Laliscia Concetta, Fabrini Maria Grazia, Delishaj Durim, Morganti Riccardo, Greco Carlo, Cantarella Martina, Tana Roberta, Paiar Fabiola, Gadducci Angiolo
*Division of Radiation Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, †Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; ‡Champalimaud Foundation, Lisbon, Portugal; §Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Int J Gynecol Cancer. 2017 Feb;27(2):396-402. doi: 10.1097/IGC.0000000000000885.
The objective of this study was to assess the role of stereotactic body radiotherapy (SBRT) in the treatment of distantly recurrent, oligometastatic gynecological cancer.
The hospital records of 45 patients with F-fluorodeoxyglucose (F-FDG) positron emission tomography positive, distantly recurrent, oligometastatic gynecological cancer were reviewed. All these patients had a number of target lesions less than 5, with largest diameter less than 6 cm. The treatment was delivered with a TrueBeam LINAC and RapidArc technique, using 10 or 6 MV FFF beams. A total of 70 lesions were treated, and lymph nodes represented the most common site of metastases, followed by lung, liver, and soft tissues. Twenty lesions were treated with one single fraction of 24 Gy and 5 lesions received 27 Gy delivered in 3 fractions, depending on the ability to fulfill adequate target coverage and safe dose/volume constraints for the organ at risk with either regimen.
Positron emission tomography scan 3 months after SBRT showed a complete response (CR) in 45 lesions (64.3%), a partial response in 14 (20.0%), a stable disease in 5 (7.1%), and a progressive disease in 6 (8.6%). No lesions in CR after SBRT subsequently progressed. Overall acute toxicity occurred in 13 (28.9%) patients. The most common grade 1 to 2 adverse event was pain (n = 9, 20.0%), followed by nausea and vomiting (n = 5, 11.1%). No grade 3 to 4 acute toxicities occurred, and no late toxicities were observed. Patients who failed to achieve a CR had a 2.37-fold higher risk of progression and a 3.60-fold higher risk of death compared with complete responders (P = 0.04 and P = 0.03, respectively).
Stereotactic body radiotherapy offers an effective and safe approach for selected cases of oligometastatic gynecological cancer.
本研究旨在评估立体定向体部放疗（SBRT）在远处复发、寡转移妇科癌症治疗中的作用。
回顾了45例氟脱氧葡萄糖（F-FDG）正电子发射断层扫描阳性、远处复发、寡转移妇科癌症患者的医院记录。所有这些患者的靶病灶数量少于5个，最大直径小于6 cm。采用TrueBeam直线加速器和容积旋转调强放疗技术进行治疗，使用10或6 MV FFF射线束。共治疗70个病灶，淋巴结是最常见的转移部位，其次是肺、肝和软组织。根据两种方案中任何一种方案实现足够的靶区覆盖和危及器官的安全剂量/体积限制的能力，20个病灶接受单次24 Gy照射，5个病灶接受分3次给予27 Gy照射。
SBRT后3个月的正电子发射断层扫描显示，45个病灶（64.3%）完全缓解（CR），14个（20.0%）部分缓解，5个（7.1%）疾病稳定，6个（8.6%）疾病进展。SBRT后达到CR的病灶随后均未进展。13例（28.9%）患者出现总体急性毒性反应。最常见的1至2级不良事件是疼痛（n = 9，20.0%），其次是恶心和呕吐（n = 5，11.1%）。未发生3至4级急性毒性反应，也未观察到晚期毒性反应。与完全缓解者相比，未达到CR的患者进展风险高2.37倍，死亡风险高3.60倍（分别为P = 0.04和P = 0.03）。
立体定向体部放疗为选定的寡转移妇科癌症病例提供了一种有效且安全的治疗方法。
