Goodman Benjamin D, Mannina Edward M, Althouse Sandra K, Maluccio Mary A, Cárdenes Higinia R
Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
Pract Radiat Oncol. 2016 Mar-Apr;6(2):86-95. doi: 10.1016/j.prro.2015.10.011. Epub 2015 Oct 23.
To evaluate long-term outcome and toxicity of stereotactic body radiation therapy (SBRT) for hepatic oligometastases from solid tumors.
Eligible patients had 1 to 3 liver metastases, maximum sum diameter 6 cm, without extrahepatic progression. We treated 106 lesions in 81 patients; 67% with colorectal primaries. Median dose was 5400 cGy in 3 to 5 fractions.
At median follow-up of 33 months (2.5-70 months), overall local control was 94% (95% confidence interval, not estimable); Kaplan-Meier estimated 96% at 1 year and 91% at 2, 3, and 4 years. Partial/complete response was observed in 69% of lesions with less than 3% progressing. Median survival time was 33.6 months (95% confidence interval, 29.1-38.4); Kaplan-Meier survival estimates at 1, 2, 3, and 4 years were 89.9%, 68.6%, 44.0%, and 28.0%, respectively. Grade 3 or greater liver toxicity was 4.9%.
SBRT is effective for selected patients with hepatic oligometastases with limited toxicities. A phase 3 trial comparing SBRT with "gold-standard" surgical resection is warranted.
评估立体定向体部放射治疗（SBRT）对实体瘤肝寡转移的长期疗效和毒性。
符合条件的患者有1至3个肝转移灶，最大直径总和为6 cm，无肝外进展。我们对81例患者的106个病灶进行了治疗；67%为结直肠癌原发灶。中位剂量为5400 cGy，分3至5次给予。
中位随访33个月（2.5至70个月），总体局部控制率为94%（95%置信区间，不可估计）；Kaplan-Meier法估计1年时为96%，2、3和4年时为91%。69%的病灶观察到部分/完全缓解，进展的病灶少于3%。中位生存时间为33.6个月（95%置信区间，29.1至38.4）；Kaplan-Meier生存估计1、2、3和4年分别为89.9%、68.6%、44.0%和28.0%。3级或更高级别的肝毒性为4.9%。
SBRT对选定的肝寡转移患者有效，毒性有限。有必要进行一项将SBRT与“金标准”手术切除进行比较的3期试验。
