在线磁共振引导下多分割立体定向消融放疗在肺部肿瘤中的作用。

The role of online MR-guided multi-fraction stereotactic ablative radiotherapy in lung tumours.

作者信息

Hering Svenja, Nieto Alexander, Marschner Sebastian, Hofmaier Jan, Schmidt-Hegemann Nina-Sophie, da Silva Mendes Vanessa, Landry Guillaume, Niyazi Maximilian, Manapov Farkhad, Belka Claus, Corradini Stefanie, Eze Chukwuka

机构信息

Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.

Department of Radiation Oncology, University of Tübingen, Tübingen, Germany.

出版信息

Clin Transl Radiat Oncol. 2024 Jan 30;45:100736. doi: 10.1016/j.ctro.2024.100736. eCollection 2024 Mar.

BACKGROUND

The aim of this prospective observational study was to evaluate the dosimetry benefits, changes in pulmonary function, and clinical outcome of online adaptive MR-guided SBRT.

METHODS

From 11/2020-07/2022, 45 consecutive patients with 59 lesions underwent multi-fraction SBRT (3-8 fractions) at our institution. Patients were eligible if they had biopsy-proven NSCLC or lung cancer/metastases diagnosed via clinical imaging. Endpoints were local control (LC) and overall survival (OS). We evaluated PTV/GTV dose coverage, organs at risk exposure, and changes in pulmonary function (PF). Acute toxicity was classified per the National Cancer Institute-Common Terminology Criteria for Adverse Events version 5.0.

RESULTS

The median PTV was 14.4 cm (range: 3.4 - 96.5 cm). In total 195/215 (91%) plans were reoptimised. In the reoptimised vs. predicted plans, PTV coverage by the prescribed dose increased in 94.6% of all fractions with a median increase in PTV V of 5.6% (range: -1.8 - 44.6%, p < 0.001), increasing the number of fractions with PTV V ≥ 95% from 33% to 98%. The PTV D and D (BED) increased in 93% and 95% of all fractions with a median increase of 7.7% (p < 0.001) and 10.6% (p < 0.001). The PTV D (BED) increased by a mean of 9.6 Gy (SD: 10.3 Gy, p < 0.001). At a median follow-up of 21.4 months (95% CI: 12.3-27.0 months), 1- and 2-year LC rates were 94.8% (95% CI: 87.6 - 100.0%) and 91.1% (95% CI: 81.3 - 100%); 1- and 2-year OS rates were 85.6% (95% CI: 75.0 - 96.3%) and 67.1 % (95% CI: 50.3 - 83.8%). One grade ≥ 3 toxicity and no significant reduction in short-term PF parameters were recorded.

CONCLUSIONS

Online adaptive MR-guided SBRT is an effective, safe and generally well tolerated treatment option for lung tumours achieving encouraging local control rates with significantly improved target volume coverage.

背景

这项前瞻性观察性研究的目的是评估在线自适应磁共振引导下的立体定向体部放疗（SBRT）的剂量学优势、肺功能变化和临床结果。

方法

2020年11月至2022年7月，我们机构连续45例患者的59个病灶接受了多分次SBRT（3 - 8次分割）。经活检证实为非小细胞肺癌（NSCLC）或经临床影像诊断为肺癌/转移瘤的患者符合入选标准。观察终点为局部控制（LC）和总生存期（OS）。我们评估了计划靶体积（PTV）/大体肿瘤体积（GTV）的剂量覆盖、危及器官的受照剂量以及肺功能（PF）的变化。急性毒性按照美国国立癌症研究所不良事件通用术语标准第5.0版进行分类。

结果

PTV的中位数为14.4 cm（范围：3.4 - 96.5 cm）。总共195/215（91%）个计划进行了重新优化。在重新优化后的计划与预测计划中，94.6%的分次中规定剂量对PTV的覆盖增加，PTV的V中位数增加了5.6%（范围：-1.8 - 44.6%，p < 0.001），PTV的V≥95%的分次数量从33%增加到98%。所有分次中93%的PTV D和95%的PTV D（生物等效剂量，BED）增加，中位数分别增加7.7%（p < 0.001）和10.6%（p < 0.001）。PTV的D（BED）平均增加9.6 Gy（标准差：10.3 Gy，p < 0.001）。中位随访21.4个月（95%置信区间：12.3 - 27.0个月）时，1年和2年的LC率分别为94.8%（95%置信区间：87.6 - 100.0%）和91.1%（95%置信区间：81.3 - 100%）；1年和2年的OS率分别为85.6%（95%置信区间：75.0 - 96.3%）和67.1%（95%置信区间：50.3 - 83.8%）。记录到1例3级及以上毒性反应，短期PF参数无显著降低。