Evaluation of 192Ir-Based Hypofractionated Stereotactic Ablative Brachytherapy as A Neoadjuvant Treatment for Operable Peripheral Non-small Cell Lung Cancer
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摘要:目的
评价模板辅助192铱源大分割立体后装放射消融术（SABT）在可手术周围型非小细胞肺癌新辅助治疗中的临床效果。
方法收集经病理证实的可手术周围型非小细胞肺癌初治患者，给予模板辅助SABT（30 Gy/1 F），并计划在SABT术后4~6周进行外科手术切除肿瘤。记录所有患者SABT围手术期的不良反应，并分别于治疗前、外科手术前行正电子发射断层扫描（PET/CT）和动态灌注CT（DCECT）扫描，通过比较肿瘤区体积（VGTV）、最大标准摄取值（SUVmax）、肿瘤血容量（TBV）和肿瘤血流量（TBF）来评价新辅助治疗效果。
结果所有患者在模板辅助SABT围手术期未出现严重并发症；4~6周后新辅助治疗效果评价指标明显下降（VGTV（P < 0.001）、SUVmax（P < 0.001）、TBV（P < 0.001）和TBF（P=0.009））。
结论对于可手术周围型非小细胞肺癌，模板辅助SABT新辅助治疗疗效明显，各评价指标明显下降，同时未观察到严重的不良反应。
Abstract:ObjectiveTo evaluate the safety, feasibility and efficacy of template-assisted 192Ir-based hypofractionated stereotactic ablative brachytherapy (SABT) combined with surgery for peripheral non-small cell lung cancer (NSCLC) patients.
MethodsWe enrolled the patients who were pathologically confirmed as operable peripheral NSCLC. The patients underwent template-assisted SABT (30 Gy delivered in one fraction) and were scheduled for tumor resection 4-6 weeks after SABT. The perioperative adverse reactions of SABT were recorded to evaluate the safety and feasibility of SABT as a neoadjuvant therapy. Imaging with 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) and dynamic contrast-enhanced computed tomography (DCECT) were scheduled before SABT and surgery to evaluate the efficacy of SABT by comparing the gross tumor volume, maximum standardized uptake value, tumor blood volume and tumor blood flow.
ResultsAll patients did not experience any serious adverse event. After 4-6 weeks, the indicators for the efficacy of neoadjuvant therapy significantly decreased in all patients: gross tumor volume (P < 0.001), maximum standardized uptake value (P < 0.001), tumor blood volume (P < 0.001) and tumor blood flow (P=0.009).
ConclusionThe efficacy of template-assisted SABT as a neoadjuvant therapy is significant in operable peripheral NSCLC patients, without any serious adverse reaction.
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Key words:
- Brachytherapy /
- Neoadjuvant /
- Non-small cell lung cancer /
- Safety /
- Efficacy
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作者贡献石翔翔: 采集数据结果并起草论文; 庞皓文、孙小杨、任培蓉: 协助完善数据及后装放疗计划的设计、制作和实施; 吴敬波: 审核后装放疗计划; 林盛: 试验项目管理工作并指导论文写作
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图 1 患者在SBAT新辅助治疗前后肺部原发灶的影像学对比
Figure 1 Patterns of radiologic response to neoadjuvant therapy with SABT
表 1 接受SABT新辅助治疗入组患者的一般情况
Table 1 Baseline characteristics of patients who underwent neoadjuvant SABT
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表 3 GTV相关参数在SABT新辅助治疗前后的变化(x±s)
Table 3 VGTV, SUVmax, TBF and TBV before and after SABT (x±s)
下载: 导出CSV
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