Analysis of failure patterns and survival after SBRT for 147 cases of T1-2N0M0 stage non-small cell lung cancer
Wang Lin1,2, Wang Ruiqi2, Dong Baiqiang3,4, Hu Xiao2, Ma Honglian2, Wang Zhun2, Lai Xiaojing2, Feng Wei2, Lin Xiao2, Jiang Youhua5, Wang Changchun5, Zhao Qiang5, Jiang Haitao6, Li Pu7, Du Xianghui2, Chen Ming3,4, Chen Qixun5, Xu Yujin2
1School of Medicine, Shaoxing University, Shaoxing 312000, China; 2Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China; 3State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; 4United Laboratory of Frontier Radiotherapy Technology of Sun Yat-sen University & Chinese Academy of Sciences Ion Medical Technology Co., Ltd, Guangzhou 510060, China; 5Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China; 6Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China; 7Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China
Abstract：Objective To analyze the failure patterns and survival after stereotactic body radiotherapy (SBRT) in patients with T1-2N0M0 non-small cell lung carcinoma (NSCLC). Methods Clinical data of early-stage NSCLC patients who received SBRT at Zhejiang Cancer Hospital from January 2012 to September 2018 were retrospectively analyzed. The primary observed endpoint was the pattern of disease progression, which was divided into intra-field recurrence, regional lymph node recurrence and distant metastasis. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox's model. Results A total of 147 patients with 156 lesions were included. The median follow-up time was 44.0 months (16.5-95.5 months). A total of 57 patients (38.8%) progressed: 14 patients (24.5%) had recurrence with the 1-, 3-, and 5-year local recurrence rates of 2.0%, 10.9%, and 14.3%, respectively; 36 patients (63.2%) had Distant metastasis with the 1-, 3- and 5-year distant metastasis rates of 12.2%, 22.4% and 28.6%, respectively; and 7 patients (12.3%) had recurrence complicated with distant metastasis. The 3-, 5- and 7-year OS rates were 80.5%, 64.2% and 49.9% for all patients, respectively. The median OS was 78.4 months. The 3-, 5- and 7-year PFS rates were 64.8%,49.5% and 41.5%, with a median PFS of 57.9 months (95%CI: 42.3-73.5 months). Univariate and multivariate analyses showed that biologically equivalent dose and age were the factors affecting the efficacy of SBRT (both P<0.05). Conclusion Distant metastasis is the main failure pattern in patients with T1-2N0M0 NSCLC after SBRT. High-risk population should be selected for further systematic treatment to improve the efficacy.
Wang Lin,Wang Ruiqi,Dong Baiqiang et al. Analysis of failure patterns and survival after SBRT for 147 cases of T1-2N0M0 stage non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2023, 32(8): 683-688.
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2023, Vol. 32 
