患者发生3级或更高级别的肺部毒性。
SBRT是一种有前景的挽救性治疗选择，用于非小细胞肺癌术后胸部寡复发/转移，毒性可接受。SBRT前低中性粒细胞与淋巴细胞比值（NLR）和低Charlson合并症指数（CCI）与较好的预后和更长的生存期相关，可能被视为接受SBRT治疗的这些患者可靠的独立预后因素。
