Song Xue, Zhao Lijun, Jiang Ning, Ding Naixin, Zong Dan, Zhang Nan, Wang Dejun, Wen Jing, He Xia, Kong Cheng, Zhu Xiangzhi
Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
Curr Probl Cancer. 2023 Jun;47(3):100956. doi: 10.1016/j.currproblcancer.2023.100956. Epub 2023 Mar 11.
Treatment-related toxicity following stereotactic ablative radiotherapy (SABR) in patients with central and ultracentral non-small cell lung cancer (NSCLC) is of potential concern, and the best regimens are still being explored. This study aimed to evaluate the clinical outcomes and toxicities of the patients with ultracentral and central NSCLC treated with SABR at our institution.
This retrospective study included patients with central and ultracentral NSCLC treated with SABR to prescription doses of 50 Gy in five fractions, 56 Gy in seven fractions, or 60 Gy in ten fractionsat Jiangsu Cancer Hospital between May 2013 and October 2018. The patients were grouped as central or ultracentral tumors.Overall survival (OS), progression-free survival (PFS), and grade ≥3 toxicities were analyzed.
Forty patients (31 male, nine female) were included. Median follow-up was 41 (5-81) months. The 1-, 2-, and 3-year OS rates were 90.0%, 83.6%, and 66.0%, respectively, and the 1-, 2-, and 3-year PFS rates were 82.5%, 62.9%, and 54.2%, respectively. OS in the ultracentral group was inferior compared with the central group (median, 52.0 months, 95%CI: 43.0-61.0 vs. not reached, P=0.03).The median PFS was 38.0 months in the ultracentral group (95%CI: 19.8-56.2) vs. not reached in the central group, although this difference was not statistically significant (P= 0.06). The overall incidence of grade ≥3 toxicity was five (12.5%) patients, (5 in the ultracentralgroup vs. 0 in the central group; P=0. 11), including one patient with grade 3 pneumonitis, two with grade 3 bronchial obstruction, one with grade 5 bronchial obstruction, and one with grade 5 esophageal perforation.
Worse outcomes were obseverd in patients with ultracentral NSCLC than those with central tumors after SABR. Higher rate of treatment-related grade 3 or more toxicity was observed in the ultracentral group.
立体定向消融放疗（SABR）治疗中央型和超中央型非小细胞肺癌（NSCLC）患者后与治疗相关的毒性是一个潜在问题，最佳治疗方案仍在探索中。本研究旨在评估在我院接受SABR治疗的超中央型和中央型NSCLC患者的临床结局和毒性。
本回顾性研究纳入了2013年5月至2018年10月期间在江苏省肿瘤医院接受SABR治疗、处方剂量为50 Gy分5次、56 Gy分7次或60 Gy分10次的中央型和超中央型NSCLC患者。将患者分为中央型或超中央型肿瘤组。分析总生存期（OS）、无进展生存期（PFS）和≥3级毒性。
纳入40例患者（男性31例，女性9例）。中位随访时间为41（5 - 81）个月。1年、2年和3年OS率分别为90.0%、83.6%和66.0%，1年、2年和3年PFS率分别为82.5%、62.9%和54.2%。超中央型组的OS低于中央型组（中位值52.0个月，95%CI：43.0 - 61.0对比未达到，P = 0.03）。超中央型组的中位PFS为38.0个月（95%CI：19.8 - 56.2），而中央型组未达到，尽管这种差异无统计学意义（P = 0.06）。≥3级毒性的总发生率为5例（12.5%）患者（超中央型组5例对比中央型组0例；P = 0.11），包括1例3级肺炎患者、2例3级支气管阻塞患者、1例5级支气管阻塞患者和1例5级食管穿孔患者。
SABR治疗后，超中央型NSCLC患者的结局比中央型肿瘤患者差。超中央型组观察到更高的治疗相关3级或更高级别毒性发生率。
