Boldrini Luca, Romano Angela, Castanò Ilaria, Martino Antonella, Lococo Filippo, Cicchetti Giuseppe, Nardini Matteo, Panza Giulia, Placidi Lorenzo, Chiloiro Giuditta
Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
Radiol Med. 2025 Jul 22. doi: 10.1007/s11547-025-02056-1.
Non-small cell lung cancer is the most common malignancy of the lung, with over 40% of the cases in patients aged 75 years or older. Many of these patients are inoperable due to comorbidities, limiting treatment options. Stereotactic body radiotherapy (SBRT) offers a curative alternative, achieving local control (LC) rates similar to surgery with manageable toxicity. This retrospective analysis aimed to investigate the efficacy and safety of MRI-guided SBRT (MRIgSBRT) for elderly lung cancer patients.
Data of patients aged ≥ 75 years, treated in our Institution between 2017 and 2023, were retrospectively collected. Survival curves for local recurrence-free survival (LRFS), progression-free survival and overall survival (OS) were estimated using the Kaplan-Meier method. Toxicity was assessed using the Common Terminology Criteria for Adverse Events (CTCAE version 5.0) scale.
The study included 38 patients with a total of 45 lung lesions, median age of 82 years (range 75-87). The median total radiotherapy dose was 62,5 Gy (range 24-75 Gy) delivered in 5 fractions (range 3-8). The median follow-up was of 16.9 months (range 0,97-66,7). The 1-, 2- and 3-year OS rates were 98% 96% and 80%, respectively, while the 1-, 2- and 3-year LRFS was 97,5%. Six patients (15.78%) and one patient (2.63%) had late G1 radiation-induced pneumonia and G2 dyspnoea, respectively.
MRIgSBRT is a valid therapeutic option for patients aged ≥ 75 with comorbidities, frailty and risk factors limiting their performance status and eligibility for invasive treatments, offering good LC and favourable toxicity profile.
非小细胞肺癌是最常见的肺部恶性肿瘤，75岁及以上患者的病例占比超过40%。这些患者中的许多人因合并症而无法进行手术，限制了治疗选择。立体定向体部放疗（SBRT）提供了一种治愈性替代方案，其局部控制（LC）率与手术相似，且毒性可控。本回顾性分析旨在研究MRI引导下的SBRT（MRIgSBRT）对老年肺癌患者的疗效和安全性。
回顾性收集了2017年至2023年在我院接受治疗的年龄≥75岁患者的数据。使用Kaplan-Meier方法估计局部无复发生存期（LRFS）、无进展生存期和总生存期（OS）的生存曲线。使用不良事件通用术语标准（CTCAE第5.0版）量表评估毒性。
该研究纳入了38例患者，共45个肺部病灶，中位年龄为82岁（范围75 - 87岁）。中位总放疗剂量为62.5 Gy（范围24 - 75 Gy），分5次给予（范围3 - 8次）。中位随访时间为16.9个月（范围0.97 - 66.7个月）。1年、2年和3年的OS率分别为98%、96%和80%，而1年、2年和3年的LRFS为97.5%。分别有6例患者（15.78%）和1例患者（2.63%）发生了晚期1级放射性肺炎和2级呼吸困难。
MRIgSBRT对于年龄≥75岁、合并症、身体虚弱以及存在限制其体能状态和侵入性治疗资格的危险因素的患者是一种有效的治疗选择，具有良好的局部控制效果和有利的毒性特征。
