Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois.
Department of Radiation Oncology, Duke University, Durham, North Carolina.
Pract Radiat Oncol. 2013 Oct-Dec;3(4):316-22. doi: 10.1016/j.prro.2012.08.006. Epub 2012 Oct 3.
Hypofractionated image guided radiation therapy (HIGRT) is increasingly used for limited metastases. Reported studies have mostly treated small volume tumors. Here, we report the toxicity and oncologic outcomes following treatment of large volume metastases.
HIGRT patients treated from October 2005 to March 2010 were reviewed. Gross tumor volumes (GTV) and planning target volumes (PTV) were obtained from planning software. A metastasis was considered large volume if the treated PTV exceeded 50 cc. Patients were treated with either 10-fraction (4-5 Gy per fraction) or 3-5 fraction (8-14 Gy per fraction) regimens. Toxicity was obtained from both prospectively collected databases and retrospectively from patient charts.
Sixty-four patients with 93 treated lesions >50 cc were identified. The median GTV and PTV volumes were 41 and 119 cc, respectively. The median number of treated large volume lesions was 1, and a maximum of 3 large volume lesions were treated in a single patient. Primary malignancies included non-small cell lung cancer, renal cell, colorectal, breast, bladder, pituitary, small cell lung cancer, sarcoma, head-and-neck cancer, and hepatocellular cancer. Treated sites included lung (n = 33), regional lymph nodes (n = 20), bone (n = 17), adrenal (n = 9), and liver (n = 6). The most frequently used treatment regimen was 50 Gy in 5 Gy fractions. The median follow-up was 27 months for surviving patients. Treated lesion control was 78%. Low rates of acute and late grade 3 or higher toxicity were reported, with 3 and 5 patients experiencing each, respectively.
HIGRT to large volume oligometastatic disease is tolerable and feasible with promising tumor control. Local radiation therapy should be considered in patients with large volume, limited metastatic disease.
适形分割图像引导放疗（HIGRT）越来越多地用于治疗局限性转移瘤。已报道的研究大多治疗小体积肿瘤。在此，我们报告了治疗大体积转移瘤后的毒性和肿瘤学结果。
回顾了 2005 年 10 月至 2010 年 3 月接受 HIGRT 的患者。从规划软件中获得大体肿瘤体积（GTV）和计划靶区（PTV）。如果治疗的 PTV 超过 50cc，则认为转移灶为大体积。患者接受 10 次分割（每次 4-5Gy）或 3-5 次分割（每次 8-14Gy）治疗方案。毒性数据来自前瞻性收集的数据库和患者病历的回顾性数据。
确定了 64 例 93 个大于 50cc 的治疗病灶。GTV 和 PTV 的中位数分别为 41 和 119cc。中位数治疗的大体积病灶数为 1 个，单个患者最多治疗 3 个大体积病灶。原发恶性肿瘤包括非小细胞肺癌、肾细胞癌、结直肠癌、乳腺癌、膀胱癌、垂体瘤、小细胞肺癌、肉瘤、头颈部癌和肝细胞癌。治疗部位包括肺（n=33）、区域淋巴结（n=20）、骨（n=17）、肾上腺（n=9）和肝（n=6）。最常使用的治疗方案是 50Gy 分 5 次。对生存患者的中位随访时间为 27 个月。治疗病灶控制率为 78%。报告的急性和迟发性 3 级或更高级别毒性发生率较低，分别有 3 例和 5 例患者出现。
大体积寡转移疾病的 HIGRT 是可以耐受和可行的，肿瘤控制效果良好。对于大体积、局限性转移疾病的患者，应考虑局部放射治疗。
