Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Radiat Oncol. 2023 Mar 8;18(1):49. doi: 10.1186/s13014-023-02229-0.
Stereotactic body radio therapy (SBRT) has emerged as a standard treatment option for nonsurgical candidates with early-stage non-small cell lung cancer (NSCLC). Pathological proof is sometimes difficult to obtain in patients with solitary pulmonary nodules (SPNs). We aimed to compare the clinical outcomes of stereotactic body radiotherapy via helical tomotherapy (HT-SBRT) for early-stage lung cancer patients with or without a pathological diagnosis.
Between June 2011 and December 2016, we treated 119 lung cancer patients with HT-SBRT, including 55 with a clinical diagnosis and 64 with a pathological diagnosis. Survival outcomes, including local control (LC), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS), were compared between two cohorts with and without a pathological diagnosis.
The median follow-up for the whole group was 69 months. Patients with a clinical diagnosis were significantly older (p = 0.002). No significant differences were observed between the clinical and pathological diagnosis cohorts in terms of the long-term outcome, with 5-year LC, PFS, CSS, and OS of 87% versus 83% (p = 0.58), 48% versus 45% (p = 0.82), 87% versus 84% (p = 0.65), and 60% versus 63% (p = 0.79), respectively. Recurrence patterns and toxicity were also similar.
Empiric SBRT appears to be a safe and effective treatment option in a multidisciplinary setting when patients with SPNs highly suggestive of malignancy are unable/refuse to obtain a definitive pathological diagnosis.
立体定向体部放射治疗（SBRT）已成为非手术早期非小细胞肺癌（NSCLC）患者的标准治疗选择。对于孤立性肺结节（SPN）患者，有时难以获得病理证实。我们旨在比较有或无病理诊断的早期肺癌患者行螺旋断层放疗（HT-SBRT）的临床结果。
2011 年 6 月至 2016 年 12 月，我们用 HT-SBRT 治疗了 119 例肺癌患者，包括 55 例临床诊断和 64 例病理诊断。我们比较了两组有和无病理诊断患者的生存结果，包括局部控制（LC）、无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）。
全组患者的中位随访时间为 69 个月。临床诊断组患者年龄显著较大（p=0.002）。临床和病理诊断组在长期结果方面无显著差异，5 年 LC、PFS、CSS 和 OS 分别为 87%比 83%（p=0.58）、48%比 45%（p=0.82）、87%比 84%（p=0.65）和 60%比 63%（p=0.79）。复发模式和毒性也相似。
在多学科环境下，当高度怀疑恶性的 SPN 患者无法或拒绝获得明确的病理诊断时，经验性 SBRT 似乎是一种安全有效的治疗选择。
