|本期目录/Table of Contents|

立体定向放疗联合化疗治疗中央型局部晚期非小细胞肺癌的疗效分析

《现代肿瘤医学》[ISSN:1672-4992/CN:61-1415/R]

期数:
2022年16期
页码:
2942-2947
栏目:
论著(胸部肿瘤)
出版日期:
2022-07-12

文章信息/Info

Title:
Efficacy of stereotactic body radiotherapy combined with chemotherapy in the treatment of central locally advanced non-small cell lung cancer
作者:
贾 臻张火俊曹洋森顾 蕾沈钰新清水汪方 芳居小萍
海军军医大学附属长海医院放疗科,上海 200433
Author(s):
JIA ZhenZHANG HuojunCAO YangsenGU LeiSHEN YuxinQING ShuiwangFANG FangJU Xiaoping
Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China.
关键词:
局部晚期非小细胞肺癌中央型立体定向放疗有效性不良反应
Keywords:
locally advanced non-small cell lung cancercentralSBRTefficacyadverse reaction
分类号:
R734.2
DOI:
10.3969/j.issn.1672-4992.2022.16.015
文献标识码:
A
摘要:
目的:探讨使用射波刀行立体定向放疗(stereotactic body radiotherapy,SBRT)联合化疗治疗中央型局部晚期非小细胞肺癌(locally advanced non-small cell lung cancer,LA-NSCLC)的疗效和不良反应,评估射波刀的安全性和有效性,并进一步探索最佳的联合治疗方案。方法:回顾性分析了从2013年1月至2018年12月在我科接受射波刀联合化疗的中央型LA-NSCLC患者的临床病理特征,统计分析采用Kaplan-Meier检验和Cox多元回归模型。结果:共有59例患者纳入本研究,患者3年总生存率(overall survival,OS)、局部控制率(local control,LC)分别为25.4%和20.3%。与BED≤80 Gy组相比,BED>80 Gy组患者LC明显更好(P=0.008)且OS有延长的趋势(P=0.083)。≥3级放疗相关不良反应的发生率为13.6%。结论:射波刀联合化疗治疗中央型LA-NSCLC有效且不良反应可耐受。
Abstract:
Objective:To investigate the efficacy and adverse reactions of Cyberknife stereotactic body radiotherapy combined with chemotherapy in the treatment of central locally advanced non-small cell lung cancer.Methods:We retrospectively reviewed the clinicopathological characteristics of patients with central LA-NSCLC who received Cyberknife combined with chemotherapy in our department from January 2013 to December 2018.Kaplan-Meier test and Cox multivariate regression model wereused for analysis.Results:A total of 59 patients were included in this study,and the 3-year overall survival (OS),local control (LC) were 25.4%and 20.3%.Compared with patients of BED≤80 Gy group,BED>80 Gy group patients had a statistically significant difference in LC(P=0.008),and they did have a trend towards better OS (P=0.083).The incidence of grade≥3 radiation-related adverse reactions was 13.6%.Conclusion:Our evaluation results indicated that Cyberknife combined with chemotherapy in the treatment of central LA-NSCLC was effective and the adverse reactions can be tolerated.

