| ObjectiveComplete surgical resection is the standard and recommended treatment for nonsmall cell lung cancer(NSCLC);however,the rate of post-surgical recurrence is still high.Recently,certain patients with a limited number of recurrent lesions(<=5 lesions),a state is called oligo-recurrence/metastasis,are expected to achieve long-term survival and even are cured by aggressive local therapy alone.However,there are few articles have reported the efficacy and safety of SBRT on post-operative thoracic oligo-metastasis or oligo-recurrence of NSCLC.The study aimed to assess the efficacy and safety of stereotactic body radiotherapy(SBRT)using CyberKnife(CK)in patients with postoperative thoracic oligo-recurrence/metastasis of Non-Small Cell Lung Cancer(NLCLC)and to analyze the prognostic factors affecting overall survival after SBRT.MethodsIn our study,thoracic oligo-recurrence was defined as 1-3 loco-regional confined to lung lobe,hilar/mediastinal 1ymph nodes,bronchial stump,or chest wall.Post-operative thoracic oligo-recurrence of Non-Small-Cell Lung Cancer(NLCLC)treated with SBRT were reviewed from September 2010 to July 2019 at the CyberKnife SBRT Center Jinling Hospital.Primary endpoints included local control(LC),overall survival(OS),progression-free survival(PFS),the pattern of failure after salvage SBRT,and toxicities.The SPSS 25.0 software was used for the statistical analysis of the research data.X-tile software was constructed to define the optimal cut-off values of the NLR.The LC,OS,and PFS rate estimates were calculated using the Kaplan-Meier method and compared using the stratified log-rank test.The predictors of LC and OS after salvage SBRT were analyzed by using Kaplan-Meier methods and Cox regression models.P<0.05 was considered statistically significant.ResultsThe study population finally comprised 44 patients,with median age of 68 years(range,39-85 years),and the median follow-up time after salvage SBRT was 48.5 months(95%CI:26.63-70.37 months).Measuring from the date of salvage SBRT,the median OS of the 44 patients was 52.6 months(95%CI:29.59-75.60 months).SBRT was delivered to a total dose of 30 to 60Gy over 2 to 6 fractions.The biological effective dose(BED)ranged from 60-180 Gy,and the median BED was 124.8Gy.The 1-,3-year and,5-year local control rates from the start of SBRT were 97.7%,85.1%,and 80.1%,respectively.The median PFS was 21.7 months(95%CI:11.85-31.55 months).At 1,3,and 5 years,the disease-free survival rates were 77.1%,28.8%,and 5.3%,respectively.The 1-,3-and 5-year OS rates from the start of SBRT were 97.7%,65.3%,and 47.7%,respectively.Based on the X-tile analysis,the optimal cut-off values of the NLR were 2.68.Univariate analysis showed that several clinical factors,including ECOG performance status,PTV,and the pre-SBRT neutrophil-to-lymphocyte ratio(NLR)were all significantly associated with OS(p<0.05).Patients with high NLR had significantly shorter overall(OS)32.17 months[95%Cl:27.7 to 37.29 months]than those with low NLR 86.87 months[95%CI:46.26 to 127.47 months](P=0.0001).During the study period,31(70.5%)patients experienced disease progression.Among these,the vast majority of which(20[64.5%])were distant metastases.All patients completed the course of SBRT on schedule.Overall toxicity is acceptable.No patients developed grade 3 or greater pulmonary toxicity.ConclusionStereotactic body radiotherapy using CyberKnife is a promising salvage therapeutic option for postoperative thoracic oligo-metastasis/recurrence of non-smallcell lung cancer with acceptable toxicity.The low pre-SBRT neutrophil-to-lymphocyte ratio was associated with a better prognosis and longer survival and might be considered as reliable and independent prognostic factors in these patients treated with SBRT. |
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