Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Ann Oncol. 2014 Feb;25(2):467-71. doi: 10.1093/annonc/mdt537. Epub 2013 Dec 18.
Stereotactic radiotherapy (SRT) is a safe and locally effective treatment for patients with inoperable oligometastases. The challenge remains identifying subsets of patients that benefit in terms of overall survival (OS).
Between 2005 and 2011, 309 patients with ≤5 metastases were treated by stereotactic body radiotherapy (n=209) and/or by intracranial single or fractionated stereotactic radiotherapy (n=107). We analyzed OS and carried out a risk factor analysis.
The median survival of all patients was 24 months. The 3-, 4- and 5-year OS rates were 32%, 25% and 19%, respectively. The following four risk factors were independently associated with impaired OS: nonadenocarcinoma histology (P<0.01), intracranial metastases (P<0.01), synchronous oligometastatic disease (P<0.01) and male gender (P=0.02). Patients with 0, 1 and 2 risk factors displayed a median survival (95% CI) of 40 (24-63), 29 (23-35) and 23 (16-29) months, respectively, and are defined as patients with good prognosis. Patients with 3 and 4 risk factors had a median survival of 9 (6-11) and 4 (1-7) months only and are defined as bad prognostic patients.
We identified subsets of oligometastatic cancer patients with good prognosis after SRT. These patients are candidates for inclusion in prospective randomized trials for defining the role of SRT in the management of oligometastases.
立体定向放疗（SRT）是治疗无法手术的寡转移瘤患者的一种安全有效的方法，局部效果显著。然而，目前仍然需要确定能够从整体生存（OS）中获益的患者亚组。
2005 年至 2011 年间，309 例≤5 个转移灶的患者接受了立体定向体部放疗（n=209）和/或颅内单次或分割立体定向放疗（n=107）。我们分析了 OS 并进行了危险因素分析。
所有患者的中位生存期为 24 个月。3、4 和 5 年 OS 率分别为 32%、25%和 19%。以下四个危险因素与 OS 不良独立相关：非腺癌组织学（P<0.01）、颅内转移（P<0.01）、同步寡转移疾病（P<0.01）和男性（P=0.02）。0、1 和 2 个危险因素的患者中位生存期（95%CI）分别为 40（24-63）、29（23-35）和 23（16-29）个月，定义为预后良好的患者。有 3 和 4 个危险因素的患者中位生存期分别为 9（6-11）和 4（1-7）个月，定义为预后不良的患者。
我们确定了 SRT 后预后良好的寡转移癌患者亚组。这些患者有资格纳入前瞻性随机试验，以确定 SRT 在寡转移治疗中的作用。
