Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea.
Acta Oncol. 2012 May;51(5):596-602. doi: 10.3109/0284186X.2012.681698. Epub 2012 May 1.
To analyze the treatment outcomes of a potentially curative therapy, stereotactic body radiation therapy (SBRT), for patients with single or oligometastasis to the lungs.
Sixty-seven metastatic lung lesions in 57 patients were treated with SBRT between September 2001 and November 2010. All patients had single or oligo-metastasis to the lungs following a meticulous clinical work-up, including PET-CT scans. The lungs were the most common primary organ (33 lesions, 49.3%), followed by the head and neck (11 lesions, 16.4%), the liver (nine lesions, 13.5%), the colorectum (seven lesions, 10.4%), and other organs (seven lesions, 10.4%). Three different fractionation schedules were used: 50 Gy/5 fractions to four lesions (6.0%); 60 Gy/5 fractions to 44 lesions (65.7%); and 60 Gy/4 fractions to 19 lesions (28.3%).
Local tumor progression occurred in three lesions (4.5%). The three-year actuarial local control rate was 94.5%. Tumors larger than or equal to 2.5 cm showed poorer local control (98.3% vs. 77.8%, p <0.01). Metastatic tumors from the liver and colorectum showed lower local control rates than those from other organs (77.8%, 85.7%, and 100%, p =0.04). The two-year overall survival rate was 57.2%. Patients with tumors smaller than 2.5 cm had more favorable survival rates (64.0% vs. 38.9% at two-year, p =0.032). Patients with extrathoracic disease had poorer survival rates (66.1% vs. 0% at two-year, p =0.003). Patients with disease-free intervals longer than two years showed a trend toward good prognosis (71.1% vs. 51.1% at two-year, p =0.106). Grade 2 lung toxicity occurred in four patients (6.0%). One patient experienced Grade 5 lung toxicity following SBRT.
SBRT for single or oligo-metastasis to the lung seems quite effective and safe. Tumor size, disease-free interval, and presence of extrathoracic disease are prognosticators for survival.
为了分析立体定向体部放射治疗（SBRT）对肺部单发或寡转移患者的治疗效果。
2001 年 9 月至 2010 年 11 月，57 例患者的 67 个肺部转移性病灶接受了 SBRT 治疗。所有患者在经过精心的临床检查后，包括 PET-CT 扫描，均显示肺部单发或寡转移。最常见的原发器官是肺部（33 个病灶，49.3%），其次是头颈部（11 个病灶，16.4%）、肝脏（9 个病灶，13.5%）、结直肠（7 个病灶，10.4%）和其他器官（7 个病灶，10.4%）。采用了三种不同的分割方案：4 个病灶（6.0%）接受 50 Gy/5 次分割；44 个病灶（65.7%）接受 60 Gy/5 次分割；19 个病灶（28.3%）接受 60 Gy/4 次分割。
3 个病灶（4.5%）出现局部肿瘤进展。3 年局部无进展生存率为 94.5%。肿瘤直径≥2.5 cm 的患者局部控制率较差（98.3% vs. 77.8%，p<0.01）。来源于肝脏和结直肠的转移瘤局部控制率低于其他器官来源的转移瘤（77.8%、85.7%和 100%，p=0.04）。2 年总生存率为 57.2%。肿瘤直径<2.5 cm 的患者生存率更高（2 年时为 64.0% vs. 38.9%，p=0.032）。有远处转移的患者生存率较差（2 年时为 66.1% vs. 0%，p=0.003）。无疾病间隔时间超过 2 年的患者有较好的预后趋势（2 年时为 71.1% vs. 51.1%，p=0.106）。4 例（6.0%）患者出现 2 级肺部毒性反应。1 例患者在 SBRT 后出现 5 级肺部毒性反应。
SBRT 治疗肺部单发或寡转移似乎非常有效且安全。肿瘤大小、无疾病间隔时间和远处转移是生存的预后因素。
