早期非小细胞肺癌立体定向消融放射治疗失败模式分析

doi:10.3760/cma.j.cn113030-20211008-00387

摘要
图/表
参考文献(25)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的分析早期非小细胞肺癌(ES-NSCLC)行立体定向消融放射治疗(SABR)后的失败模式及影响因素。方法回顾性分析郑州大学附属肿瘤医院2012—2020年行SABR治疗的ES-NSCLC患者113例。分析其失败模式、复发时间、复发部位及影响复发的因素。采用Kaplan-Meier法计算局部复发率,区域淋巴结复发率及远处转移率。Log-rank检验进行单因素分析,Cox模型行多因素分析。结果中位随访时间58(6~108)个月,全组患者共45例(39.8%)出现复发,中位复发时间36个月。31例患者(27.4%)出现远处转移(DM),单纯DM 24例(21.2%);局部复发(LR)12例(10.6%),单纯LR 7例(6.2%);区域淋巴结复发(RR)11例(9.7%),单纯RR 6例(5.3%);LR+RR 1例(0.9%),LR+DM 3例(2.7%),LR+RR+DM 1例(0.9%),RR+DM 3例(2.7%)。全组患者1、2、3、4、5年复发率分别是5.4%、16.6%、27.5%、44.0%和51.2%。单因素及多因素分析结果提示,EGFR突变是复发率高的影响因素。结论单纯SABR治疗ES-NSCLC患者有较高复发率,远处转移是最常见的失败模式,尤其EGFR突变阳性患者,建议后续辅助治疗。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	郑晓丽
	叶柯
	孙亚楠
	范诚诚
	杨洋
	王晓辉
	刘杨
	程宸
	葛红

关键词 ：立体定向消融放射治疗, 癌,非小细胞肺,早期, 复发模式, 影响因素

Abstract：Objective To analyze the failure patterns and influencing factors of stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer (ES-NSCLC). Methods 113 cases of ES-NSCLC treated with SABR from 2012 to 2020 in our hospital were retrospectively analyzed. The failure patterns, recurrence time, recurrence site and influencing factors were analyzed. Kaplan-Meier method was used to calculate the local recurrence rate, regional lymph node recurrence rate and distant metastasis rate. Univariate analysis was performed by Log-rank test, and multivariate analysis was performed by Cox model. Results The median follow-up time was 58 months (range:6-108 months), and a total of 45 patients (39.8%) recurred. The median recurrence time was 36 months. Distant metastasis (DM) occurred in 31 patients (27.4%) and DM alone in 24 patients (21.2%). Local recurrence (LR) was developed in 12 patients (10.6%) and LR alone in 7(6.2%). Regional lymph node recurrence (RR) occurred in 11 patients (9.7%) and RR alone in 6 patients (5.3%). LR combined with RR was observed in 1 case (0.9%), LR combined with DM in 3(2.7%), LR combined with RR and DM in 1(0.9%), and RR combined with DM in 3(2.7%). The 1-, 2-, 3-, 4-and 5-year recurrence rates were 5.4%, 16.6%, 27.5%, 44% and 51.2%, respectively. Univariate and multivariate analyses suggested that EGFR mutation was an influencing factor of high recurrence rate. Conclusion ES-NSCLC patients treated with SABR alone have a high recurrence rate, and DM is the most common mode of failure. Follow-up consolidation therapy is recommended, especially for EGFR mutation-positive NSCLC patients.

Key words： Stereotactic ablative radiotherapy Carcinoma, non-small-cell lung, early stage Recurrence pattern Risk factor

收稿日期: 2021-10-08

基金资助:国家自然科学基金面上项目(81773230)

通讯作者: 葛红,Email:gehong666@126.com

引用本文:

郑晓丽,叶柯,孙亚楠等. 早期非小细胞肺癌立体定向消融放射治疗失败模式分析[J]. 中华放射肿瘤学杂志, 2022, 31(6): 519-524.

Zheng Xiaoli,Ye Ke,Sun Yanan et al. Analysis of recurrence patterns of early-stage non-small cell lung cancer treated with stereotactic ablative radiotherapy[J]. Chinese Journal of Radiation Oncology, 2022, 31(6): 519-524.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.cn113030-20211008-00387 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2022/V31/I6/519

