Parisi Elisabetta, Arpa Donatella, Ghigi Giuglia, Micheletti Simona, Neri Elisa, Tontini Luca, Pieri Martina, Romeo Antonino
Radiotherapy Unit, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola 47014, Italy.
World J Clin Cases. 2021 Jul 16;9(20):5540-5546. doi: 10.12998/wjcc.v9.i20.5540.
Chemotherapy and radiotherapy followed by durvalumab is currently the standard treatment for locally advanced node-positive non-small-cell lung cancer (NSCLC). We describe the case of a patient with locally advanced node-positive NSCLC (LA-NSCLC) treated in a phase II prospective protocol with chemotherapy, accelerated hypofractionated radiotherapy (AHRT) and surgery in the pre-immunotherapy era.
A 69-year-old male, ex-smoker (20 PY), with a Karnofsky performance status of 90, was diagnosed with locally advanced squamous cell lung carcinoma. He was staged by total body computed tomography (CT) scanning, and integrated F-fluorodeoxyglucose positron emission tomography/CT scan [cT4 cN3 cM0, stage IIIC according to TNM (tumor-node-metastasis) 8 edition] and received AHRT between chemotherapy cycles, in accordance with the study protocol (EudractCT registration 2008-006525-14). At the end of the study the patient underwent surgery, which was not part of the protocol, and showed a complete pathological response.
This case report confirms that AHRT can be used successfully to treat primary LA-NSCLC with bilateral mediastinal lymph node involvement. Our case is of particular interest because of the pathological response after AHRT and the lack of surgical complications. We hypothesize that this radiotherapeutic approach, with its proven efficacy, could be delivered as a short course reducing treatment costs, increasing patient compliance and reducing toxicity. We are currently investigating the possibility of combining hypofractionation, chemotherapy and immunotherapy for patients with LA-NSCLC.
化疗、放疗后使用度伐鲁单抗目前是局部晚期淋巴结阳性非小细胞肺癌（NSCLC）的标准治疗方法。我们描述了一例在免疫治疗前时代，按照II期前瞻性方案接受化疗、加速分割放疗（AHRT）和手术治疗的局部晚期淋巴结阳性NSCLC（LA - NSCLC）患者的病例。
一名69岁男性，既往有20年吸烟史，现已戒烟，卡氏评分90分，被诊断为局部晚期肺鳞癌。通过全身计算机断层扫描（CT）和F - 氟脱氧葡萄糖正电子发射断层扫描/CT融合扫描进行分期[cT4 cN3 cM0，根据TNM（肿瘤 - 淋巴结 - 转移）第8版为IIIC期]，并按照研究方案（欧洲临床试验数据库注册号2008 - 006525 - 14）在化疗周期之间接受AHRT。研究结束时，患者接受了手术（手术并非研究方案的一部分），术后显示完全病理缓解。
本病例报告证实AHRT可成功用于治疗双侧纵隔淋巴结受累的原发性LA - NSCLC。由于AHRT后的病理缓解以及无手术并发症，我们的病例特别引人关注。我们推测这种放疗方法因其已证实的疗效，可以作为短疗程进行，从而降低治疗成本、提高患者依从性并减少毒性。我们目前正在研究将分割放疗、化疗和免疫治疗联合用于LA - NSCLC患者的可能性。
