Rubio Carmen, Hernando-Requejo Ovidio, Zucca Aparicio Daniel, ALlona Krauel María, López Gonzalez Mercedes, Pérez Juan María, Sánchez Saugar Emilio, Fernández Letón Pedro
Departments of Radiation Oncology, HM Hospitales, Spain.
Departments of Medical Physics, HM Hospitales, Spain.
Rep Pract Oncol Radiother. 2017 Mar-Apr;22(2):150-157. doi: 10.1016/j.rpor.2016.07.006. Epub 2016 Sep 17.
To report the outcome and toxicity of sequential stereotactic body radiotherapy (SBRT) for multiple liver metastases in patients treated with ExacTrac Adaptive Gating.
In selected patients with a limited number of liver metastases, SBRT has been evaluated as a safe and effective treatment, with minimal toxicity and high rates of local control.
From April 2008 to October 2013, 21 patients with multiple (3-14) liver metastases ( = 101) were treated sequentially with SBRT at our institution. Maximum tumor diameter was 7.5 cm. Prior to treatment, internal markers were placed inside or near the tumor. CT or PET-CT simulation was used for the definition of gross tumor volume (GTV). Median planning target volume was 32.3 cc (3.6-139.3 cc). Treatment consisted of 3 fractions (12-20 Gy/fraction) or 5 fractions (10 Gy/fraction), prescribed to the 90-95% of the PTV volume. Daily intra-fraction image guidance was performed with ExacTrac Adaptive Gating. Regular follow-up included CT or PET-CT imaging.
After a median of 23.2 months, the estimated local control rate was 94.4%, 80.6%, 65% and 65% after 1, 2, 3 and 4 years; the median overall survival was 62 months (95% CI 49.12-74.87) and the actuarial survival reached at 60 months was 57.6%. The univariate data analysis revealed that only primary histology other than colorectal adenocarcinoma was shown as an independent significant prognostic factor for local control ( = 0.022). Number of treated metastases did not modify significantly the overall survival ( = 0.51). No toxicity higher than G3 (1 patient with chest wall pain) and no radiation-induced liver disease were observed.
Sequential SBRT with ExacTrac Adaptive Gating for multiple liver metastases can be considered an effective, safe therapeutic option, with a low treatment-related toxicity. Excellent rates of local control and survival were obtained.
报告采用ExacTrac自适应门控技术对多发肝转移患者进行序贯立体定向体部放疗（SBRT）的疗效和毒性。
在选定的肝转移数量有限的患者中，SBRT已被评估为一种安全有效的治疗方法，毒性极小且局部控制率高。
2008年4月至2013年10月，我院对21例有多发（3 - 14个）肝转移灶（n = 101）的患者进行了序贯SBRT治疗。最大肿瘤直径为7.5 cm。治疗前，在肿瘤内部或附近放置内部标志物。采用CT或PET-CT模拟来确定大体肿瘤体积（GTV）。计划靶体积中位数为32.3 cc（3.6 - 139.3 cc）。治疗包括3次分割（每次12 - 20 Gy）或5次分割（每次10 Gy），处方剂量为PTV体积的90% - 95%。每日采用ExacTrac自适应门控技术进行分次内图像引导。定期随访包括CT或PET-CT成像。
中位随访23.2个月后估算的1年、2年、3年和4年局部控制率分别为94.4%、80.6%、65%和65%；中位总生存期为62个月（95%CI 49.12 - 74.87），60个月时的精算生存率为57.6%。单因素数据分析显示，仅结直肠腺癌以外的原发组织学类型是局部控制的独立显著预后因素（P = 0.022）。治疗的转移灶数量对总生存期无显著影响（P = 0.51）。未观察到高于3级的毒性反应（1例患者出现胸壁疼痛），也未出现放射性肝病。
采用ExacTrac自适应门控技术对多发肝转移进行序贯SBRT可被视为一种有效、安全的治疗选择，治疗相关毒性低。获得了优异的局部控制率和生存率。
