García Rafael, Santa-Olalla Iciar, Lopez Guerra Jose Luis, Sanchez Silvia, Azinovic Ignacio
Department of Radiation Oncology, IMOncology, Madrid, Spain.
Department of Radiation Physics, IMOncology, Madrid, Spain.
Rep Pract Oncol Radiother. 2017 Mar-Apr;22(2):111-117. doi: 10.1016/j.rpor.2016.10.002. Epub 2016 Nov 24.
This study evaluates the toxicity and outcome in patients treated with robotic radiosurgery for liver metastases.
Modern technologies allow the delivery of high doses to the liver metastases while lowering the dose to the neighboring organs at risk. Whether this dosimetric advantage translates into clinical benefit is not well known yet.
A total of 9 patients with 17 liver metastases have been treated with robotic stereotactic body radiotherapy SBRT from March 2011 to December 2014. Local response to SBRT was graded by the Response Evaluation Criteria in Solid Tumors criteria to describe change in treated tumor lesion. Adverse events after SBRT were graded on a 1-5 scale according to the National Cancer Institute common terminology criteria for adverse events v4.0.
Patients received either three (78%) or five (22%) fractions. Patients were treated with a mean fraction dose of 14 Gy with a range from 9 to 20 Gy. The median total radiation dose provided to patients was 45 Gy with a range of 45-60 Gy. Four out of the 17 (23.5%) treated lesions had a complete response, 9 (53%) partial response and 3 (17.6%) stable disease. With a median follow-up of 15.2 months after SBRT treatment, local control and overall survival rated were 89% and 66%, respectively. No patient experienced grade ≥3 toxicity. The most common toxicity reported was asthenia. Only two patients had nausea and diarrhea, 10 and 14 days after SBRT, respectively.
Robotic radiosurgery is a safe and effective local treatment option for secondary liver tumors. Further prospective studies are ongoing to determine long-term response and survival after robotic-SBRT for liver metastases.
本研究评估接受机器人放射外科治疗肝转移瘤患者的毒性反应及治疗结果。
现代技术能够在降低对临近危险器官剂量的同时，向肝转移瘤输送高剂量射线。这种剂量学优势是否能转化为临床获益尚不清楚。
2011年3月至2014年12月期间，共有9例患者的17处肝转移瘤接受了机器人立体定向体部放射治疗（SBRT）。SBRT的局部反应按照实体瘤疗效评价标准进行分级，以描述治疗后肿瘤病灶的变化。SBRT后的不良事件根据美国国立癌症研究所不良事件通用术语标准第4.0版进行1-5级分级。
患者接受了3次（78%）或5次（22%）分割照射。患者的平均分次剂量为14 Gy，范围为9至20 Gy。给予患者的中位总辐射剂量为45 Gy，范围为45-60 Gy。17处治疗病灶中有4处（23.5%）完全缓解，9处（53%）部分缓解，3处（17.6%）病情稳定。SBRT治疗后中位随访15.2个月，局部控制率和总生存率分别为89%和66%。无患者出现≥3级毒性反应。报告的最常见毒性反应是乏力。仅2例患者分别在SBRT后10天和14天出现恶心和腹泻。
机器人放射外科是继发性肝肿瘤安全有效的局部治疗选择。正在进行进一步的前瞻性研究，以确定机器人SBRT治疗肝转移瘤后的长期反应和生存率。
