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Early lung cancer patients, suggesting treatment by metastasis pattern analysis after stereotactic body radiotherapy

To investigate the pattern of mediastinal lymph node metastases after stereotactic body radiotherapy for primary lung cancer and the current status of treatment

▲ Professor Kim Byeong-hyeok (Photo = Courtesy of Seoul Boramae Hospital)

[메디컬투데이=이한희 기자] In the 2021 cause of death statistics published by the National Statistical Office this year, the number of lung cancer deaths in Korea was 36.8 per 100,000 population, the highest among all cancers, and the number of patients is increasing gradually.

Stereotactic body radiation therapy (SBRT) is a radiation therapy that is mainly applied to early lung cancer patients. It is a technique that accurately irradiates high dose radiation to the tumor area The control effect local is very good at about 95%, but about 10 % of patients after treatment have mediastinum It has been said that lymph nodes can recur.

To present a pattern of metastasis to the mediastinal lymph glands after stereotactic body radiation therapy (SBRT) for primary lung cancer and salvage treatment for this, Professor Kim Byung-hyeok from the Department of Radiation Oncology at Hospital Boramae and researchers at Seoul National University Hospital were invited to the Lung Cancer Division of the Korea Radiation Oncology Research Council The study was conducted based on clinical data from 11 domestic medical institutions belonging to .

First, the medical records of 114 patients who experienced mediastinal lymph node metastases after pulmonary SBRT were reviewed, and patterns of recurrence were classified according to the presence or absence of distant metastases.

Recurrent patients received salvage radiation therapy (treatment given after failure of standard therapy; RT), chemotherapy, or palliative care, as appropriate. As a result of evaluation of lymph node recurrence sites, common sites were ipsilateral hilum (47.2%), ipsilateral upper mediastinum (40.6%), and subcarinal area (42.5%). Of these, 68 patients (total 59.6%) were able to receive additional treatment (salvage radiotherapy 24 patients, other palliative care 44 patients) after local recurrence.

Based on the time to return of the regional lymph nodes, the progression-free survival rate (the length of time the disease did not get worse; PFS) and the overall survival rate (the proportion of patients alive at the end of the study; OS) were measured, and the results showed that between treatment regimens according to the type of additional treatment, There is a difference. The progression-free survival rates of the 1st and 2nd year of salvage therapy were 27.7% and 18.5%, respectively , and palliative care was 14.0% and 4.7% and 11.0%.

Multivariate analysis showed that patients without concurrent distant metastases and those who received additional treatment had a better prognosis even after adjusting for other clinical factors. In addition, it has been suggested that approximately 70% of patients with regional lymph node recurrence have disease confined to a local region, in which case aggressive salvage radiation therapy could be considered.

Corresponding author Professor Kim Byeong-hyeok from the Department of Radiation Oncology said, “Through this study, the effects of salvage treatment on the prognosis and whether there was distant metastasis were analyzed, and the recurrence pattern of mediastinal lymph nodes was confirmed after autopsy stereotactic. radiation treatment in domestic patients.” “In one institution, it was difficult to collect a sufficient number of patients for analysis, so it was carried out as a domestic multi-centre study, the intention of which was to help determine the appropriate treatment in the clinical field, especially in the case of metastases after stereotactic body radiation therapy, especially in the case of metastases to the mediastinal lymph gland.”

Meanwhile, this study was published in the latest issue of Radiotherapy and Oncology, an international academic journal at SCIE level.

Medical Today Reporter Lee Han-hee (hnhn0414@mdtoday.co.kr)

[저작권자ⓒ 메디컬투데이. 무단전재-재배포 금지]

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