立体定向机器人体部放射治疗不可切除肝寡转移瘤患者。

Stereotactic Robotic Body Radiotherapy for Patients With Unresectable Hepatic Oligorecurrence.

机构信息

Department of Radiation Oncology, University Hospital of Liège, Liege, Belgium.

出版信息

Clin Colorectal Cancer. 2017 Dec;16(4):349-357.e1. doi: 10.1016/j.clcc.2017.03.006. Epub 2017 Mar 21.

DOI:10.1016/j.clcc.2017.03.006

PMID:28462852

Abstract

BACKGROUND

The purpose of this study was to analyze local control (LC), liver progression-free survival (PFS), and distant PFS (DFS), overall survival (OS), and toxicity in a cohort of patients treated with stereotactic body radiotherapy (SBRT) with fiducial tracking for oligorecurrent liver lesions; and to evaluate the potential influence of lesion size, systemic treatment, physical and biologically effective dose (BED), treatment calculation algorithms and other parameters on the obtained results.

PATIENTS AND METHODS

Unoperable patients with sufficient liver function had [18F]-fluorodeoxyglucose-positron emission tomography-computed tomography and liver magnetic resonance imaging to confirm the oligorecurrent nature of the disease and to further delineate the gross tumor volume (GTV). An intended dose of 45 Gy in 3 fractions was prescribed on the 80% isodose and adapted if risk-related. Treatment was executed with the CyberKnife system (Accuray Inc) platform using fiducials tracking. Initial plans were recalculated using the Monte Carlo algorithm. Patient and treatment data were processed using the Kaplan-Meier method and log rank test for survival analysis.

RESULTS

Between 2010 and 2015, 42 patients (55 lesions) were irradiated. The mean GTV and planning target volume (PTV) were 30.5 cc and 96.8 cc, respectively. Treatments were delivered 3 times per week in a median of 3 fractions to a PTV median dose of 54.6 Gy. The mean GTV and PTV D98% were 51.6 Gy and 51.2 Gy, respectively. Heterogeneity corrections did not influence dose parameters. After a median follow-up of 18.9 months, the 1- and 2-year LC/liver PFS/DFS/OS were 81.3%/55%/62.4%/86.9%, and 76.3%/42.3%/52%/78.3%, respectively. Performance status and histology had a significant effect on LC, whereas age (older than 65 years) marginally influenced liver PFS. Clinical target volume physical dose V45 Gy > 95%, generalized equivalent uniform dose (a = -30) > 45 Gy and a BED (α/β = 10) V105 Gy > 96% showed statistically significant effect on the LC. Acute Grade 3 gastrointestinal (GI) and late Grade 2 GI and fatigue toxicity were found in 5% and 11% patients, respectively.

CONCLUSION

Favorable survival and toxicity results support the potential paradigm shift in which the use of SBRT in oligorecurrent liver disease could benefit patients with unresectable or resectable liver metastases.

摘要

背景

本研究旨在分析接受立体定向体放射治疗（SBRT）联合放射性标记物跟踪技术治疗寡复发肝脏病变患者的局部控制（LC）、肝无进展生存期（PFS）、远处无进展生存期（DFS）、总生存期（OS）和毒性，并评估病变大小、全身治疗、物理和生物有效剂量（BED）、治疗计算算法和其他参数对获得结果的潜在影响。

方法

功能足够的不可切除患者通过[18F]-氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描和肝脏磁共振成像来确认寡复发疾病的性质，并进一步描绘大体肿瘤体积（GTV）。规定的 80%等剂量处给予 45Gy 的处方剂量，如果与风险相关则进行调整。使用 CyberKnife 系统（Accuray Inc）平台结合放射性标记物跟踪进行治疗。初始计划使用蒙特卡罗算法重新计算。使用 Kaplan-Meier 方法和对数秩检验对患者和治疗数据进行处理，以进行生存分析。

结果

2010 年至 2015 年期间，42 名患者（55 个病灶）接受了放疗。GTV 和计划靶区（PTV）的平均体积分别为 30.5cc 和 96.8cc。PTV 中位剂量为 54.6Gy，每周治疗 3 次，中位数为 3 个分次。GTV 和 PTV D98%的平均剂量分别为 51.6Gy 和 51.2Gy。不均匀性校正不影响剂量参数。中位随访 18.9 个月后，1 年和 2 年的 LC/肝 PFS/DFS/OS 分别为 81.3%/55%/62.4%/86.9%和 76.3%/42.3%/52%/78.3%。功能状态和组织学对 LC 有显著影响，而年龄（大于 65 岁）对肝 PFS 有轻微影响。临床靶区物理剂量 V45Gy>95%、广义等效均匀剂量（a=-30）>45Gy 和生物有效剂量（α/β=10）V105Gy>96%对 LC 有统计学意义。分别有 5%和 11%的患者出现急性 3 级胃肠道（GI）和晚期 2 级胃肠道和疲劳毒性。