Department for Radiation Oncology, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria.
Academic Teaching Hospital, Institute of Medical Physics, Feldkirch, Austria.
Radiat Oncol. 2022 Jul 7;17(1):120. doi: 10.1186/s13014-022-02083-6.
In radiation treatment of locally advanced non-small cell lung cancer (LA-NSCLC), 'margins' from internal target volumes to planning target volumes in the range of 12 to 23 mm are reported, and avoiding exposure of the contralateral lung is common practice. We investigated prospectively an approach with tight margins (7 mm) and maximal sparing of the ipsilateral normal lung. Mature results for the first endpoint (pneumonitis) and further toxicities are reported.
Primary tumors were treated by VMAT with 73.8-90.0 Gy in positive correlation to tumor volumes, nodes with 61.2 Gy, a restricted volume of nodes electively with 45 Gy. Fractional doses of 1.8 Gy bid, interval 8 h. Before radiotherapy, two cycles platin-based chemotherapy were given. 12 patients finished maintenance therapy with Durvalumab. Median follow up time for all patients is 19.4 months, for patients alive 27.0 months (3.4-66.5 months).
100 consecutive, unselected patients with LA-NSCLC in stages II through IVA were enrolled (UICC/AJCC, 8th edition). No acute grade 4/5 toxicity occurred. Pneumonitis grade 2 and 3 was observed in 12% and 2% of patients, respectively; lowering the risk of pneumonitis grade ≥ 2 in comparison to the largest study in the literature investigating pneumonitis in LA-NSCLC, is significant (p < 0.0006). Acute esophageal toxicity grade 1, 2 and 3 occurred in 12%, 57% and 3% of patients, respectively. Two patients showed late bronchial stricture/atelectasis grade 2. In two patients with lethal pulmonary haemorrhages a treatment correlation cannot be excluded. Median overall survival for all stage III patients, and for those with 'RTOG 0617 inclusion criteria' is 46.6 and 50.0 months, respectively.
Overall toxicity is low. In comparison to results in the literature, maximal sparing the ipsilateral normal lung lowers the risk for pneumonitis significantly.
Ethics committee of Vorarlberg, Austria; EK-0.04-105, Registered 04/09/2017-Retrospectively registered. http://www.ethikkommission-vorarlberg.at.
在局部晚期非小细胞肺癌（LA-NSCLC）的放射治疗中，据报道，内部靶区到计划靶区的“边缘”范围为 12 至 23 毫米，避免对侧肺暴露是常见的做法。我们前瞻性地研究了一种采用紧密边缘（7 毫米）和最大限度保护同侧正常肺的方法。现将第一个终点（肺炎）和进一步毒性的成熟结果报告如下。
原发性肿瘤采用 VMAT 治疗，与肿瘤体积呈正相关给予 73.8-90.0Gy，淋巴结给予 61.2Gy，选择性给予受限淋巴结 45Gy。分次剂量为 1.8Gy bid，间隔 8 小时。放射治疗前给予两个周期铂类化疗。12 例患者完成了度伐单抗维持治疗。所有患者的中位随访时间为 19.4 个月，存活患者为 27.0 个月（3.4-66.5 个月）。
共纳入 100 例连续、未经选择的 II 至 IVA 期 LA-NSCLC 患者（UICC/AJCC，第 8 版）。无急性 4/5 级毒性。分别有 12%和 2%的患者出现肺炎 2 级和 3 级；与文献中最大规模的 LA-NSCLC 肺炎研究相比，显著降低了肺炎 2 级以上的风险（p<0.0006）。急性食管毒性 1、2 和 3 级分别发生在 12%、57%和 3%的患者中。两名患者出现 2 级支气管狭窄/肺不张。在两名致命性肺出血的患者中，不能排除治疗相关性。所有 III 期患者的中位总生存期和符合“RTOG 0617 纳入标准”的患者的中位总生存期分别为 46.6 和 50.0 个月。
总体毒性较低。与文献结果相比，最大限度地保护同侧正常肺可显著降低肺炎的风险。
奥地利福拉尔贝格州伦理委员会；EK-0.04-105，注册日期 2017 年 9 月 4 日-回顾性注册。http://www.ethikkommission-vorarlberg.at.
