最新JAMA研究披露,，早期的發(fā)現(xiàn)提示,，一種包括無數(shù)高度聚焦及強效放射線的輻射治療為幾乎所有的患者提供了標(biāo)定的腫瘤控制，減少了與治療有關(guān)的疾病,，并可能最終改善患有無法手術(shù)的非小細胞性肺癌病人的存活率,。
那些患有無法手術(shù)的早期肺癌患者通常會接受常規(guī)的放射治療（常常是在20-30次的門診治療時給予這些放射治療）或是在沒有特別癌癥治療的情況下對其進行觀察。立體定向體部放療（SBRT）是一種非創(chuàng)傷性的癌癥治療,。醫(yī)生會在1至5次的治療中應(yīng)用無數(shù)小型,、高度聚焦且精準(zhǔn)的放射線來向腫瘤標(biāo)靶發(fā)送強效的輻射劑量。
Dr. Timmerman及其同僚所進行的Radiation Therapy Oncology Group (RTOG) 0236試驗是第一個在北美開展的多中心,、合作性的團組研究,，旨在測試SBRT在治療醫(yī)學(xué)上無法手術(shù)的罹患早期非小細胞性肺癌患者的功效。最終的研究人群中包括有55名患者（44人患有T1腫瘤,，11人患有T2腫瘤）,，對其的中間（中點）隨訪時間為34.4個月。
在該項研究的所有患者中,，只有一人經(jīng)歷了紀(jì)錄到的腫瘤在原發(fā)部位的復(fù)發(fā)或擴展,。3年原發(fā)腫瘤控制率為97.6%。結(jié)合局部及區(qū)域性的失敗數(shù)字,，3年腫瘤局部-區(qū)域控制率為87.2%,。復(fù)發(fā)中具有播散性成分（即某一癌癥在身體的多個地方重新出現(xiàn)）的情況發(fā)生在11位病人中。3年播散失敗率為22.1%,，其中有8位的治療失敗發(fā)生在24個月之前,。
文章在作者寫道：“這一前瞻性研究的主要發(fā)現(xiàn)是對原發(fā)腫瘤的很高的控制率（3年時為97.6%）。原發(fā)性腫瘤控制是治愈肺癌的一個基本要求,。RTOG 0236所給予的立體定位體部放療比以往報告所描述的常規(guī)放療的原發(fā)腫瘤控制率要高出一倍以上,。”(生物谷Bioon.com)
生物谷推薦原文出處：
JAMA. 2010;303(11):1070-1076.
Stereotactic Body Radiation Therapy for Inoperable Early Stage Lung Cancer
Robert Timmerman, MD; Rebecca Paulus, BS; James Galvin, PhD; Jeffrey Michalski, MD; William Straube, PhD; Jeffrey Bradley, MD; Achilles Fakiris, MD; Andrea Bezjak, MD; Gregory Videtic, MD; David Johnstone, MD; Jack Fowler, PhD; Elizabeth Gore, MD; Hak Choy, MD
Context Patients with early stage but medically inoperable lung cancer have a poor rate of primary tumor control (30%-40%) and a high rate of mortality (3-year survival, 20%-35%) with current management.
Objective To evaluate the toxicity and efficacy of stereotactic body radiation therapy in a high-risk population of patients with early stage but medically inoperable lung cancer.
Design, Setting, and Patients Phase 2 North American multicenter study of patients aged 18 years or older with biopsy-proven peripheral T1-T2N0M0 non–small cell tumors (measuring <5 cm in diameter) and medical conditions precluding surgical treatment. The prescription dose was 18 Gy per fraction x 3 fractions (54 Gy total) with entire treatment lasting between 1 and 2 weeks. The study opened May 26, 2004, and closed October 13, 2006; data were analyzed through August 31, 2009.
Main Outcome Measures The primary end point was 2-year actuarial primary tumor control; secondary end points were disease-free survival (ie, primary tumor, involved lobe, regional, and disseminated recurrence), treatment-related toxicity, and overall survival.
Results A total of 59 patients accrued, of which 55 were evaluable (44 patients with T1 tumors and 11 patients with T2 tumors) with a median follow-up of 34.4 months (range, 4.8-49.9 months). Only 1 patient had a primary tumor failure; the estimated 3-year primary tumor control rate was 97.6% (95% confidence interval [CI], 84.3%-99.7%). Three patients had recurrence within the involved lobe; the 3-year primary tumor and involved lobe (local) control rate was 90.6% (95% CI, 76.0%-96.5%). Two patients experienced regional failure; the local-regional control rate was 87.2% (95% CI, 71.0%-94.7%). Eleven patients experienced disseminated recurrence; the 3-year rate of disseminated failure was 22.1% (95% CI, 12.3%-37.8%). The rates for disease-free survival and overall survival at 3 years were 48.3% (95% CI, 34.4%-60.8%) and 55.8% (95% CI, 41.6%-67.9%), respectively. The median overall survival was 48.1 months (95% CI, 29.6 months to not reached). Protocol-specified treatment-related grade 3 adverse events were reported in 7 patients (12.7%; 95% CI, 9.6%-15.8%); grade 4 adverse events were reported in 2 patients (3.6%; 95% CI, 2.7%-4.5%). No grade 5 adverse events were reported.
Conclusion Patients with inoperable non–small cell lung cancer who received stereotactic body radiation therapy had a survival rate of 55.8% at 3 years, high rates of local tumor control, and moderate treatment-related morbidity.
