Franceschini Davide, Loi Mauro, Marzo Antonio Marco, Dominici Luca, Spoto Ruggero, Bertolini Anna, Lo Faro Lorenzo, La Fauci Francesco, Marini Beatrice, Di Cristina Luciana, Scorsetti Marta
Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy.
Department of Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, 50134 Florence, Italy.
Diseases. 2024 Jul 12;12(7):153. doi: 10.3390/diseases12070153.
Few data are available on the role of SBRT re-irradiation for isolated recurrences. We designed a prospective phase I study to evaluate the maximum tolerated dose (MTD) of SBRT for thoracic re-irradiation, for peripheral lung lesions. RT was delivered with a dose escalation design from 30 Gy in five fractions up to 50 Gy in five fractions. The primary end point was the definition of the maximum tolerated dose (MTD) of SBRT for thoracic re-irradiation. The dose-limiting toxicity was pneumonia ≥G3. Fifteen patients were enrolled. No cases of pneumonia ≥G3 occurred in any of our cohorts. Only one patient developed pneumonia G1 during treatment. Three patients developed acute toxicities that included dyspnea G1, cardiac failure G3, and chest wall pain. One patient developed G3 late toxicity with acute coronary syndrome. After a median follow-up of 21 months (range 3.6-29.1 months), six patients (40%) had a local relapse. Distant relapse occurred in five patients (33.3%). At the last follow-up, six patients died, all but two due to progressive disease. SBRT dose escalation for thoracic re-irradiation is an effective and well-tolerated option for patients with inoperable lung lesions after a first thoracic RT with acceptable acute and late toxicities.
关于立体定向体部放疗（SBRT）再程放疗对孤立性复发的作用，目前可用数据较少。我们设计了一项前瞻性I期研究，以评估SBRT对胸部再程放疗用于外周肺部病变的最大耐受剂量（MTD）。放疗采用剂量递增设计，从30 Gy分5次照射至50 Gy分5次照射。主要终点是确定SBRT对胸部再程放疗的最大耐受剂量（MTD）。剂量限制性毒性为≥3级肺炎。共纳入15例患者。我们的任何队列中均未发生≥3级肺炎病例。仅1例患者在治疗期间发生1级肺炎。3例患者出现急性毒性反应，包括1级呼吸困难、3级心力衰竭和胸壁疼痛。1例患者发生3级晚期毒性反应并伴有急性冠状动脉综合征。中位随访21个月（范围3.6 - 29.1个月）后，6例患者（40%）出现局部复发。5例患者（33.3%）发生远处复发。在最后一次随访时，6例患者死亡，除2例之外均死于疾病进展。对于首次胸部放疗后无法手术的肺部病变患者，SBRT剂量递增用于胸部再程放疗是一种有效且耐受性良好的选择，其急性和晚期毒性均可接受。
