Tekatli Hilâl, Giraud Nicolas, van Eekelen Rik, Lagerwaard Frank J, Senan Suresh
Department of Radiation Oncology, Amsterdam UMC, The Netherlands.
Department of Radiation Oncology, Amsterdam UMC, The Netherlands.
Radiother Oncol. 2023 Nov;188:109848. doi: 10.1016/j.radonc.2023.109848. Epub 2023 Aug 9.
SABR performed for central and ultracentral lung tumors is associated with increased toxicity but limited data is available on late toxicities. We studied toxicity in patients followed-up ≥ 2 years post-SABR at a single-institution.
All patients were treated using VMAT for a primary or recurrent central lung cancer between 2008-2015. 60 Gy was delivered in 8 or 12 fractions. Grade ≥ 3 clinical and radiological bronchial toxicity was scored. Multivariable Cox regression models were used to estimate hazard ratios.
Of 127 eligible patients, 63% were treated with 8 fractions. Median tumor diameter was 4.4 cm (range 1.3-12.0). Median overall survival was 25.0 months (95% CI 16.5-33.5); 4% developed isolated local recurrences. The actuarial 5-year rate for severe clinical toxicity was 34.1% (95% CI 21.2-44.9). Both clinical toxicity and fatal lung haemorrhage were most observed when tumors were located ≤ 1 cm from the trachea or main bronchi (46% of all cases). The 5-year actuarial rate of radiological bronchial toxicity was 37.5% (95% CI 21.5-50.2). Multivariable analysis revealed that a performance score of 2 or 3 (HR 3.6; 95% CI 1.7-7.8), and tumor location ≤ 1 cm from the trachea or main bronchi (HR 4.3; 95% CI 1.2-14.9) were significant predictors for severe clinical toxicity.
The actuarial rates for both severe clinical and radiological bronchial toxicity after central SABR was approximately 35% in patients surviving 5 years. Patients with tumors located ≤ 1 cm from the trachea or main bronchus were at the highest risk for severe clinical toxicity.
立体定向消融放疗（SABR）用于治疗中央型和超中央型肺肿瘤时毒性增加，但关于晚期毒性的可用数据有限。我们研究了在单一机构接受SABR治疗后随访≥2年的患者的毒性情况。
2008年至2015年间，所有患者均采用容积调强弧形放疗（VMAT）治疗原发性或复发性中央型肺癌。分8次或12次给予60 Gy剂量。对≥3级临床和放射学支气管毒性进行评分。使用多变量Cox回归模型估计风险比。
127例符合条件的患者中，63%接受了8次分割治疗。肿瘤中位直径为4.4 cm（范围1.3 - 12.0 cm）。中位总生存期为25.0个月（95%置信区间16.5 - 33.5）；4%出现孤立性局部复发。严重临床毒性的5年精算发生率为34.1%（95%置信区间21.2 - 44.9）。当肿瘤位于距气管或主支气管≤1 cm时，临床毒性和致命性肺出血最为常见（占所有病例的46%）。放射学支气管毒性的5年精算发生率为37.5%（95%置信区间21.5 - 50.2）。多变量分析显示，体能状态评分为2或3（风险比3.6；95%置信区间1.7 - 7.8）以及肿瘤位于距气管或主支气管≤1 cm（风险比4.3；95%置信区间1.2 - 14.9）是严重临床毒性的显著预测因素。
在存活5年的患者中，中央型SABR后严重临床和放射学支气管毒性的精算发生率约为35%。肿瘤位于距气管或主支气管≤1 cm的患者发生严重临床毒性的风险最高。
