Results of multifield conformal radiation therapy of nonsmall-cell lung carcinoma using multileaf collimation beams.

S Bahri, J C Flickinger, A M Kalend, M Deutsch, C P Belani, F C Sciurba, J D Luketich, J S Greenberger
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引用次数: 20

Abstract

A five-field conformal technique with three-dimensional radiation therapy treatment planning (3-DRTP) has been shown to permit better definition of the target volume for lung cancer, while minimizing the normal tissue volume receiving greater than 50% of the target dose. In an initial study to confirm the safety of conventional doses, we used the five-field conformal 3-DRTP technique. We then used the technique in a second study, enhancing the therapeutic index in a series of 42 patients, as well as to evaluate feasibility, survival outcome, and treatment toxicity. Forty-two consecutive patients with nonsmall-cell lung carcinoma (NSCLC) were evaluated during the years 1993-1997. The median age was 60 years (range 34-80). The median radiation therapy (RT) dose to the gross tumor volume was 6,300 cGy (range 5,000-6,840 cGy) delivered over 6 to 6.5 weeks in 180-275 cGy daily fractions, 5 days per week. There were three patients who received a split course treatment of 5,500 cGy in 20 fractions, delivering 275 cGy daily with a 2-week break built into the treatment course after 10 fractions. The stages of disease were II in 2%, IIIA in 40%, IIIB in 42.9%, and recurrent disease in 14.3% of the patients. The mean tumor volume was 324.14 cc (range 88.3-773.7 cc); 57.1% of the patients received combined chemoradiotherapy, while the others were treated with radiation therapy alone. Of the 42 patients, 7 were excluded from the final analysis because of diagnosis of distant metastasis during treatment. Two of the patients had their histology reinterpreted as being other than NSCLC, 2 patients did not complete RT at the time of analysis, and 1 patient voluntarily discontinued treatment because of progressive deterioration. Median follow-up was 11.2 months (range 3-32.5 months). Survival for patients with Stage III disease was 70.2% at 1 year and 51.5% at 2 years, with median survival not yet reached. Local control for the entire series was 23.3+/-11.4% at 2 years. However, for Stage III patients, local control was 50% at 1 year and 30% at 2 years. Patients who received concurrent chemotherapy had significantly improved survival (P = 0.002) and local control (P = 0.004), compared with RT alone. Late esophageal toxicity of > or =Grade 3 occurred in 14.1+/-9.3% of patients (3 of 20) receiving combined chemoradiotherapy, but in none of the 15 patients treated with RT alone. Pulmonary toxicity limited to Grades 1-2 occurred in 6.8% of the patients, and none developed > or =Grade 3 pulmonary toxicity. Patients with locally advanced NSCLC, who commonly have tumor volumes in excess of 200 cc, presenta challenge for adequate dose delivery without significant toxicity. Our five-field conformal 3-DRTP technique, which incorporates treatment planning by dose/volume histogram (DVH) was associated with minimal toxicity and may facilitate dose escalation to the gross tumor.

多叶准直光束多视场适形放射治疗非小细胞肺癌的结果。
三维放射治疗计划(3-DRTP)的五场适形技术已被证明可以更好地定义肺癌的靶体积,同时最大限度地减少正常组织体积,接受超过50%的靶剂量。在确认常规剂量安全性的初步研究中,我们使用了五场适形3-DRTP技术。随后,我们在第二项研究中使用了该技术,提高了42例患者的治疗指数,并评估了可行性、生存结果和治疗毒性。我们在1993-1997年间对42例非小细胞肺癌(NSCLC)患者进行了评估。中位年龄为60岁(34-80岁)。总肿瘤体积的中位放射治疗(RT)剂量为6300 cGy(范围为5000 - 6840 cGy),每日180-275 cGy,每周5天,持续6至6.5周。有3名患者接受了5500 cGy的20次分疗程治疗,每天给予275 cGy, 10次后在疗程中休息2周。疾病分期为II期占2%,IIIA期占40%,IIIB期占42.9%,复发性疾病占14.3%。平均肿瘤体积为324.14 cc (88.3-773.7 cc);57.1%的患者接受联合放化疗,其余患者单独接受放化疗。在42例患者中,7例因治疗过程中诊断远处转移而被排除在最终分析之外。2例患者的组织学被重新解释为非NSCLC, 2例患者在分析时未完成RT, 1例患者因进行性恶化而自愿停止治疗。中位随访时间为11.2个月(3-32.5个月)。III期疾病患者的1年生存率为70.2%,2年生存率为51.5%,中位生存期尚未达到。整个系列的局部控制率为23.3+/-11.4%。然而,对于III期患者,1年和2年的局部控制率分别为50%和30%。与单独放疗相比,同时接受化疗的患者生存率(P = 0.002)和局部对照(P = 0.004)均有显著提高。在接受联合放化疗的患者中,14.1+/-9.3%(20例中有3例)发生了> 3级或= 3级的晚期食管毒性,但在单独接受放疗的15例患者中没有发生。6.8%的患者发生1-2级肺毒性,没有患者发展为>或= 3级肺毒性。局部晚期非小细胞肺癌患者的肿瘤体积通常超过200cc,这对在没有明显毒性的情况下给予足够的剂量是一个挑战。我们的五场适形3-DRTP技术结合了剂量/体积直方图(DVH)的治疗计划,与最小的毒性相关,并可能促进剂量增加到总体肿瘤。
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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