Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China.
Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA.
Radiother Oncol. 2023 Oct;187:109817. doi: 10.1016/j.radonc.2023.109817. Epub 2023 Jul 20.
Reirradiation with stereotactic body radiotherapy (SBRT) for patients with primary or secondary lung malignancies represents an appealing definitive approach, but its feasibility and safety are not well defined. The purpose of this study was to investigate the tumor control probability (TCP) and toxicity for patients receiving reirradiation with SBRT.
Eligible patients with recurrence of primary or secondary lung malignancies from our hospital were subjected to reirradiation with SBRT, and PubMed- and Embase-indexed articles were reviewed. The patient characteristics, pertinent SBRT dosimetric details, local tumor control, and toxicities were extracted. The logistic dose-response models were compared for TCP and overall survival (OS) in terms of the physical dose and three-, four-, and five-fraction equivalent doses.
The data of 17 patients from our hospital and 195 patients extracted from 12 articles were summarized. Reirradiation with SBRT yielded 2-year estimates of 80% TCP for doses of 50.10 Gy, 55.85 Gy, and 60.54 Gy in three, four, and five fractions, respectively. The estimated TCP with common fractionation schemes were 50%, 60%, and 70% for 42.04 Gy, 47.44 Gy, and 53.32 Gy in five fractions, respectively. Similarly, the 2-year estimated OS was 50%, 60%, and 70% for 41.62 Gy, 46.88 Gy, and 52.55 Gy in five fractions, respectively. Central tumor localization may be associated with severe toxicity.
Reirradiation with SBRT doses of 50-60 Gy in 3-5 fractions is feasible for appropriately selected patients with recurrence of peripheral primary or secondary lung malignancies, but should be carefully considered for centrally-located tumors due to potentially severe toxicity. Further studies are warranted for optimal dose/fractionation schedules and more accurate selection of patients suitable for reirradiation with SBRT.
对于原发性或继发性肺部恶性肿瘤患者，立体定向体部放射治疗（SBRT）再放射治疗是一种有吸引力的根治方法，但可行性和安全性尚未明确。本研究旨在探讨 SBRT 再放射治疗患者的肿瘤控制概率（TCP）和毒性。
从我院收治的原发性或继发性肺部恶性肿瘤复发患者中筛选出符合条件的患者，接受 SBRT 再放射治疗，并对 PubMed 和 Embase 索引的文章进行综述。提取患者特征、相关 SBRT 剂量学细节、局部肿瘤控制和毒性。采用逻辑剂量反应模型比较物理剂量和三、四、五分剂量等效剂量的 TCP 和总生存（OS）。
总结了我院 17 例患者和从 12 篇文章中提取的 195 例患者的数据。SBRT 再放射治疗的 2 年 TCP 估计值分别为 3 个、4 个和 5 个剂量为 50.10Gy、55.85Gy 和 60.54Gy 的分数。常见分割方案的估计 TCP 分别为 42.04Gy、47.44Gy 和 53.32Gy 的 5 个分数为 50%、60%和 70%。同样，2 年 OS 估计值分别为 41.62Gy、46.88Gy 和 52.55Gy 的 5 个分数为 50%、60%和 70%。中央肿瘤定位可能与严重毒性有关。
对于外周原发性或继发性肺部恶性肿瘤复发的适当选择患者，SBRT 再放射治疗 50-60Gy 的 3-5 个剂量是可行的，但对于中央肿瘤，由于潜在的严重毒性，应慎重考虑。需要进一步的研究来确定最佳剂量/分割方案，并更准确地选择适合 SBRT 再放射治疗的患者。
