Mesko Shane, Sandler Kiri, Cohen Joshua, Konecny Gottfried, Steinberg Michael, Kamrava Mitchell
*School of Medicine, University of California Irvine, Irvine; and Departments of †Radiation Oncology, ‡Gynecologic Oncology, and §Medical Oncology, University of California Los Angeles, Los Angeles, CA.
Int J Gynecol Cancer. 2017 Feb;27(2):403-408. doi: 10.1097/IGC.0000000000000869.
We report single-institution clinical outcomes of women treated with stereotactic ablative radiotherapy (SABR) for oligometastatic or progressive gynecological malignancies.
From 2009 to 2015, 47 lesions from 28 patients were treated with SABR and retrospectively analyzed. All patients had oligometastatic (93%) or oligoprogressive (7%) disease. Primary cancer diagnoses were 15 ovarian, 8 endometrial, 2 cervical, 2 vaginal, and 1 uterine carcinosarcoma. Treatment was delivered using a median of 5 fractions to a median total dose of 40 Gy. Targets were grouped by treatment site and assessed for response using Response Evaluation Criteria in Solid Tumors v1.1. Mean biologically effective dose and pre-SABR tumor size were compared with response. Progression-free survival (PFS) was determined using Kaplan-Meier analysis, and toxicity outcomes were graded using Common Terminology Criteria for Adverse Events version 4.03.
Median follow-up was 12.8 months. Target locations were 17% liver, 21% lung, 17% paraaortic node, 26% other node, and 19% pelvic soft tissue. After treatment, 34% of targets were stable (SD), 32% had a partial response (PR), 17% had a complete response (CR), and 17% had progressive disease (PD). No failures occurred in lung or nodal targets. Mean ± standard deviation pre-SABR tumor diameter was 24 ± 22 mm. There was a significant difference in mean size between lesions that had a favorable (SD, PR, and CR) versus unfavorable response (PD) (17.2 vs 57.6 mm, P = 0.0044). Lesions that responded favorably were also more likely to have received a higher biologically effective dose (79.0 vs 59.6 Gy, P = 0.027). Median PFS was 10.8 months, and 1 patient experienced grade 3 toxicity.
The SABR is a safe and effective local treatment modality in patients with oligometastatic gynecological disease. Distant progression remains the primary mode of failure in this patient population. In carefully selected patients, a combination of systemic treatment and SABR may offer long-term PFS.
我们报告了采用立体定向消融放疗（SABR）治疗寡转移或进展期妇科恶性肿瘤女性患者的单机构临床结果。
2009年至2015年，对28例患者的47个病灶进行了SABR治疗并进行回顾性分析。所有患者均患有寡转移（93%）或寡进展（7%）疾病。原发癌诊断包括15例卵巢癌、8例子宫内膜癌、2例宫颈癌、2例阴道癌和1例子宫癌肉瘤。治疗采用中位5次分割，中位总剂量为40Gy。根据治疗部位对靶区进行分组，并使用实体瘤疗效评价标准第1.1版评估反应。比较平均生物等效剂量和SABR治疗前肿瘤大小与反应情况。采用Kaplan-Meier分析确定无进展生存期（PFS），并使用不良事件通用术语标准第4.03版对毒性结果进行分级。
中位随访时间为12.8个月。靶区位置分别为肝脏17%、肺21%、主动脉旁淋巴结17%、其他淋巴结26%和盆腔软组织19%。治疗后，34%的靶区病情稳定（SD），32%部分缓解（PR），17%完全缓解（CR），17%疾病进展（PD）。肺部或淋巴结靶区未出现治疗失败。SABR治疗前肿瘤平均直径±标准差为24±22mm。反应良好（SD、PR和CR）与反应不佳（PD）的病灶平均大小存在显著差异（17.2对57.6mm，P = 0.0044）。反应良好的病灶也更有可能接受了更高的生物等效剂量（79.0对59.6Gy，P = 0.027）。中位PFS为10.8个月，1例患者出现3级毒性反应。
SABR是寡转移妇科疾病患者安全有效的局部治疗方式。远处进展仍然是该患者群体主要的失败模式。在经过精心挑选的患者中，全身治疗与SABR联合应用可能带来长期无进展生存。
