中心位置医学上不能手术的早期非小细胞肺癌（T1-T3N0M0）的立体定向体放射治疗(SBRT)−扩展HILUS研究的亚组分析

IF 4.5 2区医学 Q1 ONCOLOGY

Lung Cancer Pub Date : 2025-03-31 DOI:10.1016/j.lungcan.2025.108527

Sara Lindberg , Vitali Grozman , Kristin Karlsson , Eva Onjukka , Elias Lindbäck , Joanna Östling Palme , Karam Al Jirf , Ingmar Lax , Peter Wersäll , Gitte Fredberg Persson , Mirjana Josipovic , Azza Ahmed Khalil , Ditte Sloth Møller , Lone Hoffmann , Marianne Marquard Knap , Jan Nyman , Ninni Drugge , Per Bergström , Jörgen Olofsson , Lotte Victoria Rogg , Karin Lindberg

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引用次数: 0

摘要

中心位置的肿瘤靠近支气管的早期非小细胞肺癌（ES NSCLC）有可能通过立体定向全身放射治疗（SBRT）治愈。为了评估治疗的临床获益，需要评估高级别毒性风险和治疗效果。材料和方法从扩大的HILUS队列中，72例T1-T3N0M0 NSCLC患者被纳入当前的分析。对于距离气管支气管树2厘米以内的肿瘤，所有患者都接受了8至56 Gy的SBRT治疗。主要终点是无进展生存期（PFS），次要终点包括失败模式、局部控制（LC）、肺癌特异性生存期（LCSS）、总生存期（OS）和毒性。采用Kaplan-Meier法和Cox回归分析。结果该队列的中位年龄为73岁，所有患者在SBRT前均患有合并症。65%的患者出现T2-T3肿瘤。17例患者在SBRT后复发，远处复发是最常见的复发形式。3年PFS为31% (95% CI 22-44)，主要原因是3年总生存率较短（38% (95% CI 22-44)）。LC和LCSS的三年发生率分别为97% （95% CI 92-100）和76% （95% CI 65-89）。12例患者（17%）出现5级毒性，其中9例为支气管肺出血。结论严重的毒性限制了SBRT治疗中心位置ES型NSCLC患者的临床获益。

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Stereotactic body radiation therapy (SBRT) of centrally located medically inoperable early-stage non-small cell lung cancer (T1-T3N0M0) − A subgroup analysis of the expanded HILUS study

Introduction

Centrally located early-stage non-small cell lung cancer (ES NSCLC) with tumors close to the bronchi is potentially curable with stereotactic body radiation therapy (SBRT). To evaluate the clinical benefit of the treatment, both the risk of high-grade toxicity as well as the treatment efficacy need to be assessed.

Material and methods

From the expanded HILUS cohorts, 72 patients with T1-T3N0M0 NSCLC were included in the current analysis. All patients had been treated with SBRT in 8 fractions to 56 Gy for a tumor located within 2 cm from the tracheobronchial tree. Primary endpoint was progression free survival (PFS) and secondary endpoints included pattern of failure, local control (LC), lung cancer-specific survival (LCSS), overall survival (OS) and toxicity. The Kaplan-Meier method and Cox regression analysis were used.

Results

The median age of the cohort was 73 years and all patients suffered from comorbidities prior to SBRT. T2-T3 tumors were seen in 65 % of the patients. Seventeen patients relapsed after SBRT and distant recurrence was the most common form of relapse. Three-year PFS was 31 % (95 % CI 22–44) and largely explained by the short overall survival (38 % (95 % CI 22–44) at 3 years). Three-year rates of LC and LCSS were 97 % (95 % CI 92–100) and 76 % (95 % CI 65–89), respectively. Twelve patients (17 %) suffered from grade 5 toxicity, of which 9 were bronchopulmonary bleedings.

Conclusion

The severe toxic profile limits the clinical benefit using SBRT with the investigated approach for patients with centrally located ES NSCLC.

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来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

期刊介绍： Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.