立体定向放射用于接受克唑替尼治疗的ALK阳性肺癌患者可以安全、持久控制中枢神经系统外孤立部位疾病进展

Stereotactic Radiation Therapy can Safely and Durably Control Sites of Extra-Central Nervous System Oligoprogressive Disease in Anaplastic Lymphoma Kinase-Positive Lung Cancer Patients Receiving Crizotinib
2014-03-06 15:35发表评论
期刊: INT J RADIAT ONCOL2014年1月期卷

Purpose
To analyze the durability and toxicity of radiotherapeutic local ablative therapy (LAT) applied to extra-central nervous system (eCNS) disease progression in anaplastic lymphoma kinase-positive non-small cell lung cancer (NSCLC) patients.

Methods and Materials
Anaplastic lymphoma kinase-positive NSCLC patients receiving crizotinib and manifesting ≤4 discrete sites of eCNS progression were classified as having oligoprogressive disease (OPD). If subsequent progression met OPD criteria, additional courses of LAT were considered. Crizotinib was continued until eCNS progression was beyond OPD criteria or otherwise not suitable for further LAT.

Results
Of 38 patients, 33 progressed while taking crizotinib. Of these, 14 had eCNS progression meeting OPD criteria suitable for radiotherapeutic LAT. Patients with eCNS OPD received 1-3 courses of LAT with radiation therapy. The 6- and 12-month actuarial local lesion control rates with radiation therapy were 100% and 86%, respectively. The 12-month local lesion control rate with single-fraction equivalent dose >25 Gy versus ≤25 Gy was 100% versus 60% (P=.01). No acute or late grade >2 radiation therapy-related toxicities were observed. Median overall time taking crizotinib among those treated with LAT versus those who progressed but were not suitable for LAT was 28 versus 10.1 months, respectively. Patients continuing to take crizotinib for >12 months versus ≤12 months had a 2-year overall survival rate of 72% versus 12%, respectively (P<.0001).

Conclusions
Local ablative therapy safely and durably eradicated sites of individual lesion progression in anaplastic lymphoma kinase-positive NSCLC patients receiving crizotinib. A dose–response relationship for local lesion control was observed. The suppression of OPD by LAT in patients taking crizotinib allowed an extended duration of exposure to crizotinib, which was associated with longer overall survival.

结论:局部消融治疗可安全、持久控制ALK阳性的非小细胞肺癌患者的孤立部位的疾病进展。这种控制效果呈剂量依赖性。通过局部消融治疗获得的孤立部位疾病进展的控制可以使患者接受更长时间的克唑替尼治疗,从而获得更好的总体生存。

 

学科代码:呼吸病学 肿瘤学   关键词:立体定向放射用于接受克唑替尼治疗的ALK阳性肺癌患者可以安全 ,全球精选文摘 爱思唯尔医学网, Elseviermed
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