[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(1):7-30. DOI:10.3322/caac.21590.
[2] Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening[J]. N Engl J Med, 2011, 365(5):395-409. DOI:10.1056/NEJMoa1102873.
[3] Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. lung cancer study group[J]. Ann Thorac Surg, 1995, 60(3):615-622;discussion 622-623. DOI:10.1016/0003-4975(95)00537-u.
[4] Timmerman RD, Paulus R, Pass HI, et al. Stereotactic body radiation therapy for operable early-stage lung cancer:findings from the NRG oncology RTOG 0618 trial[J]. JAMA Oncol, 2018, 4(9):1263-1266. DOI:10.1001/jamaoncol.2018.1251.
[5] Bezjak A, Paulus R, Gaspar LE, et al. Safety and efficacy of a five-fraction stereotactic body radiotherapy schedule for centrally located non-small-cell lung cancer:NRG oncology/RTOG 0813 trial[J]. J Clin Oncol, 2019, 37(15):1316-1325. DOI:10.1200/JCO.18.00622.
[6] Timmerman RD, Hu C, Michalski JM, et al. Long-term results of stereotactic body radiation therapy in medically inoperable stage Ⅰ non-small cell lung cancer[J]. JAMA Oncol, 2018, 4(9):1287-1288. DOI:10.1001/jamaoncol.2018.1258.
[7] Chang JY, Mehran RJ, Feng L, et al. Stereotactic ablative radiotherapy for operable stage Ⅰ non-small-cell lung cancer (revised STARS):long-term results of a single-arm, prospective trial with prespecified comparison to surgery[J]. Lancet Oncol, 2021, 22(10):1448-1457. DOI:10.1016/S1470-2045(21)00401-0.
[8] Palma DA, Nguyen TK, Louie AV, et al. Measuring the integration of stereotactic ablative radiotherapy plus surgery for early-stage non-small cell lung cancer:a phase 2 clinical trial[J]. JAMA Oncol, 2019, 5(5):681-688. DOI:10.1001/jamaoncol.2018.6993.
[9] Senthi S, Lagerwaard FJ, Haasbeek CJ, et al. Patterns of disease recurrence after stereotactic ablative radiotherapy for early stage non-small-cell lung cancer:a retrospective analysis[J]. Lancet Oncol, 2012, 13(8):802-809. DOI:10.1016/S1470-2045(12)70242-5.
[10] Peguret N, Dahele M, Lagerwaard F, et al. A brief report of 10-year trends in the use of stereotactic lung radiotherapy at a dutch academic medical center[J]. J Thorac Oncol, 2014, 9(1):114-117. DOI:10.1097/JTO.0000000000000012.
[11] Palma D, Visser O, Lagerwaard FJ, et al. Impact of introducing stereotactic lung radiotherapy for elderly patients with stage Ⅰ non-small-cell lung cancer:a population-based time-trend analysis[J]. J Clin Oncol, 2010, 28(35):5153-5159. DOI:10.1200/JCO.2010.30.0731.
[12] Videtic GM, Hu C, Singh AK, et al. A randomized phase 2 study comparing 2stereotactic body radiation therapy schedules for medically inoperable patients with stage Ⅰ peripheral non-small cell lung cancer:NRG oncology RTOG 0915(NCCTG n0927)[J]. Int J Radiat Oncol Biol Phys, 2015, 93(4):757-764. DOI:10.1016/j.ijrobp.2015.07.2260.
[13] Onishi H, Shirato H, Nagata Y, et al. Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage Ⅰ non-small cell lung cancer:updated results of 257 patients in a japanese multi-institutional study[J]. J Thorac Oncol, 2007, 2(7 suppl 3):S94-100. DOI:10.1097/JTO.0b013e318074de34.
[14] Spratt DE, Wu AJ, Adeseye V, et al. Recurrence patterns and second primary lung cancers after stereotactic body radiation therapy for early-stage non-small-cell lung cancer:implications for surveillance[J]. Clin Lung Cancer, 2016, 17(3):177-183.e2. DOI:10.1016/j.cllc.2015.09.006.
[15] Giuliani ME, Hope A, Mangona V, et al. Predictors and patterns of regional recurrence following lung SBRT:a report from the Elekta lung research group[J]. Clin Lung Cancer, 2017, 18(2):162-168. DOI:10.1016/j.cllc.2016.10.006.
[16] Wulf J, Haedinger U, Oppitz U, et al. Stereotactic radiotherapy for primary lung cancer and pulmonary metastases:a noninvasive treatment approach in medically inoperable patients[J]. Int J Radiat Oncol Biol Phys, 2004, 60(1):186-196. DOI:10.1016/j.ijrobp.2004.02.060.
[17] Guckenberger M, Wulf J, Mueller G, et al. Dose-response relationship for image-guided stereotactic body radiotherapy of pulmonary tumors:relevance of 4D dose calculation[J]. Int J Radiat Oncol Biol Phys, 2009, 74(1):47-54. DOI:10.1016/j.ijrobp.2008.06.1939.
[18] Chen Y, Guo W, Lu Y, et al. Dose-individualized stereotactic body radiotherapy for T1-3N0 non-small cell lung cancer:long-term results and efficacy of adjuvant chemotherapy[J]. Radiother Oncol, 2008, 88(3):351-358. DOI:10.1016/j.radonc.2008.07.013.
[19] Baumann P, Nyman J, Hoyer M, et al. Outcome in a prospective phase Ⅱ trial of medically inoperable stage Ⅰ non-small-cell lung cancer patients treated with stereotactic body radiotherapy[J]. J Clin Oncol, 2009, 27(20):3290-3296. DOI:10.1200/JCO.2008.21.5681.
[20] Nakamura M, Nishikawa R, Mayahara H, et al. Pattern of recurrence after CyberKnife stereotactic body radiotherapy for peripheral early non-small cell lung cancer[J]. J Thorac Dis, 2019, 11(1):214-221. DOI:10.21037/jtd.2018.12.115.
[21] Lynch TJ, Bell DW, Sordella R, et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib[J]. N Engl J Med, 2004, 350(21):2129-2139. DOI:10.1056/NEJMoa040938.
[22] Kwak EL, Bang YJ, Camidge DR, et al. Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer[J]. N Engl J Med, 2010, 363(18):1693-1703. DOI:10.1056/NEJMoa1006448.
[23] Yagishita S, Horinouchi H, Katsui Taniyama T, et al. Epidermal growth factor receptor mutation is associated with longer local control after definitive chemoradiotherapy in patients with stage Ⅲ nonsquamous non-small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys, 2015, 91(1):140-148. DOI:10.1016/j.ijrobp.2014.08.344.
[24] Wu YL, Tsuboi M, He J, et al. Osimertinib in resected EGFR-mutated non-small-cell lung cancer[J]. N Engl J Med, 2020, 383(18):1711-1723. DOI:10.1056/NEJMoa2027071.
[25] Jumeau R, Bahig H, Filion?, et al. Assessing the need for adjuvant chemotherapy after stereotactic body radiation therapy in early-stage non-small cell lung carcinoma[J]. Cureus, 2016, 8(11):e901. DOI:10.7759/cureus.901.