国产碳离子系统治疗54例肺癌临床分析

Clinical analysis of 54 cases of lung cancer treated by domestic carbon ion system

目的探讨碳离子治疗早期(Ⅰ期)和局部晚期(Ⅱ-Ⅲ期)肺癌的治疗预后情况并分析预后影响因素。方法回顾性分析2020年3月至2022年9月在甘肃省武威肿瘤医院重离子中心完成碳离子治疗、随访的54例肺癌患者的一般临床资料、治疗、不良反应以及生存情况等资料。采用Kaplan-Meier法绘制生存曲线,log-rank法进行差异检验,并采用logistic回归对影响患者预后的因素进行分析。结果根据入选、排除标准共纳入54例患者,其中早期肺癌患者10例,局部晚期肺癌患者44例。10例早期肺癌患者中位随访时间为11.0(6.75,17.25)个月,照射中位剂量为60 Gy[相对生物效应(RBE)],至末次随访,3例完全缓解,3例部分缓解;4例病情稳定,没有出现病情进展的患者,1、2年局部控制率(LCR)、无进展生存(PFS)率、总生存(OS)率均为100%。治疗及随访期间,出现2例1级放射性肺炎,1例2级放射性肺炎、1例胸壁损伤(胸壁疼痛),没有2级以上的不良反应。44例局部晚期患者中位随访时间为12.5(4.25,21.75)个月,照射中位剂量为72 Gy(RBE),治疗过程中32例(73%)患者采用同步放化疗,放疗后有20例(45%)患者接受了序贯化疗、14例(32%)患者接受了免疫维持治疗、3例(7%)患者病情进展采用了靶向药物治疗。至末次随访,3例(7%)完全缓解,17例(39%)部分缓解,19例(43%)病情稳定,5例(11%)病情进展。1、2年LCR分别为96.0%、87.3%;1、2年PFS率分别为90.9%、84.1%;1、2年OS率分别为93.2%、86.4%;患者中位OS、PFS尚未达到。多因素分析显示放疗后维持治疗(P=0.027)、临床靶区(CTV)照射体积(P=0.028)是影响PFS的因素;同步放化疗(P=0.042)、放疗后维持治疗(P=0.020)是影响OS的因素;肿瘤靶体积(GTV)≥215 ml(P=0.068)可能是发生2级以上放射性肺炎的独立危险因素。结论碳离子系统治疗早期和局部晚期肺癌临床效果确切、不良反应可控,联合同步化疗以及治疗后进一步维持治疗明显改善患者预后,且不良反应没有显著增加。

Objective To evaluate clinical prognosis and prognostic factors of patients with early stage(Ⅰstage)and locally advanced(Ⅱ/Ⅲstage)lung cancer treated with carbon ion radiotherapy(CIRT).Methods Clinical data,treatment,adverse reactions,survival and so on of 54 lung cancer patients who received CIRT and follow-up in the Heavy Ion Center of Wuwei Cancer Hospital of Gansu Province from March 2020 to September 2022 were retrospectively analyzed.The survival curve was plotted using Kaplan-Meier method.Difference tests were performed using log-rank test.Logistic regression analysis was used to identify prognostic factors.Results According to inclusion and exclusion criteria,54 patients were enrolled in the study,including 10 patients with early stage lung cancer and 44 patients with locally advanced lung cancer.The median follow-up time for 10 patients with early stage lung cancer was 11.0(6.75,17.25)months,and the median dose of irradiation was 60 Gy[relative biological effect(RBE)].Upon the last follow-up,3 patients had complete response(CR)and 3 patients had partial response(PR).Four patients had stable disease(SD)and no progressive disease(PD).The 1-year and 2-year local control rates(LCR),progression-free survival(PFS)rates and overall survival(OS)rates were 100%.During treatment and follow-up,2 patients developed grade 1 radiation pneumonia,1 case of grade 2 radiation pneumonia,1 case of chest wall injury(chest wall pain),and there were no adverse reactions greater than grade 2.The median follow-up time of 44 patients with locally advanced stage was 12.5(4.25,21.75)months,and the median irradiation dose was 72 Gy(RBE).Thirty-two(73%)patients received concurrent chemotherapy during treatment,20(45%)patients received sequential chemotherapy after treatment,14(32%)patients received immune maintenance therapy and 3(7%)patients obtained PD and received targeted drugs.Upon the last follow-up,3(7%)patients had CR,17(39%)patients had PR,19(43%)patients obtained SD,and 5(11%)patients had PD.The 1-year and 2-year LCR were 96.0%and 87.3%,90.9%and 84.1%for the 1-year and 2-year PFS rates,and 93.2%and 86.4%for the 1-year and 2-year OS rates,respectively.The median OS and PFS of patients were not reached.Multivariate logistic regression analysis showed that maintenance therapy after radiotherapy(P=0.027)and clinical target volume(CTV)irradiation volume(P=0.028)were the factors affecting PFS.Simultaneous chemoradiotherapy(P=0.042)and maintenance therapy after radiotherapy(P=0.020)were the factors affecting OS.And gross tumor volume(GTV)≥215 ml(P=0.068)might be an independent risk factor for grade 2 and above radiation pneumonia.Conclusions The domestic carbon ion system has definite clinical effect and controllable toxic and side effects in the treatment of early stage and locally advanced lung cancer.The combination of synchronous chemotherapy and further maintenance treatment can significantly improve clinical prognosis of patients without significantly increasing the risk of toxic and side effects.