Dynamic Changes Of The Circulating Tumor Cells In The Patients With Advanced Non-small Cell Lung Cancer Before And After Fractionated Intensity Modulated Radiation Therapy And Its Clinical Significance

Objective:Circulating tumor cell detection is a new minimally invasive liquid biopsy technique,which could be applied for early diagnosis and disease monitoring during treatment.This report was to monitor the dynamic changes of circulating tumor cells in advanced non-small cell lung cancer patients before and after hypofractionated intensity modulated radiation therapy,and then to explore the correlation of CTCs with clinical characteristics and the recent curative effect.Methods:The ISET technique had been applied to detect the CTCs in 35 stage III-IV NSCLC patients from June 12 2016 to December 18 2017 in Changzhou Tumor Hospital before and after hypofractionated intensity modulated radiation therapy,and the correlation between CTCs with clinical characteristics and the recent curative effect of patients had been explored.Results:The positive rate of CTCs was associated with distant metastasis in patients with advanced NSCLC before radiotherapy(P=0.012).The recent curative effect of 35 patients was evaluated,and the Disease Control Rate(DCR)was up to 74.3%(26/35).Among patients with DCR,the number of CTCs decreased in 20 cases(76.9%,20/26)and increased in 6 cases(23.1%,6/26)compared with that before radiotherapy.In PD patients,the number of CTCs decreased in 3 cases(33.3%,3/9)and increased in 6 cases(66.7%,6/9)compared with that before radiotherapy(P=0.038).The progression-free survival(PFS)of CTCs positive patients was 7.5 months,while that of CTCs negative patients was 12 months(P=0.035).The median PFS of CTCs positive patients after radiotherapy was 7 months,versus 10 months of CTCs negative patients(P=0.041),the differences were statistically significant.The median PFS of patients with declined CTCs after radiotherapy was 10 months,while the median PFS of patients with increased CTCs after radiotherapy was 6.5 months,with statistical significance(P=0.026).Conclusion:CTCs appereance was associated with distant metastasis in patients with advanced NSCLC.CTCs could be used as a predictive indicator of PFS of advanced NSCLC patients treated with hypofractionated intensity modulated radiation.Patients with declined CTCs after radiotherapy are expected to receive better recent curative effect.