Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non-Small Cell Lung Cancer: Long-Term Clinical Outcomes.

IF 6.4 1区 医学 Q1 ONCOLOGY
Vivian S Tan, Rohann J M Correa, Timothy K Nguyen, Alexander V Louie, Richard A Malthaner, Dalilah Fortin, George B Rodrigues, Brian P Yaremko, Joanna M Laba, Keith Kwan, Stewart Gaede, Ting Lee, Aaron D Ward, Andrew Warner, Richard I Inculet, David A Palma
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Abstract

Purpose: For early-stage non-small cell lung cancer, surgery is the preferred approach in operable patients, whereas SABR is preferred for patients who are medically inoperable. The combination of neoadjuvant SABR followed by surgery was tested in the Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non-Small Cell Lung Cancer (MISSILE) phase 2 trial. We report long-term outcomes beyond 5 years of follow-up.

Methods and materials: Patients diagnosed with T1-2N0M0 non-small cell lung cancer with good performance status and adequate lung function were enrolled. Patients underwent neoadjuvant SABR followed by lobectomy/wedge resection. Forty enrolled patients received SABR, of which 36 patients proceeded to surgery.

Results: The pathologic and major complete response rates were 60% and 63%, respectively. Median follow-up was 6.6 years following surgery. Five-year overall, disease-free, and cancer-specific survival were 66.7% (95% CI, 48.8%-79.5%), 58.3% (95% CI, 40.7%-72.4%), and 76.4% (95% CI, 58.2%-87.4%), respectively. Five-year local, regional, and distant control were 93.5% (95% CI, 76.3%-98.4%), 80.1% (95% CI, 62.7%-90.0%), and 82.4% (95% CI, 64.9%-91.7%), respectively. After SABR and surgery, 16.7% (n = 6) of patients experienced related grade ≥3 adverse events, and there were no grade 5 events.

Conclusions: The combined approach of SABR and surgery was safe and demonstrated reasonable long-term clinical outcomes, but similar to surgery alone.

衡量立体定向消融放疗加手术治疗早期非小细胞肺癌(MISSILE)的综合疗效:长期临床结果。
导言:对于早期非小细胞肺癌(NSCLC),可手术患者首选手术治疗,而无法手术的患者则首选立体定向消融放疗(SABR)。在 MISSILE II 期试验中,对新辅助 SABR 后手术的组合进行了测试。我们报告了超过 5 年的长期随访结果:方法:我们招募了确诊为T1-2N0M0 NSCLC且表现良好、肺功能正常的患者。患者接受新辅助SABR治疗,然后进行肺叶切除术/边缘切除术。40名患者接受了SABR治疗,其中36名患者接受了手术治疗:病理和主要完全缓解率分别为60%和63%。手术后的中位随访时间为 6.6 年。五年总生存率、无病生存率和癌症特异性生存率分别为66.7%(95% CI:48.8-79.5)、58.3%(95% CI:40.7-72.4)和76.4%(95% CI:58.2-87.4)。五年的局部、区域和远处控制率分别为 93.5%(95% CI:76.3-98.4)、80.1%(95% CI:62.7-90.0)和 82.4%(95% CI:64.9-91.7)。SABR和手术后,16.7%(n=6)的患者出现了相关的≥3级不良事件,没有出现5级事件:结论:SABR和手术的联合治疗方法是安全的,并显示出合理的长期临床疗效,但与单独手术相似。
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来源期刊
CiteScore
11.00
自引率
7.10%
发文量
2538
审稿时长
6.6 weeks
期刊介绍: International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field. This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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