Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.
Pathol Oncol Res. 2024 Feb 13;30:1611589. doi: 10.3389/pore.2024.1611589. eCollection 2024.
This single institute prospective study aimed to evaluate the feasibility of LINAC-based stereotactic body radiotherapy (SBRT) in treating patients with early-stage non-small cell lung cancer (NSLSC). We focused on the survival data with the local and distant control profiles and the cancer- and non-cancer-specific survival. Treatment-related side effects were also collected and analyzed. Patients with early-stage NSCLC between January 2018 and October 2021 were included in our prospective study; a total of 77 patients receiving LINAC-based SBRT were analyzed. All patients had pretreatment multidisciplinary tumor board decisions on SBRT. The average patient age was 68.8 years (median: 70 years, range: 52-82); 70 patients were in ECOG 0 status (91%), while seven patients were in ECOG 1-2 status (9%). 52% of the patients (40) had histologically verified NSCLC, and the other 48% were verified based on PETCT results. We applied the SBRT scheme 8 x 7.5 Gy for central tumors (74%) or 4 x 12 Gy for peripheral tumors (26%). The mean follow-up time was 25.4 months (median 23, range 18-50). The Kaplan-Meier estimation for overall survival in patients receiving LINAC-based SBRT was 41.67 months. Of the 77 patients treated by SBRT, death was reported for 17 patients (9 cases cancer-specific, 8 cases non-cancer specific reason). The mean local tumor control was 34.25 months (range 8.4-41), and the mean systemic control was 24.24 months (range 7-25). During the treatments, no Grade I-II were reported; in 30 cases, Grade I non-symptomatic treatment-related lung fibrosis and two asymptomatic rib fractures were reported. In the treatment of early-stage NSCLC, LINAC-based SBRT can be a feasible alternative to surgery. Although we reported worse OS data in our patient cohort compared to the literature, the higher older average age and the initial worse general condition (ECOG1-2) in our patient cohort appear to be the reason for this difference. With the comparable local control and survival data and the favorable side effect profile, SBRT might be preferable over surgery in selected cases.
这项单中心前瞻性研究旨在评估基于 LINAC 的立体定向体放射治疗（SBRT）治疗早期非小细胞肺癌（NSLSC）患者的可行性。我们重点关注局部和远处控制情况以及癌症和非癌症特异性生存的生存数据。还收集和分析了与治疗相关的副作用。
我们的前瞻性研究纳入了 2018 年 1 月至 2021 年 10 月期间的早期 NSCLC 患者，共分析了 77 例接受 LINAC 基于 SBRT 的患者。所有患者均在接受 SBRT 之前进行了多学科肿瘤委员会的预处理决定。患者的平均年龄为 68.8 岁（中位数：70 岁，范围：52-82 岁）；70 例患者的 ECOG 0 状态（91%），7 例患者的 ECOG 1-2 状态（9%）。52%的患者（40 例）有组织学证实的 NSCLC，其余 48%基于 PETCT 结果证实。我们应用 SBRT 方案，中央肿瘤 8 x 7.5 Gy（74%）或外周肿瘤 4 x 12 Gy（26%）。平均随访时间为 25.4 个月（中位数 23，范围 18-50）。接受 LINAC 基于 SBRT 的患者的总体生存的 Kaplan-Meier 估计为 41.67 个月。在接受 SBRT 治疗的 77 例患者中，有 17 例患者报告死亡（9 例癌症特异性，8 例非癌症特异性原因）。平均局部肿瘤控制时间为 34.25 个月（范围 8.4-41），平均全身控制时间为 24.24 个月（范围 7-25）。在治疗期间，未报告 1-2 级不良反应；30 例患者报告出现无症状的治疗相关肺纤维化和 2 例无症状肋骨骨折。
在治疗早期 NSCLC 时，基于 LINAC 的 SBRT 可以作为手术的一种可行替代方法。尽管我们报告的患者队列的 OS 数据比文献中的数据差，但我们患者队列中较高的平均年龄和初始较差的一般状况（ECOG1-2）似乎是造成这种差异的原因。鉴于相似的局部控制和生存数据以及有利的副作用情况，SBRT 在某些情况下可能优于手术。
