Shin Hyunju, Noh Jae Myoung, Pyo Hongryull, Ahn Yong Chan, Oh Dongryul
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Radiat Oncol J. 2021 Mar;39(1):24-32. doi: 10.3857/roj.2020.01074. Epub 2021 Mar 4.
This study aimed to evaluate the clinical outcomes and toxicities of salvage proton beam therapy (PBT) in patients with locoregional recurrent non-small cell lung cancer (NSCLC).
We retrospectively reviewed 53 patients who received salvage PBT for locoregionally recurrent NSCLC between January 2016 and December 2019. The median clinical target volume (CTV) was 71.2 cm3 (range, 13.3 to 1,200.7 cm3). The median prescribed dose was 64.0 cobalt gray equivalent (CGE) (range, 45.0 to 70.0 CGE). One-third of the patients (32.1%) received concurrent chemoradiotherapy (CCRT).
The patients' median age was 67 years (range, 44 to 86 years). The initial treatments were surgery in 31 (58.5%), definitive CCRT in 12 (22.6%), and definitive radiotherapy in 10 (18.9%) patients. The median disease-free interval (DFI) was 14 months (range, 3 to 112 months). Thirty-seven patients (69.8%) had a previous radiotherapy history. Among them, 18 patients (48.7%) had in-field recurrence. The median follow-up time after salvage PBT was 15.0 months (range, 3.5 to 49.3 months). During the follow-up period, 26 patients (49.1%) experienced disease progression: local in 13 (24.5%), regional in 14 (26.5%), and distant metastases in 15 (26.5%). The 2-year overall survival (OS) rate, local control rate, and progression-free survival rate were 79.2%, 68.2%, and 37.1%, respectively. Shorter DFI (≤12 months; p = 0.015) and larger CTV (>80 mL; p = 0.014) were associated with poor OS. Grade 3 toxicities occurred in 8 patients (15.1%): esophagitis in 2, dermatitis in 3, and pulmonary toxicities in 4.
Salvage PBT for locoregionally recurrent NSCLC was effective, and treatment-related toxicities were tolerable.
本研究旨在评估挽救性质子束治疗（PBT）对局部区域复发的非小细胞肺癌（NSCLC）患者的临床疗效和毒性。
我们回顾性分析了2016年1月至2019年12月期间接受挽救性PBT治疗局部区域复发NSCLC的53例患者。临床靶体积（CTV）中位数为71.2 cm³（范围13.3至1200.7 cm³）。处方剂量中位数为64.0钴灰当量（CGE）（范围为45.0至70.0 CGE）。三分之一的患者（32.1%）接受了同步放化疗（CCRT）。
患者的中位年龄为67岁（范围44至86岁）。初始治疗为手术31例（58.5%），根治性CCRT 12例（22.6%），根治性放疗10例（18.9%）。无病间期（DFI）中位数为14个月（范围3至112个月）。37例患者（69.8%）有放疗史。其中18例（48.7%）为野内复发。挽救性PBT后的中位随访时间为15.0个月（范围3.5至49.3个月）。随访期间，26例患者（49.1%）出现疾病进展：局部进展13例（24.5%），区域进展14例（26.5%），远处转移15例（26.5%）。2年总生存率（OS）、局部控制率和无进展生存率分别为79.2%、68.2%和37.1%。较短的DFI（≤12个月；p = 0.015）和较大的CTV（>80 mL；p = 0.014）与较差的OS相关。8例患者（15.1%）发生3级毒性反应：食管炎2例，皮炎3例，肺部毒性反应4例。
挽救性PBT治疗局部区域复发的NSCLC有效，且治疗相关毒性反应可耐受。
