大（>5厘米）不可切除的III期非小细胞肺癌在常规放疗前进行部分立体定向消融放疗加强（P-SABR）
Partial Stereotactic Ablative Radiotherapy Boost Before Conventional Radiotherapy (P-SABR) for Large (> 5 cm) Unresectable Stage III Nonsmall Cell Lung Cancer.
作者信息
Bai Yun, Gao Xianshu, Qin Shangbin, Li Shanshi, Ma Mingwei, Cao Xi, Lyu Feng, Chen Jiayan, Qi Xin, Liu Siwei, Gao Yan, Li Hongzhen, Li Xiaomei, Li Xiaoying, Ren Xueying, Huang Lei
机构信息
Department of Radiation Oncology, Peking University First Hospital, Beijing, China.
Department of Radiation Oncology, William Beaumont Hospital, Oak, Michigan, USA.
出版信息
Thorac Cancer. 2025 Jan;16(2):e15514. doi: 10.1111/1759-7714.15514. Epub 2024 Dec 14.
OBJECTIVE
Stereotactic ablative radiotherapy (SABR) is renowned for its high local control (LC) rates. Nonetheless, for tumors that are either large in volume or in close proximity to critical organs at risk, the application of SABR to the entire tumor becomes impractical. This study aims to evaluate the efficacy and safety of partial SABR boost before conventional radiotherapy (P-SABR) for the treatment of large (> 5 cm) unresectable stage III nonsmall cell lung cancer (NSCLC).
METHODS
From April 2014 to January 2024, 44 patients with > 5 cm unresectable T3-4N0-3M0 stage III NSCLC were analyzed. The median diameter was 9 cm (5.2-22.7 cm). The P-SABR plan is combined with a partial SABR boost part and a conventional fractionated radiotherapy (CFRT) part. In the partial SABR boost plan, the prescription dose for planning target volume (PTV) was 1.8-3 Gy per fraction over 3-4 fractions, and the artificially delineated gross tumor boost volume (GTVb) within GTV received a simultaneously integrated SABR dose (6 or 8 Gy per fraction). In the following CFRT plan, the median dose for the entire PTV was 54 Gy in 22 fractions. For the synthetic P-SABR plan, the median cumulative dose delivered to the PTV was 62.1 Gy, while the median cumulative dose to the GTVb was escalated to 78 Gy.
RESULTS
The median follow-up time was 36 months (95% CI, 14.6-57.4 months). The LC rates at 1 and 2 years were 90.2% and 76.8%, respectively. The median OS was 47.0 months (95% CI, 16.8-77.2 months) and 15.0 months (95% CI, 6.0-24.0 months) for the chemoradiotherapy and radiotherapy groups, respectively. Univariate analysis showed that P-SABR combined with immunotherapy was associated with significantly longer OS (HR, 0.163; 95% CI, 0.038-0.704). Only one (2.3%) patient experienced grade 3 acute pneumonitis.
CONCLUSIONS
The P-SABR treatment has shown a high rate of LC and tolerable toxicity in patients with large unresectable stage III NSCLC.
目的
立体定向消融放疗（SABR）以其高局部控制（LC）率而闻名。然而，对于体积较大或紧邻危险关键器官的肿瘤，对整个肿瘤应用SABR变得不切实际。本研究旨在评估在传统放疗前进行部分SABR增敏（P-SABR）治疗不可切除的大体积（>5 cm）Ⅲ期非小细胞肺癌（NSCLC）的疗效和安全性。
方法
分析2014年4月至2024年1月期间44例>5 cm不可切除的T3-4N0-3M0Ⅲ期NSCLC患者。中位直径为9 cm（5.2 - 22.7 cm）。P-SABR计划由部分SABR增敏部分和传统分割放疗（CFRT）部分组成。在部分SABR增敏计划中，计划靶体积（PTV）的处方剂量为每分次1.8 - 3 Gy，共3 - 4次，在大体肿瘤体积（GTV）内人为划定的大体肿瘤增敏体积（GTVb）接受同步整合的SABR剂量（每分次6或8 Gy）。在随后的CFRT计划中，整个PTV的中位剂量为54 Gy，分22次给予。对于综合P-SABR计划，PTV的中位累积剂量为62.1 Gy，而GTVb的中位累积剂量增至78 Gy。
结果
中位随访时间为36个月（95%CI，14.6 - 57.4个月）。1年和2年的LC率分别为90.2%和76.8%。化疗放疗组和放疗组的中位总生存期（OS）分别为47.0个月（95%CI，16.8 - 77.2个月）和15.0个月（95%CI，6.0 - 24.0个月）。单因素分析显示，P-SABR联合免疫治疗与显著更长的OS相关（HR，0.163；95%CI，0.038 - 0.704）。仅1例（占2.3%）患者发生3级急性肺炎。
结论
P-SABR治疗在不可切除的大体积Ⅲ期NSCLC患者中显示出高LC率和可耐受毒性。
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