Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China.
Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Lung Cancer Institute of Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China.
Lung Cancer. 2021 Jun;156:82-90. doi: 10.1016/j.lungcan.2021.04.020. Epub 2021 Apr 27.
To explore the efficacy and toxicities of split-course hypo-fractionated radiotherapy with concurrent chemotherapy (HFRT-CHT) with intensity modulated radiotherapy (IMRT) technique in non-small cell lung cancer (NSCLC) patients with postoperative locoregional recurrence (LRR).
NSCLC patients were eligible if confirmed as LRR disease without distant metastasis after complete resection. HFRT-CHT using IMRT technique was administered with 51 Gy in 17 fractions or 40 Gy in 10 fractions as the first course followed by a break. Patients with no disease progression and no persistent Grade ≥2 toxicities had the second course of 15 Gy in 5 fractions or 28 Gy in 7 fractions as a boost. The primary endpoint was progression-free survival (PFS).
Fifty-eight patients were enrolled and analyzed. With a median follow-up of 23.9 months for all, the 2-year and 3-year PFS rate was 59.7 % and 46.4 %, the 2-year and 3-year OS rate was 72.5 % and 52.2 %, respectively, and a favorable objective response rate of 95.9 % was obtained after the whole courses protocol. Grade 3 acute pneumonitis and esophagitis occurred in 2 (3.4 %) and 7 (12.1 %) patients, and fatal pneumonitis was reported in one case (1.7 %). Exploratory subgroup analysis showed that performance status (PS) (PS 0 vs. 1: 2-year PFS, 88.1 % vs. 46.9 %,P = 0.001; 2-year OS, 100 % vs. 59.4 %, P < 0.001), recurrence site (single vs. multiple: 2-year PFS, 93.8 % vs. 47.4 %, P = 0.008; 2-year OS, 100 % vs. 63.0 %, P = 0.001), and gross tumor volume (GTV) (<50cm vs. ≥ 50cm: 2-year PFS, 70.6 % vs. 46.2 %, P = 0.024; 2-year OS, 85.6 % vs. 57.4 %, P = 0.034) were significantly associated with PFS and OS.
Split-course HFRT-CHT with IMRT technique achieved promising disease control and satisfactory survival with moderate toxicities in postoperative LRR of NSCLC. Good PS, a single recurrence site and GTV<50cm tended to have prolonged PFS and OS. Early detection of LRR may improve the efficacy of HFRT-CHT.
探索调强放疗（IMRT）技术下分割短程低分割放疗同步化疗（HFRT-CHT）在非小细胞肺癌（NSCLC）术后局部区域复发（LRR）患者中的疗效和毒性。
如果在完全切除后证实为 LRR 疾病且无远处转移，则符合 NSCLC 患者入选条件。采用 IMRT 技术进行 HFRT-CHT，第一疗程为 51Gy 分 17 次或 40Gy 分 10 次，随后休息。无疾病进展且无持续 2 级以上毒性的患者，进行第二疗程 15Gy 分 5 次或 28Gy 分 7 次作为推量。主要终点是无进展生存期（PFS）。
共纳入并分析了 58 例患者。所有患者中位随访 23.9 个月，2 年和 3 年的 PFS 率分别为 59.7%和 46.4%，2 年和 3 年的 OS 率分别为 72.5%和 52.2%，整个疗程方案后获得了 95.9%的良好客观缓解率。2 例（3.4%）和 7 例（12.1%）患者发生 3 级急性肺炎和食管炎，1 例（1.7%）发生致命性肺炎。探索性亚组分析显示，体力状态（PS）（PS 0 与 1：2 年 PFS，88.1%与 46.9%，P=0.001；2 年 OS，100%与 59.4%，P<0.001）、复发部位（单发与多发：2 年 PFS，93.8%与 47.4%，P=0.008；2 年 OS，100%与 63.0%，P=0.001）和大体肿瘤体积（GTV）（<50cm 与≥50cm：2 年 PFS，70.6%与 46.2%，P=0.024；2 年 OS，85.6%与 57.4%，P=0.034）与 PFS 和 OS 显著相关。
在 NSCLC 术后 LRR 中，采用 IMRT 技术的分割短程 HFRT-CHT 实现了有希望的疾病控制和令人满意的生存，且毒性适中。良好的 PS、单个复发部位和 GTV<50cm 往往具有更长的 PFS 和 OS。早期发现 LRR 可能会提高 HFRT-CHT 的疗效。
