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<编辑精选>局限期小细胞肺癌选择性淋巴结照射与累及野放疗:单机构经验。

<Editors' Choice> Elective nodal irradiation versus involved field radiotherapy for limited disease small cell lung cancer: a single-institution experience.

机构信息

Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan.

Departments of Pulmonary Medicine, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan.

出版信息

Nagoya J Med Sci. 2022 May;84(2):327-338. doi: 10.18999/nagjms.84.2.327.

Abstract

Elective nodal irradiation (ENI) and involved field radiotherapy (IFRT) are definitive radiotherapeutic approaches used to treat patients with limited-disease small cell lung cancer (LD-SCLC). However, no solid consensus exists on their optimal target volume. The current study aimed to assess the clinical outcomes of patients with LD-SCLC who received definitive ENI or IFRT. A retrospective single-institution study of patients who received definitive radiotherapy between 2008 and 2020 was performed. All patients underwent whole-body positron emission tomography/computed tomography before three-dimensional conformal radiotherapy. Among the 37 patients analyzed, 22 and 15 received ENI and IFRT, respectively. The thoracic radiotherapy dose was mostly either 60 Gy in 30 fractions delivered in 2-Gy fractions once daily or 45 Gy in 30 fractions delivered in 1.5-Gy fractions twice daily. The median follow-up period was 21.4 months. A total of 12 patients (32%) experienced locoregional relapse: 10 within and 2 outside the irradiation fields. One patient in the IFRT group experienced isolated nodal failure. Differences in locoregional relapse-free, progression-free, and overall survival rates between ENI and IFRT were not significant. Overall, IFRT did not promote a significant increase in locoregional recurrence compared to ENI. Our findings suggested the utility of IFRT in standard clinical practice and support its use for patients with LD-SCLC.

摘要

选择性淋巴结照射(ENI)和累及野放疗(IFRT)是治疗局限期小细胞肺癌(LD-SCLC)患者的明确放射治疗方法。然而,对于它们的最佳靶区体积,目前尚无明确共识。本研究旨在评估接受明确 ENI 或 IFRT 治疗的 LD-SCLC 患者的临床结局。这是一项回顾性的单机构研究,纳入了 2008 年至 2020 年期间接受明确放疗的患者。所有患者在接受三维适形放疗前均接受全身正电子发射断层扫描/计算机断层扫描。在分析的 37 名患者中,22 名和 15 名分别接受了 ENI 和 IFRT。胸部放疗剂量大多为 60 Gy,30 次分割,2 Gy 分次,每天一次,或 45 Gy,30 次分割,1.5 Gy 分次,每天两次。中位随访时间为 21.4 个月。共有 12 名患者(32%)发生局部区域复发:10 名在照射野内,2 名在照射野外。IFRT 组有 1 名患者发生孤立性淋巴结失败。ENI 和 IFRT 组的局部区域无复发生存率、无进展生存率和总生存率差异无统计学意义。总体而言,IFRT 并未显著增加局部区域复发率。我们的研究结果表明 IFRT 在标准临床实践中的有效性,并支持其用于治疗 LD-SCLC 患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d423/9350561/578051e2c8c9/2186-3326-84-0327-g001.jpg

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