Outcomes Following Stereotactic Body Radiotherapy with Intensity-Modulated Therapy versus Three-Dimensional Conformal Radiotherapy in Early Stage Non-Small Cell Lung Cancer.
Michael Mix, Sean Tanny, Tamara Nsouli, Ryan Alden, Rishabh Chaudhari, Russell Kincaid, Paula F Rosenbaum, Jeffrey A Bogart, Paul Aridgides
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引用次数: 3
Abstract
Introduction: The treatment techniques used for stereotactic body radiation therapy (SBRT) for early-stage lung cancer continue to evolve. In this study, clinical outcomes following SBRT were evaluated according to the use of either 3D conformal radiotherapy (3DCRT) or intensity-modulated radiation therapy (IMRT).
Patients and methods: Patients with stage I NSCLC who received SBRT from 2007 to 2015 were retrospectively reviewed. Disease control and survival were assessed using Kaplan-Meier estimates. Dosimetric analyses for target dose heterogeneity and coverage were performed.
Results: A total of 297 patients with 351 lesions were included. 3DCRT was used in 52% and IMRT in 48%. IMRT was utilized at a higher rate in more recent years. The most common regimens were 48 Gy in 4 fractions and 54-60 Gy in 3 fractions. With a median follow up of 22.7 months, there were 17 local failures for a crude relapse rate of 5.7%. Local failure did not differ in patients treated with 3DCRT and IMRT (4.9% vs 6.5%, p=0.573). Mean dose to gross tumor volume (GTV) as a percent of prescription dose was higher with 3DCRT compared with IMRT (107.7% vs 103.6%, p < 0.0001). Tumor stage, histology, and SBRT regimen did not correlate with local tumor control. Overall survival for the entire population approximated 72% at 2 years. Treatment was well tolerated with 6 documented grade 3+ events.
Conclusion: In this single-institution cohort of SBRT for early-stage NSCLC, there was no discernible difference in clinical outcomes between those treated with 3DCRT and IMRT.
用于早期肺癌立体定向放射治疗(SBRT)的治疗技术在不断发展。在这项研究中,根据使用3D适形放疗(3DCRT)或调强放疗(IMRT)来评估SBRT后的临床结果。患者和方法:回顾性分析2007 - 2015年接受SBRT治疗的I期NSCLC患者。采用Kaplan-Meier估计法评估疾病控制和生存率。对靶剂量的异质性和覆盖率进行了剂量学分析。结果:共纳入297例患者,351个病灶。3DCRT占52%,IMRT占48%。近年来,IMRT的使用率较高。最常见的治疗方案是48 Gy分4次,54-60 Gy分3次。中位随访22.7个月,局部失败17例,粗复发率5.7%。3DCRT和IMRT治疗的患者局部失败无差异(4.9% vs 6.5%, p=0.573)。3DCRT的平均总肿瘤体积(GTV)占处方剂量的百分比高于IMRT (107.7% vs 103.6%, p < 0.0001)。肿瘤分期、组织学和SBRT治疗方案与局部肿瘤控制无关。整个人群2年的总生存率约为72%。治疗耐受性良好,有6例3+级事件记录。结论:在SBRT治疗早期NSCLC的单机构队列中,3DCRT和IMRT治疗的临床结果没有明显差异。