最新JAMA研究披露，早期的发现提示，一种包括无数高度聚焦及强效放射线的辐射治疗为几乎所有的患者提供了标定的肿瘤控制，减少了与治疗有关的疾病，并可能最终改善患有无法手术的非小细胞性肺癌病人的存活率。
那些患有无法手术的早期肺癌患者通常会接受常规的放射治疗（常常是在20-30次的门诊治疗时给予这些放射治疗）或是在没有特别癌症治疗的情况下对其进行观察。立体定向体部放疗（SBRT）是一种非创伤性的癌症治疗。医生会在1至5次的治疗中应用无数小型、高度聚焦且精准的放射线来向肿瘤标靶发送强效的辐射剂量。
Dr. Timmerman及其同僚所进行的Radiation Therapy Oncology Group (RTOG) 0236试验是第一个在北美开展的多中心、合作性的团组研究，旨在测试SBRT在治疗医学上无法手术的罹患早期非小细胞性肺癌患者的功效。最终的研究人群中包括有55名患者（44人患有T1肿瘤，11人患有T2肿瘤），对其的中间（中点）随访时间为34.4个月。
在该项研究的所有患者中，只有一人经历了纪录到的肿瘤在原发部位的复发或扩展。3年原发肿瘤控制率为97.6%。结合局部及区域性的失败数字，3年肿瘤局部-区域控制率为87.2%。复发中具有播散性成分（即某一癌症在身体的多个地方重新出现）的情况发生在11位病人中。3年播散失败率为22.1%，其中有8位的治疗失败发生在24个月之前。
文章在作者写道：“这一前瞻性研究的主要发现是对原发肿瘤的很高的控制率（3年时为97.6%）。原发性肿瘤控制是治愈肺癌的一个基本要求。RTOG 0236所给予的立体定位体部放疗比以往报告所描述的常规放疗的原发肿瘤控制率要高出一倍以上。”(生物谷Bioon.com)
生物谷推荐原文出处：
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.
