Ugurluer Gamze, Dincer Neris, Mustafayev Teuta Zoto, Gungor Gorkem, Abacioglu Mehmet Ufuk, Sengoz Meric, Ozyar Enis, Atalar Banu
Department of Radiation Oncology, Acibadem MAA University School of Medicine, 34450, Istanbul, Turkey.
Department of Radiation Oncology, Acibadem Maslak Hospital, Darüşşafaka, Büyükdere Cd. No:40, 34398, Sarıyer, Istanbul, Turkey.
Strahlenther Onkol. 2024 Dec 2. doi: 10.1007/s00066-024-02328-1.
Stereotactic body radiotherapy is pivotal in the treatment of lung tumors, demonstrating effective local control. However, challenges persist with intra-fractional anatomical changes and organs at risk during delivery. Magnetic resonance-guided online adaptive stereotactic body radiotherapy (MRgSBRT) represents a novel technique promising to achieve safe delivery of ablative doses with improved outcomes for primary lung tumors or lung oligometastases.
In this single-institution retrospective analysis, we evaluated 64 patients (92 lesions) with primary lung cancer or lung oligometastases treated with MRgSBRT. Using Kaplan-Meier method and log-rank test; we estimated local control (LC), local progression-free survival (LPFS), distant progression-free survival (DPFS), and overall survival (OS).
A total of 64 patients (92 lesions) treated with MRgSBRT were included comprising 14.1% primary lung cancer lesions and 85.9% lung oligometastases. Median total dose, fraction number, fraction dose and BED were 50 Gy (range, 21-70 Gy), 5 (range, 1-10), 10 Gy (range, 6-34 Gy), 100 Gy (range, 48-180.0 Gy) respectively. Of the 420 fractions administered, 88.6% (n = 372) involved on-table adapted plans. Median LPFS was not reached and the 1‑ and 3‑year LPFS rates were 96.3% (95% CI 92.4-100.0%) and 86.4% (95% CI 76.9-95.9%), respectively. No local recurrences were observed post-treatment with a total dose of > 50 Gy, BED10 > 100 Gy, fractional dose of > 10 Gy or a CCI > 0.96.
Our study of MRgSBRT in 92 lung lesions revealed a 1-year and 3‑year LPFS rates of 96.3 and 86.4%, respectively without ≥ grade 3 toxicity. Future prospective studies evaluating lung MRgSBRT are awaited.
立体定向体部放疗在肺癌治疗中起着关键作用，显示出有效的局部控制效果。然而，在放疗过程中，分次内解剖结构变化和危及器官的问题仍然存在。磁共振引导的在线自适应立体定向体部放疗（MRgSBRT）是一种新技术，有望实现消融剂量的安全递送，并改善原发性肺癌或肺寡转移瘤的治疗效果。
在这项单机构回顾性分析中，我们评估了64例（92个病灶）接受MRgSBRT治疗的原发性肺癌或肺寡转移瘤患者。使用Kaplan-Meier方法和对数秩检验；我们估计了局部控制（LC）、局部无进展生存期（LPFS）、远处无进展生存期（DPFS）和总生存期（OS）。
总共纳入了64例（92个病灶）接受MRgSBRT治疗的患者，其中原发性肺癌病灶占14.1%，肺寡转移瘤占85.9%。总剂量中位数、分次次数、分次剂量和生物等效剂量分别为50 Gy（范围21 - 70 Gy）、5次（范围1 - 10次）、10 Gy（范围6 - 34 Gy）、100 Gy（范围48 - 180.0 Gy）。在给予的420次分次放疗中，88.6%（n = 372）涉及术中调整计划。LPFS中位数未达到，1年和3年LPFS率分别为96.3%（95%CI 92.4 - 100.0%）和86.4%（95%CI 76.9 - 95.9%）。总剂量> 50 Gy、BED10> 100 Gy、分次剂量> 10 Gy或剂量不均匀性指数（CCI）> 0.96的患者治疗后未观察到局部复发。
我们对92个肺部病灶进行的MRgSBRT研究显示，1年和3年LPFS率分别为96.3%和86.4%，且无≥3级毒性反应。期待未来进行评估肺部MRgSBRT的前瞻性研究。
