Schmitt Martin, Aussenac Lucie, Seitlinger Joseph, Lindner Véronique, Noël Georges, Antoni Delphine
Radiotherapy Department, Strasbourg Europe Cancer Institute, 17 Rue Albert Calmette, 67200 Strasbourg, France.
Pathology Department, Hautepierre University Hospital, 1 Rue Molière, 67000 Strasbourg, France.
Cancers (Basel). 2022 Mar 2;14(5):1282. doi: 10.3390/cancers14051282.
Background: Stereotactic radiotherapy for localised stage non-small-cell lung carcinoma (NSCLC) is an alternative indication for patients who are inoperable or refuse surgery. A study showed that the microscopic tumour extension (ME) of NSCLC varied according to the histological type, which allowed us to deduce adapted margins for the clinical target volume (CTV). However, to date, no study has been able to define the most relevant margins for patients with stage 1 tumours. Methods: We performed a retrospective analysis including patients with adenocarcinoma (ADC) or squamous cell carcinoma (SCC) of localised stage T1N0 or T2aN0 who underwent surgery. The ME was measured from this boundary. The profile of the type of tumour spread was also evaluated. Results: The margin required to cover the ME of a localised NSCLC with a 95% probability is 4.4 mm and 2.9 mm for SCC and ADC, respectively. A significant difference in the maximum distance of the ME between the tumour-infiltrating lymphocytes (TILs), 0−10% and 50−90% (p < 0.05), was noted for SCC. There was a significant difference in the maximum ME distance based on whether the patient had chronic obstructive pulmonary disease (COPD) (p = 0.011) for ADC. Multivariate analysis showed a statistically significant relationship between the maximum microextension distance and size with the shrinkage coefficient. Conclusion: This study definitively demonstrated that the ME depends on the pathology subtype of NSCLC. According to International Commission on Radiation Units and Measurements (ICRU) reports, 50, 62 and 83 CTV margins, proposed by these results, should be added to the GTV (Gross tumour volume). When stereotactic body radiation therapy is used, this approach should be considered in conjunction with the dataset and other margins to be applied.
立体定向放射治疗适用于局部晚期非小细胞肺癌（NSCLC），适用于无法手术或拒绝手术的患者。一项研究表明，NSCLC的微观肿瘤扩展（ME）因组织学类型而异，这使我们能够推断出临床靶区（CTV）的合适边界。然而，迄今为止，尚无研究能够确定I期肿瘤患者最相关的边界。方法：我们进行了一项回顾性分析，纳入了接受手术的局部T1N0或T2aN0期腺癌（ADC）或鳞状细胞癌（SCC）患者。从该边界测量ME。还评估了肿瘤扩散类型的特征。结果：对于SCC和ADC，以95%的概率覆盖局部NSCLC的ME所需的边界分别为4.4 mm和2.9 mm。对于SCC，肿瘤浸润淋巴细胞（TILs）为0−10%和50−90%时，ME的最大距离存在显著差异（p < 0.05）。对于ADC，基于患者是否患有慢性阻塞性肺疾病（COPD），ME的最大距离存在显著差异（p = 0.011）。多变量分析显示，最大微观扩展距离和大小与收缩系数之间存在统计学显著关系。结论：本研究明确表明，ME取决于NSCLC的病理亚型。根据国际辐射单位与测量委员会（ICRU）的报告，这些结果建议应在大体肿瘤体积（GTV）基础上增加50、62和83的CTV边界。当使用立体定向体部放射治疗时，应结合数据集和其他要应用的边界来考虑这种方法。
