Salama Joseph K, Chmura Steven J, Mehta Neil, Yenice Kamil M, Stadler Walter M, Vokes Everett E, Haraf Daniel J, Hellman Samuel, Weichselbaum Ralph R
Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637, USA.
Clin Cancer Res. 2008 Aug 15;14(16):5255-9. doi: 10.1158/1078-0432.CCR-08-0358.
Previous investigations have suggested that a subset of patients with metastatic cancer in a limited number of organs may benefit from local treatment. We investigated whether cancer patients with limited sites of metastatic disease (oligometastasis) who failed standard therapies could be identified and safely treated at one to five known sites of low-volume disease with radiotherapy.
Patients with one to five sites of metastatic cancer with a life expectancy of >3 months and good performance status received escalating doses of radiation to all known sites of cancer with hypofractionated radiation therapy. Patients were followed radiographically with computed tomography scans of the chest, abdomen, and pelvis and metabolically with [18F]fluorodeoxyglucose-positron emission tomography 1 month following treatment and then every 3 months. Acute toxicities were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 and late toxicities were scored using the Radiation Therapy Oncology Group late toxicity scoring system.
Twenty-nine patients with 56 metastatic lesions were enrolled from November 2004 to March 2007, with a median follow-up of 14.9 months. Two patients experienced acute (radiation pneumonitis and nausea) and one experienced chronic (gastrointestinal hemorrhage) grade > or =3 toxicity. Fifty-nine percent of patients responded to protocol therapy. Twenty-one percent of patients have not progressed following protocol treatment. Fifty-seven percent of treated lesions have not progressed at last follow-up. Progression was amenable to further local therapy in 48% of patients.
Patients with low-volume metastatic cancer can be identified, safely treated, and may benefit from radiotherapy.
先前的研究表明，少数器官发生转移癌的部分患者可能从局部治疗中获益。我们研究了那些标准治疗失败、转移病灶部位有限（寡转移）的癌症患者是否能够被识别出来，并在一至五个已知的低负荷病灶部位接受放射治疗且保证安全。
预期寿命超过3个月且体能状态良好、有一至五个转移癌病灶部位的患者，接受超分割放射治疗，对所有已知癌症病灶部位给予递增剂量的辐射。治疗后1个月，通过胸部、腹部和骨盆的计算机断层扫描进行影像学随访，通过[18F]氟脱氧葡萄糖正电子发射断层扫描进行代谢随访，之后每3个月随访一次。使用美国国立癌症研究所不良事件通用术语标准3.0版对急性毒性进行评分，使用放射治疗肿瘤学组迟发性毒性评分系统对迟发性毒性进行评分。
2004年11月至2007年3月，共纳入29例有56个转移病灶的患者，中位随访时间为14.9个月。2例患者出现急性（放射性肺炎和恶心）且1例出现慢性（胃肠道出血）≥3级毒性反应。59%的患者对方案治疗有反应。21%的患者在方案治疗后未进展。在最后一次随访时，57%的治疗病灶未进展。48%的患者病情进展适合进一步局部治疗。
低负荷转移癌患者可以被识别出来，接受安全的治疗，并且可能从放射治疗中获益。
