Muster Julian, Alt Niklas Josua, Edelmann Marcus, Anczykowski Mahalia Zoe, Zwerenz Carla Marie, Schirmer Markus Anton, Overbeck Tobias Raphael, Braulke Friederike, Guhlich Manuel, Shafie Rami El, Rieken Stefan, Leu Martin, Dröge Leif Hendrik
Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075, Göttingen, Germany.
Strahlenther Onkol. 2025 Mar 6. doi: 10.1007/s00066-025-02377-0.
In definitive radiotherapy/radiochemotherapy (RT/RCT) for localized non-small cell lung cancer (NSCLC), the introduction of positron-emission tomography (PET)-CT-based staging/RT planning and dynamic RT techniques (intensity-modulated radiotherapy, IMRT/volumetric modulated arc therapy, VMAT) were important innovations.
We performed a retrospective study and compared clinical outcomes (1) in patients with PET-CT-based staging (n = 170) vs. conventional staging (n = 103) and (2) in patients with dynamic RT techniques (IMRT/VMAT; n = 99) vs. three-dimensional conformal radiotherapy (3D-CRT; n = 64).
We found improved survival with PET-CT vs. conventional staging. PET-CT patients vs. conventionally staged patients had higher applied RT doses, higher RT completion rates, and a higher rate of patients who received RCT vs. RT only. Additionally, we found higher rates of leukopenia and lung infections in PET-CT patients. When comparing RT techniques (IMRT/VMAT vs. 3D-CRT), there were no differences in survival. IMRT/VMAT patients had higher RT doses and higher rates of intensified concomitant chemotherapy (cisplatin/vinorelbine vs. low-dose cisplatin). IMRT/VMAT was associated with a reduction in pneumonitis and dermatitis.
In summary, refined RT/RCT strategies with PET-CT and IMRT/VMAT enable the intensification of multimodal treatment. Reduction of toxicities with IMRT/VMAT widens the therapeutic window. The coincidence of intensified treatment, improved outcomes, and higher toxicity rates in PET-CT-staged patients emphasizes the need for a detailed risk-benefit assessment during planning and application of treatment modalities.
在局限性非小细胞肺癌（NSCLC）的根治性放疗/放化疗（RT/RCT）中，引入基于正电子发射断层扫描（PET）-CT的分期/放疗计划以及动态放疗技术（调强放疗，IMRT/容积调强弧形放疗，VMAT）是重要的创新。
我们进行了一项回顾性研究，并比较了（1）基于PET-CT分期的患者（n = 170）与传统分期的患者（n = 103）的临床结局，以及（2）采用动态放疗技术（IMRT/VMAT；n = 99）的患者与三维适形放疗（3D-CRT；n = 64）的患者的临床结局。
我们发现与传统分期相比，PET-CT可提高生存率。PET-CT分期的患者与传统分期的患者相比，接受的放疗剂量更高，放疗完成率更高，接受放化疗而非单纯放疗的患者比例更高。此外，我们发现PET-CT分期的患者白细胞减少和肺部感染的发生率更高。比较放疗技术（IMRT/VMAT与3D-CRT）时，生存率无差异。IMRT/VMAT患者的放疗剂量更高，强化同步化疗（顺铂/长春瑞滨与低剂量顺铂）的比例更高。IMRT/VMAT与肺炎和皮炎的减少有关。
总之，采用PET-CT和IMRT/VMAT的精准RT/RCT策略可强化多模式治疗。IMRT/VMAT降低毒性拓宽了治疗窗口。PET-CT分期患者强化治疗、改善结局与更高毒性发生率并存，这强调了在治疗模式的规划和应用过程中进行详细的风险效益评估的必要性。
