Corvò Renzo, Lamanna Giorgio, Vagge Stefano, Belgioia Liliana, Bosetti Davide, Aloi Deborah, Timon Giorgia, Bacigalupo Almalina
Department of Radio-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy.
Tumori. 2013 Mar-Apr;99(2):159-63. doi: 10.1177/030089161309900207.
This retrospective analysis reports the outcomes obtained with an original once-weekly stereotactic radiotherapy fractionation given to patients affected by evolving oligometastases from different solid malignancies.
From 2009 to 2011, patients with symptomatic and/or evolving oligometastases were submitted to a median 5-fraction cycle of stereotactic radiotherapy of one fraction per week in order to exploit a radiobiological rationale designed to increase the therapeutic index. Individual fractionation was mainly planned according to patient performance status, oligometastasis size and site, and record of previous irradiation in the same site.
Thirty-six patients in stage IV UICC-TNM affected by oligometastases were treated with image-guided intensity-modulated stereotactic tomotherapy with a single weekly radiation. Median age was 70 years (range, 34-89). The median weekly single dose, number of fractions and overall total radiation dose were 7 Gy, 5 fractions and 35 Gy, respectively. Thirty-five (97%) patients completed the treatment schedule. No patient suffered mild or severe radiation-related side effects. Twenty-one (87%) of 24 patients with local pain had complete symptomatic response within 30 days following the end of radiotherapy. Local control assessed at imaging after stereotactic radiotherapy was evidenced in 30 (83%) patients. Median time to response after the end of radiotherapy was 40 days.
The original radiotherapy regimen delivering only a single stereotactic dose per week seems to be highly feasible with an interesting high efficacy rate in patients with oligometastases from different solid tumors. Overall, the once-weekly treatment was very compliant in an advanced cancer stage especially for elderly and frail patients.
本回顾性分析报告了对不同实体恶性肿瘤寡转移患者采用一种全新的每周一次立体定向放射治疗分割方案所取得的治疗结果。
2009年至2011年，有症状和/或病情进展的寡转移患者接受了中位5次分割周期的立体定向放射治疗，每周一次分割，以利用旨在提高治疗指数的放射生物学原理。个体分割方案主要根据患者的体能状态、寡转移灶的大小和部位以及同一部位先前的放疗记录来制定。
36例国际抗癌联盟（UICC）TNM分期IV期的寡转移患者接受了图像引导的调强立体定向断层放射治疗，每周单次放疗。中位年龄为70岁（范围34 - 89岁）。中位每周单次剂量、分割次数和总放射剂量分别为7 Gy、5次分割和35 Gy。35例（97%）患者完成了治疗方案。无患者出现轻度或重度放疗相关副作用。24例有局部疼痛的患者中，21例（87%）在放疗结束后30天内症状完全缓解。立体定向放疗后影像学评估的局部控制率在30例（83%）患者中得到证实。放疗结束后的中位缓解时间为40天。
对于来自不同实体肿瘤的寡转移患者，每周仅给予单次立体定向剂量的原始放疗方案似乎高度可行，且有效率令人关注。总体而言，每周一次的治疗在晚期癌症阶段，特别是对老年和体弱患者非常依从。
