Milano Michael T, Katz Alan W, Muhs Ann G, Philip Abraham, Buchholz Daniel J, Schell Michael C, Okunieff Paul
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York 14642, USA.
Cancer. 2008 Feb 1;112(3):650-8. doi: 10.1002/cncr.23209.
It is hypothesized that oligometastatic disease represents a state of potentially curable, limited metastases. Stereotactic body radiation therapy (SBRT) is an option for patients who are not amenable to or do not want resection.
From 2001 to 2006, 121 patients with < or =5 detectable metastases were enrolled in 2 prospective studies that used curative-intent SBRT. Most patients were treated with 10 fractions of 5 Gray. Stereotactic radiosurgery was offered to patients with brain metastases.
The 2-year overall survival (OS), progression-free survival (PFS), local control (LC), and distant control (DC) rates were 50%, 26%, 67%, and 34%, respectively; and the respective 4-year rates values were 28%, 20%, 60%, and 25%. A greater net tumor volume predicted significantly worse OS, PFS, LC, and DC. Patients with breast cancer fared significantly better with respect to OS, PFS, LC, and DC; and patients with adrenal metastases had significantly worse OS, PFS, and DC despite the small number of such patients enrolled. Neither the number of metastatic lesions nor the number of organs involved was a significant predictor of outcome. Among 45 patients who remained alive at the last follow-up, 29 patients had no evidence of disease, including 23 patients with > or =2 years of follow-up.
Oligometastatic disease is a potentially curable state of distant cancer spread. In this hypothesis-generating analysis, patients with less volume burden of their metastatic disease and those with primary breast cancer fared better. SBRT delivered with curative intent in patients with limited metastases should be investigated further. The Southwest Oncology Group is developing a prospective protocol to treat women who have limited breast cancer metastases with SBRT.
据推测，寡转移疾病代表一种潜在可治愈的、转移灶有限的状态。立体定向体部放射治疗（SBRT）是不适于手术切除或不愿接受手术切除的患者的一种选择。
2001年至2006年，121例可检测到≤5个转移灶的患者参加了2项采用根治性SBRT的前瞻性研究。大多数患者接受10次每次5格雷的治疗。对脑转移患者提供立体定向放射外科治疗。
2年总生存率（OS）、无进展生存率（PFS）、局部控制率（LC）和远处控制率（DC）分别为50%、26%、67%和34%；4年相应的比率值分别为28%、20%、60%和25%。肿瘤净体积越大，OS、PFS、LC和DC越差。乳腺癌患者在OS、PFS、LC和DC方面明显更好；肾上腺转移患者尽管入组人数少，但OS、PFS和DC明显更差。转移灶数量和受累器官数量均不是预后的显著预测因素。在最后一次随访时仍存活的45例患者中，29例无疾病证据，包括23例随访≥2年的患者。
寡转移疾病是远处癌症扩散的一种潜在可治愈状态。在这项产生假设的分析中，转移疾病体积负担较小的患者和原发性乳腺癌患者预后更好。对转移灶有限的患者进行根治性SBRT应进一步研究。西南肿瘤协作组正在制定一项前瞻性方案，用SBRT治疗乳腺癌转移灶有限的女性患者。
