Toxicity in patients receiving radiotherapy for ultracentral stage I non-small cell lung cancer: A secondary analysis of the LUSTRE randomized trial

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2024-10-29 DOI:10.1016/j.radonc.2024.110605

Che Hsuan David Wu , Marcin Wierzbicki , Sameer Parpia , Vijayananda Kundapur , Alexis Bujold , Edith Filion , Harold Lau , Sergio Faria , Naseer Ahmed , Nelson Leong , Gordon Okawara , Khalid Hirmiz , Timothy Owen , Alexander V Louie , James R Wright , Timothy J Whelan , Anand Swaminath

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Abstract

Background and Purpose

Stereotactic body radiotherapy (SBRT) carries potentially higher risks for ultracentral (UC) NSCLC with limited prospective data to guide decision making. We conducted a secondary analysis from a randomized trial of SBRT and conventionally hypofractionated radiation (CRT) to assess these risks.

Materials and Methods

Patients (n = 233) with medically inoperable stage I NSCLC were recruited from 2014 to 2020. Patients with UC targets directly overlapping the proximal bronchial tree (PBT) were identified. The primary objective was the occurrence of related grade 3–5 toxicity > 3 months following radiation. Secondary endpoints included local control, survival, and evaluation of PBT dose and its association with late toxicity.

Results

Thirty UC tumors were identified (23 − SBRT 60 Gy/8 fractions, 7 − CRT 60 Gy/15 fractions). Median age was 72 years, and median tumor size was 2.8 cm. Most patients (67 %) had histologically confirmed NSCLC. At a median follow-up of 2.9 years, 3 and 1 patients developed grade 3 and 5 toxicity respectively (all SBRT). 3-year local control was 85 %. Mean PBT dose (converted to 2 Gy dose equivalents) was higher in patients with grade ≥ 3 toxicity, particularly for 4 cc (105.5 vs 51.8 Gy, p = 0.0004), 5 cc (84 vs 46.1 Gy, p = 0.003), and volumetric doses (V65 – V100Gy). The patient with grade 5 toxicity had the highest 5 cc dose (117 Gy), V90Gy (8.2 cc), and V100Gy (7 cc).

Conclusions

SBRT for UC NSCLC provides good local control but carries a high rate of late grade 3–5 toxicity. An apparent association between toxicity and PBT volumetric dose was observed, which should be considered if SBRT is offered.

查看原文本刊更多论文

超中央型I期非小细胞肺癌放疗患者的毒性：LUSTRE随机试验的二次分析。

背景和目的：立体定向体放射治疗（SBRT）对超中央型（UC）NSCLC具有潜在的较高风险，但用于指导决策的前瞻性数据有限。我们对SBRT和传统低分次放射治疗（CRT）的随机试验进行了二次分析，以评估这些风险：2014年至2020年，我们招募了无法手术的I期NSCLC患者（n = 233）。确定了UC靶点与近端支气管树（PBT）直接重叠的患者。首要目标是放疗后3个月内出现3-5级毒性反应。次要终点包括局部控制、生存、PBT剂量评估及其与晚期毒性的关系：共确定了 30 例 UC 肿瘤（23 例 - SBRT 60 Gy/8 分次，7 例 - CRT 60 Gy/15 分次）。中位年龄为 72 岁，中位肿瘤大小为 2.8 厘米。大多数患者（67%）经组织学确诊为 NSCLC。中位随访 2.9 年，分别有 3 名和 1 名患者出现 3 级和 5 级毒性（均为 SBRT）。3年局部控制率为85%。毒性≥3级患者的平均PBT剂量（换算成2 Gy剂量当量）较高，尤其是4 cc（105.5 vs 51.8 Gy，p = 0.0004）、5 cc（84 vs 46.1 Gy，p = 0.003）和容积剂量（V65 - V100Gy）。5级毒性患者的5cc剂量（117Gy）、V90Gy（8.2cc）和V100Gy（7cc）最高：结论：SBRT 治疗 UC NSCLC 具有良好的局部控制效果，但后期 3-5 级毒性发生率较高。据观察，毒性与PBT容积剂量之间存在明显关联，如果提供SBRT治疗，应考虑到这一点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.