Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
J Thorac Dis. 2014 Apr;6(4):369-74. doi: 10.3978/j.issn.2072-1439.2013.12.03.
To report our institutional experience with five fractions of daily 8-12 Gy stereotactic body radiotherapy (SBRT) for the treatment of oligometastatic cancer to the lung.
Thirty-four consecutive patients with oligometastatic cancers to the lung were treated with image-guided SBRT between 2008 and 2011. Patient age ranged from 38 to 81 years. There were 17 males and 17 females. Lung metastases were from the following primary cancer types: colon cancer (n=13 patients), head and neck cancer (n=6), breast cancer (n=4), melanoma (n=4), sarcoma (n=4) and renal cell carcinoma (n=3). The median prescription dose was 50 Gy in five fractions (range, 40-60 Gy) to the isocenter, with the 80% isodose line encompassing the planning target volume (PTV) [defined as gross tumor volume (GTV) + 7-11 mm volumetric expansion]. The follow-up interval ranged from 2.4-54 months, with a median of 16.7 months.
The 1-, 2-, and 3-year patient local control (LC) rates for all patients were 93%, 88%, and 80% respectively. The 1-, 2-, and 3-year overall survival (OS) rates were 62%, 44%, and 23% respectively. The 1- and 2-year patient LC rates were 95% and 88% for tumor size 1-2 cm (n=25), and 86% for tumor size 2-3 cm (n=7). The majority (n=4) of local failures occurred within 12 months. No patient experienced local failure after 12 months except for one patient with colon cancer whose tumors progressed locally at 26 months. All five patients with local recurrences had colorectal cancer. Statistical analyses showed that age, gender, previous chemotherapy, previous surgery or radiation had no significant effect on LC rates. No patient was reported to have any symptomatic pneumonitis at any time point.
SBRT for oligometastatic disease to the lung using 8-12 Gy daily fractions over five treatments resulted in excellent 1- and 2-year LC rates. Most local failures occurred within the first 12 months, with five local failures associated with colorectal cancer. The treatment is safe using this radiation fractionation schedule with no therapy-related pneumonitis.
报告我们采用 8-12Gy 每日 5 次立体定向体部放疗（SBRT）治疗肺寡转移瘤的机构经验。
2008 年至 2011 年间，34 例肺寡转移瘤患者接受了图像引导 SBRT 治疗。患者年龄 38-81 岁，男 17 例，女 17 例。肺转移瘤来源于以下原发性癌症类型：结肠癌（n=13）、头颈部癌（n=6）、乳腺癌（n=4）、黑色素瘤（n=4）、肉瘤（n=4）和肾细胞癌（n=3）。中位处方剂量为 50Gy 分 5 次（范围 40-60Gy），等剂量线 80%包绕计划靶区（PTV）[定义为大体肿瘤体积（GTV）+7-11mm 体积扩张]。随访间隔为 2.4-54 个月，中位随访时间为 16.7 个月。
所有患者的 1、2 和 3 年局部控制（LC）率分别为 93%、88%和 80%。1、2 和 3 年总生存率（OS）分别为 62%、44%和 23%。肿瘤大小为 1-2cm（n=25）的患者 1 年和 2 年 LC 率分别为 95%和 88%，肿瘤大小为 2-3cm（n=7）的患者 LC 率为 86%。大多数（n=4）局部失败发生在 12 个月内。除 1 例结肠癌患者在 26 个月时局部进展外，12 个月后无患者出现局部失败。所有 5 例局部复发患者均为结直肠癌。统计分析表明，年龄、性别、既往化疗、既往手术或放疗对 LC 率无显著影响。在任何时间点均未报告有任何症状性放射性肺炎。
采用 8-12Gy 每日 5 次分次治疗肺寡转移瘤，5 次治疗后 1 年和 2 年的 LC 率均较高。大多数局部失败发生在最初的 12 个月内，5 例局部失败与结直肠癌相关。采用这种放疗分割方案治疗是安全的，无放射性肺炎相关并发症。
