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Response Evaluation after Stereotactic Ablative Radiotherapy for Lung Cancer

초기 폐암의 정위방사선치료후 반응평가 분석

  • Choi, Ji Hoon (Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine)
  • 최지훈 (고신대학교 복음병원 방사선종양학과, 고신대학교 의과대학 방사선종양학교실)
  • Received : 2015.10.20
  • Accepted : 2015.11.09
  • Published : 2015.12.31

Abstract

We retrospectively reviewed lung cancer patients who were treated with stereotactic ablative radiotherapy (SABR). We investigated the value of response evaluation after treatment by measuring the volume change of tumors on serial chest computed tomography (CT) examinations. The study included 11 consecutive patients with early-stage (T1-T2aN0M0) non-small cell lung cancer (NSCLC) who were treated with SABR. The median dose of SABR was 6,000 cGy (range 5,000~6,400) in five fractions. Sequential follow-up was performed with chest CT scans. Median follow-up time was 28 months. Radiologic measurement was performed on 51 CT scans with a median of 3 CT scans per patient. The median time to partial response ($T_{PR}$) was 3 months and median time to complete remission ($T_{CR}$) was 5 months. Overall response rate was 90.9% (10/11). Five patients had complete remission, five had partial response, and one patient developed progressive disease without response. On follow-up, three patients (27.2%) developed progressive disease after treatment. We evaluated the the response after SABR. Our data also showed the timing of response after SABR.

정위 방사선치료를 받은 폐암환자에서 결과를 후향적으로 분석하고자 하였다. 연속된 흉부 컴퓨터단층촬영(CT)의 종양의 크기변화 분석을 통해 치료 반응 평가를 조사하였다. 11명의 초기 비소세포폐암환자를 대상으로 정위 방사선치료 선량의 중앙값은 6,000 cGy이고 분할 조사 회수의 중앙값은 5회였다. 경과 관찰기간의 중앙값은 28개월로 치료후 종양의 크기 변화는 총 51회의 CT를 통해 분석하였고, 각 환자당 중앙값 3회의 CT 촬영이 시행되었다. 본 연구에서 치료의 총 반응률은 90.9%로 5명의 환자에서 완전관해와 5명에서 부분관해가 관찰되었다. 부분관해와 완전관해까지의 기간의 중앙 값은 각각 3개월과 5개월이었다. 경과관찰에서 3명의 환자가 병의 진행양상을 나타내었다. 본 연구에서 초기 폐암의 정위방사선치료후 CT 분석을 통해 반응 평가와 함께 치료 반응 시점을 확인할 수 있었다.

Keywords

References

  1. Shimkin MB, Connelly RR, Marcus SC, et al: Pneumonectomy and lobectomy in bronchogenic carcinoma. A comparison of end results of the Overholt and Ochsner clinics. J Thorac Cardiovasc Surg 44:503-19, 1962
  2. Onishi H, Araki T, Shirato H, et al: Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer 101:1623-31, 2004 https://doi.org/10.1002/cncr.20539
  3. Lagerwaard FJ, Haasbeek CJ, Smit EF, et al: Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 70:685-92, 2008 https://doi.org/10.1016/j.ijrobp.2007.10.053
  4. Chang JY, Liu H, Balter P, et al: Clinical outcome and predictors of survival and pneumonitis after stereotactic ablative radiotherapy for stage I non-small cell lung cancer. Radiat Oncol 7:152, 2012 https://doi.org/10.1186/1748-717X-7-152
  5. Crabtree TD, Denlinger CE, Meyers BF, et al: Stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 140: 377-86, 2010 https://doi.org/10.1016/j.jtcvs.2009.12.054
  6. Iyengar P, Westover K, Timmerman RD: Stereotactic ablative radiotherapy (SABR) for non-small cell lung cancer. Semin Respir Crit Care Med 34:845-54, 2013 https://doi.org/10.1055/s-0033-1358554
  7. Lagerwaard FJ, Verstegen NE, Haasbeek CJ, et al: Outcomes of stereotactic ablative radiotherapy in patients with potentially operable stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys 83:348-53, 2012 https://doi.org/10.1016/j.ijrobp.2011.06.2003
  8. Onishi H, Shirato H, Nagata Y, et al: Stereotactic body radiotherapy (SBRT) for operable stage I non-small-cell lung cancer: can SBRT be comparable to surgery? Int J Radiat Oncol Biol Phys 81:1352-8, 2011 https://doi.org/10.1016/j.ijrobp.2009.07.1751
  9. Palma D, Visser O, Lagerwaard FJ, et al: Treatment of stage I NSCLC in elderly patients: a population-based matched-pair comparison of stereotactic radiotherapy versus surgery. Radiother Oncol 101:240-4, 2011 https://doi.org/10.1016/j.radonc.2011.06.029
  10. Shirvani SM, Jiang J, Chang JY, et al: Lobectomy, sublobar resection, and stereotactic ablative radiotherapy for early-stage non-small cell lung cancers in the elderly. JAMA Surg 149:1244-53, 2014 https://doi.org/10.1001/jamasurg.2014.556
  11. Taremi M, Hope A, Dahele M, et al: Stereotactic body radiotherapy for medically inoperable lung cancer: prospective, single-center study of 108 consecutive patients. Int J Radiat Oncol Biol Phys 82:967-73, 2012 https://doi.org/10.1016/j.ijrobp.2010.12.039
  12. Timmerman R, Paulus R, Galvin J, et al: Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 303:1070-6, 2010 https://doi.org/10.1001/jama.2010.261
  13. Verstegen NE, Oosterhuis JW, Palma DA, et al: Stage I-II non-small-cell lung cancer treated using either stereotactic ablative radiotherapy (SABR) or lobectomy by video-assisted thoracoscopic surgery (VATS): outcomes of a propensity scorematched analysis. Ann Oncol 24:1543-8, 2013 https://doi.org/10.1093/annonc/mdt026
  14. 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 timetrend analysis. J Clin Oncol 28:5153-9, 2010 https://doi.org/10.1200/JCO.2010.30.0731
  15. De Rose F, Cozzi L, Navarria P, et al: Clinical Outcome of Stereotactic Ablative Body Radiotherapy for Lung Metastatic Lesions in Non-small Cell Lung Cancer Oligometastatic Patients. Clin Oncol (R Coll Radiol), 2015
  16. Chang JY, Senan S, Paul MA, et al: Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-smallcell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 16:630-7, 2015 https://doi.org/10.1016/S1470-2045(15)70168-3
  17. Heal C, Ding W, Lamond J, et al: Definitive Treatment of Early-Stage Non-Small Cell Lung Cancer with Stereotactic Ablative Body Radiotherapy in a Community Cancer Center Setting. Front Oncol 5:146, 2015
  18. Chaudhuri AA, Tang C, Binkley MS, et al: Stereotactic ablative radiotherapy (SABR) for treatment of central and ultra-central lung tumors. Lung Cancer 89:50-6, 2015 https://doi.org/10.1016/j.lungcan.2015.04.014
  19. Shah GD, Kesari S, Xu R, et al: Comparison of linear and volumetric criteria in assessing tumor response in adult highgrade gliomas. Neuro Oncol 8:38-46, 2006 https://doi.org/10.1215/S1522851705000529
  20. Force J, Rajan A, Dombi E, et al: Assessment of objective responses using volumetric evaluation in advanced thymic malignancies and metastatic non-small cell lung cancer. J Thorac Oncol 6:1267-73, 2011 https://doi.org/10.1097/JTO.0b013e3182199be2