立体定向消融放疗（SABR）治疗转移性肺病变（MLLs）与同期原发性肺病变（PLLs）队列的回顾性分析。
Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs).
作者信息
Oskan Feras, Dzierma Yvonne, Wagenpfeil Stefan, Rübe Christian, Fleckenstein Jochen
机构信息
Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, 66421 Homburg, Saarland, Germany.
Department of Radiation Oncology, Alb-Fils Kliniken GmbH, Eichertstr. 3, 73035 Goeppingen, Germany.
出版信息
J Thorac Dis. 2017 Mar;9(3):742-756. doi: 10.21037/jtd.2017.03.07.
BACKGROUND
The net benefit from local ablative therapy for pulmonary oligometastases remains unknown. The outcomes of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) were analyzed retrospectively and compared with those of SABR for primary lung lesions (PLLs).
METHODS
Medical records of patients treated with lung SABR between 2011 and 2014 were retrospectively reviewed. Basic patient, lesion and treatment characteristics were compared using the Pearson chi-square test for categorical and Mann-Whitney U test for continuous variables. To estimate the rates of local control (LC), progression-free survival (PFS), survival after the first progression post-SABR (SAPF) and overall survival (OS), the Kaplan-Meier method was used, and the differences between groups were assessed by means of the log rank test. The uni- and multivariate Cox proportional hazards regression model was used to identify predictive factors for these endpoints.
RESULTS
Twenty-nine MLLs in 18 consecutive patients and 51 PLLs in 42 patients were treated stereotactically and included in the study. Median follow-up was 14 months (range, 4-40 months). Although patients with MLLs had a significantly better cardiopulmonary function (P=0.0001), more conservative dose-fractionation schedules were prescribed (P=0.0001), but this did not result in a significant difference in LC (P=0.98), PFS (P=0.06) and OS (P=0.14). Multivariate analysis revealed that the dose per fraction (≥ or <12 Gy) was an independent predictor for LC (P=0.02) and PFS (P=0.01) for the whole population, and for PFS (P=0.02) in the PLLs group. Late toxicities ≥ G2 occurred in six patients with PLLs, compared with none in the metastatic group.
CONCLUSIONS
SABR for MLLs was as successful as for PLLs with respect to LC and OS with lower long-term toxicity in patients with MLLs. Dose per fraction ≥12 Gy turned out to be an independent, favorable prognostic factor.
背景
局部消融治疗肺寡转移瘤的净效益尚不清楚。对立体定向消融放疗（SABR）治疗转移性肺病变（MLLs）的结果进行回顾性分析，并与SABR治疗原发性肺病变（PLLs）的结果进行比较。
方法
回顾性分析2011年至2014年接受肺部SABR治疗的患者的病历。使用Pearson卡方检验对分类变量进行比较，使用Mann-Whitney U检验对连续变量进行比较，以比较患者、病变和治疗的基本特征。为了估计局部控制（LC）率、无进展生存期（PFS）、SABR后首次进展后的生存期（SAPF）和总生存期（OS），采用Kaplan-Meier方法，并通过对数秩检验评估组间差异。使用单因素和多因素Cox比例风险回归模型来确定这些终点的预测因素。
结果
连续18例患者中的29个MLLs和42例患者中的51个PLLs接受了立体定向治疗并纳入研究。中位随访时间为14个月（范围4 - 40个月）。尽管MLLs患者的心肺功能明显更好（P = 0.0001），但采用了更保守的剂量分割方案（P = 0.0001），但这并未导致LC（P = 0.98）、PFS（P = 0.06）和OS（P = 0.14）出现显著差异。多因素分析显示，每分次剂量（≥或<12 Gy）是整个人群LC（P = 0.02）和PFS（P = 0.01）以及PLLs组PFS（P = 0.02）的独立预测因素。PLLs组有6例患者出现≥2级的晚期毒性反应，而转移组无此类情况。
结论
就LC和OS而言，SABR治疗MLLs与治疗PLLs一样成功，且MLLs患者的长期毒性较低。每分次剂量≥12 Gy是一个独立的有利预后因素。
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