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

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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.

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	Zheng Xiaoli
	Ye Ke
	Sun Yanan
	Fan Chengcheng
	Yang Yang
	Wang Xiaohui
	Liu Yang
	Cheng Chen
	Ge Hong

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

Received: 08 October 2021

Fund:Surface Project of National Natural Science Foundation of China (81773230)

Corresponding Authors: Ge Hong, Email:gehong666@126.com

Cite this article:

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.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20211008-00387 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/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.