Dong Baiqiang, Chen Runzhe, Zhu Xuan, Wu Qing, Jin Jia'nan, Wang Wenqing, Zhu Yujia, Jiang Hui, Bi Nan, Wang Xu, Xu Xiaofang, Xu Yujin, Chen Ming
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China.
Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China.
Clin Transl Radiat Oncol. 2023 Feb 15;40:100601. doi: 10.1016/j.ctro.2023.100601. eCollection 2023 May.
Patients who previously underwent surgical resection of initial primary lung cancer are at a high risk of developing multiple primary lung cancers (MPLCs). The purpose of this study was to compare the efficacy and safety between stereotactic body radiation therapy (SBRT) and surgery for MPLCs patients after prior radical resection for the first lung cancers.
In this multicenter retrospective study, eligible MPLC patients with tumor diameter of 5.0 cm or less at N0M0 who underwent SBRT or reoperation between January 2013 and August 2020 were enrolled. The primary endpoint was the 3-year locoregional recurrence and treatment-related toxicity. Kaplan-Meier method was used to calculate survival rates. The χ test was adapted to assess the difference of categorical variables between the two subgroup patients.
A total of 203 (73 in the SBRT group and 130 in the surgery group) patients from three academic cancer centers were evaluated with a median follow-up of 38.3 months. The cumulative 1-, 2-, and 3-year incidences of locoregional recurrence were 5.6 %, 7.0 % and 13.1 % in the SBRT group versus 3.2 %, 4.8 % and 7.4 % in the surgery group, respectively [hazard ratio (HR), 1.97; 95 % confidence interval (CI), 0.74-5.24; = 0.14]. The cancer-specific survival rates were 95.9 %, 94.5 % and 88.1 % versus 96.9 %, 94.6 % and 93.8 % in the SBRT and surgery groups respectively (HR, 1.72; 95 % CI, 0.67-4.44; = 0.23). In the SBRT group, two patients (2.7 %) suffered from grade 3 radiation pneumonitis, while in the surgery group, grade 3 complications occurred in four (3.1 %) patients, and four cases were expired due to pneumonia or pulmonary heart disease within 90 days after surgery.
SBRT is an effective therapeutic option with limited toxicity compared to surgery for patients with MPLCs after prior radical surgical resection, and it could be considered as an alternative treatment for those patients.
既往接受过原发性肺癌初次手术切除的患者发生多发性原发性肺癌（MPLC）的风险很高。本研究的目的是比较立体定向体部放射治疗（SBRT）与手术治疗MPLC患者（这些患者此前已接受过首次肺癌根治性切除）的疗效和安全性。
在这项多中心回顾性研究中，纳入了2013年1月至2020年8月期间接受SBRT或再次手术、肿瘤直径在5.0 cm及以下且处于N0M0期的符合条件的MPLC患者。主要终点是3年局部区域复发率和治疗相关毒性。采用Kaplan-Meier法计算生存率。采用χ检验评估两组亚组患者分类变量的差异。
来自三个学术癌症中心的共203例患者（SBRT组73例，手术组130例）接受了评估，中位随访时间为38.3个月。SBRT组1年、2年和3年局部区域复发的累积发生率分别为5.6%、7.0%和13.1%，而手术组分别为3.2%、4.8%和7.4%[风险比（HR），1.97；95%置信区间（CI），0.74 - 5.24；P = 0.14]。SBRT组和手术组的癌症特异性生存率分别为95.9%、94.5%和88.1%，以及96.9%、94.6%和93.8%（HR，1.72；95% CI，0.67 - 4.44；P = 0.23）。在SBRT组，2例患者（2.7%）发生3级放射性肺炎，而在手术组，4例患者（3.1%）发生3级并发症，4例患者在术后90天内死于肺炎或肺心病。
对于既往接受过根治性手术切除的MPLC患者，与手术相比，SBRT是一种毒性有限的有效治疗选择，可作为这些患者的替代治疗方法。
