Gollins S W, Burt P A, Barber P V, Stout R
Department of Clinical Oncology, Christie Hospital, Manchester, UK.
Clin Oncol (R Coll Radiol). 1996;8(4):239-46. doi: 10.1016/s0936-6555(05)80659-4.
Between April 1988 and December 1992, 37 patients with small, previously unirradiated, primary non-small cell carcinomas of the bronchus causing symptoms due to endobronchial disease were treated at the Christie Hospital, Manchester, with a single fraction of high dose rate intraluminal radiotherapy (ILT) using the microSelectron-HDR machine. Small primary (SP) lesions were defined as being less than 2 cm in diameter in a direction perpendicular to the central axis of the iridium-192 treatment source. Fifteen patients (41%) were treated to a dose of 15 Gy and 22 patients (59%) to 20 Gy at a distance of 1 cm from the central axis of the source. At 6 weeks following ILT, improvement in symptoms was seen in the following percentages of patients: haemoptysis 96%, pulmonary collapse 69%, cough 55% and dyspnoea 52%. The magnitude of improvement in these symptoms was largely maintained in patients surviving to 4 months and then 12 months post-ILT. Median actuarial survival was 709 days, 2-year survival 49.4% and 5-year survival 14.1%. Overall, there was no significant difference in survival after treatment with 20 Gy compared with 15 Gy at 1 cm. At the close of study, there were four patients still alive without disease recurrence with survivals of 38, 48, 49 and 63 months. All had had biopsy-proven squamous cell carcinomas and all had been treated with 20 Gy at 1 cm. Five patients died from massive haemoptysis as a terminal event at 4, 9, 9, 10 and 11 months post-ILT, well below the median survival for this group of patients. Again, all had been treated with 20 Gy as opposed to 15 Gy at 1 cm. Over the same time period, 287 patients with non-small cell carcinomas of more than 2 cm in diameter (large primary lesions, LP), were treated with a single fraction of ILT only, as their initial treatment. A consistently greater percentage of patients with SP lesions showed an improvement in the symptoms of haemoptysis and pulmonary collapse when compared with patients with LP lesions. Patients with LP lesions demonstrated a decreased actuarial survival when compared with SP lesions, with median survival being 156 days, 2-year survival 3.1% and no survivors beyond 39 months. This study demonstrates that, in patients with small endobronchial carcinomas a single fraction of ILT can give efficient palliation of symptoms and lead to long term disease-free survival, but that a dose of 20 Gy may be at the limit of bronchial radiation tolerance for a single dose technique employing a high dose rate source.
1988年4月至1992年12月期间，曼彻斯特克里斯蒂医院对37例因支气管内疾病出现症状的原发性小的、既往未接受过放疗的支气管非小细胞癌患者，使用microSelectron-HDR机器进行了单次高剂量率腔内放疗（ILT）。小原发（SP）病变定义为在垂直于铱-192治疗源中心轴的方向上直径小于2 cm。15例患者（41%）接受了15 Gy的剂量，22例患者（59%）在距源中心轴1 cm处接受了20 Gy的剂量。ILT后6周，以下百分比的患者症状得到改善：咯血96%、肺不张69%、咳嗽55%和呼吸困难52%。这些症状的改善程度在存活至ILT后4个月及之后12个月的患者中基本保持。精算中位生存期为709天，2年生存率为49.4%，5年生存率为14.1%。总体而言，在距源1 cm处接受20 Gy治疗与接受15 Gy治疗后的生存率无显著差异。在研究结束时，有4例患者仍存活且无疾病复发，生存期分别为38、48、49和63个月。所有患者均经活检证实为鳞状细胞癌，且均在距源1 cm处接受了20 Gy的治疗。5例患者在ILT后4、9、9、10和11个月死于大量咯血这一终末事件，远低于该组患者的中位生存期。同样，所有患者均在距源1 cm处接受了20 Gy而非15 Gy的治疗。在同一时期，287例直径大于2 cm的非小细胞癌患者（大原发病变，LP）仅接受了单次ILT作为初始治疗。与LP病变患者相比，SP病变患者咯血和肺不张症状改善的比例始终更高。与SP病变患者相比，LP病变患者的精算生存期降低，中位生存期为156天，2年生存率为3.1%，39个月后无幸存者。本研究表明，对于支气管内小癌患者，单次ILT可有效缓解症状并实现长期无病生存，但对于采用高剂量率源的单次剂量技术，20 Gy的剂量可能处于支气管放射耐受的极限。