参考文献/References

[1]SIEGEL RL,MILLER KD,JEMAL A.Cancer statistics,2017[J].CA Cancer J Clin,2017,67(1):7-30.
[2]VAN SCHIL PE,RAMI-PORTA R,ASAMURA H.The 8th TNM edition for lung cancer:a critical analysis[J].Ann Transl Med,2018,6(5):87. [3]CURRAN WJ JR,PAULUS R,LANGER CJ,et al.Sequential vs concurrent chemoradiation for stage III non-small cell lung cancer:randomized phase III trial RTOG 9410[J].J Natl Cancer Inst,2011,103(19):1452-1460.
[4]FOURNEL P,ROBINET G,THOMAS P,et al.Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer:Groupe Lyon-saint-Etienned'Oncologie Thoracique-Groupe Francais de Pneumo-Cancerologie NPC 95-01 study[J].J Clin Oncol,2005,23(25):5910-5917.
[5]HUBER RM,FLENTJE M,SCHMIDT M,et al.Simultaneous chemoradiotherapy compared with radiotherapy alone after induction chemotherapy in inoperable stage IIIA or IIIB non-small-cell lung cancer:study CTRT99/97 by the bronchial carcinoma therapy group[J].J Clin Oncol,2006,24(27):4397-4404.
[6]CHANG JY,SENAN S,PAUL MA,et al.Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer:a pooled analysis of two randomised trials[J].Lancet Oncol,2015,16(6):630-637.
[7]JUNG IH,SONG SY,JUNG J,et al.Clinical outcome of fiducial-less Cyber Knife radiosurgery for stage I non-small cell lung cancer[J].Radiat Oncol J,2015,33(2):89-97.
[8]ROBINSON CG,DEWEES TA,ELNAQAI M,et al.Patterns of failure after stereotactic body radiation therapy or lobar resection for clinical stage I non-small-cell lung cancer[J].J Thorac Oncol,2013,8(2):192-201.
[9]PALMA DA,NGUYEN TK,LOUIE AV,et al.Measuring the integration of stereotactic ablative radiotherapy plus surgery for early-stage non-small cell lung cancer:a phase 2 clinical trial[J].JAMA Oncol,2019,5(5):681-688.
[10]FAKIRIS AJ,MCGARRY RC,YIANNOUTSOS CT,et al.Stereotactic body radiation therapy for early-stage non-small-cell lung carcinoma:four year results of a prospective phase II study[J].Int J Radiat Oncol Biol Phys,2009,75(3):677-682.
[11]SONG SY,CHOI W,SHIN SS,et al.Fractionated stereotactic body radiation therapy for medically inoperable stage I lung cancer adjacent to central large bronchus[J].Lung Cancer,2009,66(1):89-93.
[12]CHANG JY,BEZJAK A,MORNEX F,et al.Stereotactic ablative radiotherapy for centrally located early stage non-small-cell lung cancer:what we have learned[J].J Thorac Oncol,2015,10(4):577-585.
[13]GRIMM J,LACOUTURE T,CROCE R,et al.Dose tolerance limits and dose volume histogram evaluation for stereotactic body radiotherapy[J].J Appl Clin Med Phys,2011,12(2):3368.
[14]EISENHAUER EA,THERASSE P,BOGAERTS J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline (version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[15]CHANG JY,LI QQ,XU QY,et al.Stereotactic ablative radiation therapy for centrally located early stage or isolated parenchymal recurrences of non-small cell lung cancer:how to fly in a "no fly zone"[J].Int J Radiat Oncol Biol Phys,2014,88(5):1120-1128.
[16] BEZJAK A,PAULUS R,GASPAR LE,et al.Safety and efficacy of a five-fraction stereotactic body radiotherapy schedule for centrally located non-small-cell lung cancer:NRG oncology/RTOG 0813 trial[J].J Clin Oncol,2019,37(15):1316-1325.
[17] HANNA N,NEUBAUER M,YIANNOUTSOS C,et al.Phase III study of cisplatin,etoposide,and concurrent chest radiation with or without consolidation docetaxel in patients with inoperable stage III non-small-cell lung cancer:the Hoosier oncology group and US.Oncology[J].J Clin Oncol,2008,26(35):5755-5760.
[18] BRADLEY JD,PAULUS R,KOMAKI R,et al.Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617):a randomised,two-by-two factorial phase 3 study[J].Lancet Oncol,2015,16(2):187-199.
[19] AUPERIN A,LEPECHOUX C,ROLLAND E,et al.Meta-analysis of concomitant versussequential radiochemotherapy in locally advanced non-small-cell lung cancer[J].J Clin Oncol,2010,28:2181-2190.
[20] KIM YJ,KIM SS,SONG SY,et al.Feasibility of stereotactic radiotherapy for lung lesions and conventional radiotherapy for nodal areas in primary lung malignancies[J].Radiat Oncol,2018,13(1):127.
[21] CONG Y,XUAN L,SUN B,et al.Retrospective comparison of stereotactic body radiotherapy versus intensity-modulated radiotherapy for stage III ultra-central squamous non-small-cell lung cancer[J].Future Oncol,2019,15(16):1855-1862.
[22] CONG Y,SUN B,WANG J,et al.Outcomes and toxicity of stereotactic body radiation therapy for advanced stage ultra-central non-small cell lung cancer[J].Thorac Cancer,2019,10(7):1567-1575.
[23] CHI A,NGUYEN NP,KOMAKI R.The potential role of respiratory motion management and image guidance in the reduction of severe toxicities following stereotactic ablative radiation therapy for patients with centrally located early stage non-small cell lung cancer or lung metastases[J].Front Oncol,2014,4:151.
[24] CHANG JY,VERMA V,LI M,et al.Proton beam radiotherapy and concurrent chemotherapy for unresectable stage III non-small cell lung cancer:final results of a phase 2 study[J].JAMA Oncol,2017,3(8):e172032.
[25] BRADLEY JD,MOUGHAN J,GRAHAM MV,et al.A phase I/II radiation dose escalation study with concurrent chemotherapy for patients with inoperable stages I to III non-small-cell lung cancer:phase I results of RTOG 0117[J].Int J Radiat Oncol Biol Phys,2010,77(2):367-372.
[26]SCHILD SE,HILLMAN SL,TAN AD,et al.Long-term results of a trial of concurrent chemotherapy and escalating doses of radiation for unresectable non-small cell lung cancer:NCCTG N0028 (Alliance) [J].J Thorac Oncol,2017,12(4):697-703.
[27] NYMAN J,HALLQVIST A,LUND JA,et al.SPACE-a randomized study of SBRT vs conventional fractionated radiotherapy in medically inoperable stage INSCLC[J].Radiother Oncol,2016,121(1):1-8.
[28]RAKAEE M,BUSUND LT,PAULSEN EE,et al.Prognostic effect of intratumoral neutrophils across histological subtypes of non-small cell lung cancer[J].Oncotarget,2016,7(44):72184-72196.
[29] MUROVIC J,DING V,HAN SS,et al.Impact of cyberknife radiosurgery on overall survival and various parameters of patients with 1-3 versus ≥ 4 brain metastases[J].Cureus,2017,9(10):e1798.
[30] WANG J,KALHOR N,HU J,et al.Pretreatment neutrophil to lymphocyte ratio is associated with poor survival in patients with stage Ⅰ-Ⅲ non-small cell lung cancer[J].PloS One,2016,11(10):e0163397.

备注/Memo

备注/Memo:
-
更新日期/Last Update: 1900-01-01