Department of Radiation Oncology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
Xcare Practice for Radiation Therapy, Saarlouis, Germany.
Strahlenther Onkol. 2021 May;197(5):405-415. doi: 10.1007/s00066-021-01756-7. Epub 2021 Mar 16.
Integrating moderate hypofractionation to the macroscopic tumor with elective nodal irradiation while sparing the organs at risk (OAR) in chemoradiotherapy of locally advanced non-small-cell lung cancer.
From 2010-2018, treatment, patient and tumor characteristics of 138 patients from two radiation therapy centers were assessed. Chemoradiotherapy by intensity-modulated radiation therapy (IMRT) with a simultaneous integrated boost (SIB) to the primary tumor and macroscopic lymph node metastases was used.
A total of 124 (90%) patients received concurrent chemotherapy. 106 (76%) patients had UICC (Union for International Cancer Control) stage ≥IIIB and 21 (15%) patients had an oligometastatic disease (UICC stage IV). Median SIB and elective total dose was 61.6 and 50.4 Gy in 28 fractions, respectively. Furthermore, 64 patients (46%) had an additional sequential boost to the primary tumor after the SIB-IMRT main series: median 6.6 Gy in median 3 fractions. The median cumulative mean lung dose was 15.6 Gy (range 6.2-29.5 Gy). Median follow-up and radiological follow-up for all patients was 18.0 months (range 0.6-86.9) and 16.0 months (range 0.2-86.9), respectively. Actuarial local control rates at 1, 2 and 3 years were 80.4, 68.4 and 57.8%. Median overall survival and progression-free survival was 30.0 months (95% confidence interval [CI] 23.5-36.4) and 12.1 months (95% CI 8.2-16.0), respectively. Treatment-related toxicity was moderate. Radiation-induced pneumonitis grade 2 and grade 3 occurred in 13 (9.8%) and 3 (2.3%) patients.
Chemoradiotherapy using SIB-IMRT showed promising local tumor control rates and acceptable toxicity in patients with locally advanced and in part oligometastatic lung cancer. The SIB concept, resulting in a relatively low mean lung dose, was associated with low numbers of clinically relevant pneumonitis. The overall survival appears promising in the presence of a majority of patients with UICC stage ≥IIIB disease.
在局部晚期非小细胞肺癌的放化疗中，将中剂量分割与选择性淋巴结照射相结合，同时保护危及器官（OAR）。
2010 年至 2018 年，评估了来自两个放射治疗中心的 138 名患者的治疗、患者和肿瘤特征。采用调强放疗（IMRT）联合原发肿瘤和宏观淋巴结转移的同步整合增敏（SIB）进行放化疗。
共有 124 名（90%）患者接受了同期化疗。106 名（76%）患者为 UICC（国际抗癌联盟）分期≥IIIB，21 名（15%）患者为寡转移疾病（UICC 分期 IV）。SIB 和选择性总剂量中位数分别为 28 次分割中的 61.6 和 50.4Gy。此外，64 名（46%）患者在 SIB-IMRT 主系列后进行了原发肿瘤的额外序贯增敏：中位数 6.6Gy，中位数 3 次分割。累积平均肺剂量中位数为 15.6Gy（范围 6.2-29.5Gy）。所有患者的中位随访和影像学随访时间分别为 18.0 个月（范围 0.6-86.9）和 16.0 个月（范围 0.2-86.9）。1、2、3 年的局部控制率分别为 80.4%、68.4%和 57.8%。中位总生存期和无进展生存期分别为 30.0 个月（95%置信区间[CI]23.5-36.4）和 12.1 个月（95%CI8.2-16.0）。治疗相关毒性为中度。13 名（9.8%）和 3 名（2.3%）患者发生 2 级和 3 级放射性肺炎。
采用 SIB-IMRT 的放化疗在局部晚期和部分寡转移肺癌患者中显示出有希望的局部肿瘤控制率和可接受的毒性。SIB 概念导致相对较低的平均肺剂量，与临床相关肺炎的数量较低有关。在大多数 UICC 分期≥IIIB 疾病患者中，总生存率似乎很有希望。
