Takeda Atsuya, Sanuki Naoko, Kunieda Etsuo
Atsuya Takeda, Naoko Sanuki, Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa 247-0056, Japan.
World J Gastroenterol. 2014 Apr 21;20(15):4220-9. doi: 10.3748/wjg.v20.i15.4220.
Systemic chemotherapy has enabled prolongation of survival in patients with stage IV colorectal cancer. This has subsequently increased the relative significance of local therapy for patients with oligometastases because they can be cured by removal of oligometastatic lesions. One of the most frequently reported tumor histologies for oligometastases is colorectal cancer. Resection is the standard therapy in most settings of oligometastases. Recently, studies have shown that stereotactic body radiotherapy (SBRT) may become a treatment option that provides high local control with minimal morbidity. Two-year local control rates following SBRT for hepatic and pulmonary oligometastases are almost over 80% and are even higher for patients treated with high-dose regimens. The indications of SBRT for other metastatic sites or conditions include isolated lymph nodes, spinal and adrenal metastasis, and post-surgical pelvic recurrence. Many retrospective studies have indicated that SBRT for various lesions results in good outcomes with low morbidity, both in the curative and palliative setting. However, few reports with a high level of evidence have indicated the efficacy of SBRT compared to standard therapy. Hereafter, the optimal indication of SBRT needs to be prospectively investigated to obtain convincing evidence.
全身化疗已使IV期结直肠癌患者的生存期得以延长。这随后增加了局部治疗对寡转移患者的相对重要性，因为通过切除寡转移病灶他们有可能被治愈。寡转移最常报告的肿瘤组织学类型之一是结直肠癌。在大多数寡转移情况下，手术切除是标准治疗方法。最近，研究表明立体定向体部放疗（SBRT）可能成为一种能以最低发病率实现高局部控制率的治疗选择。SBRT治疗肝和肺寡转移后的两年局部控制率几乎超过80%，对于接受高剂量方案治疗的患者甚至更高。SBRT用于其他转移部位或情况的适应症包括孤立淋巴结、脊柱和肾上腺转移以及术后盆腔复发。许多回顾性研究表明，SBRT治疗各种病灶在根治性和姑息性治疗中均能取得良好效果且发病率低。然而，很少有高证据水平的报告表明SBRT与标准治疗相比的疗效。此后，需要对SBRT的最佳适应症进行前瞻性研究以获得令人信服的证据。
