Wild Aaron T, Yamada Yoshiya
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Visc Med. 2017 Mar;33(1):54-61. doi: 10.1159/000454685. Epub 2017 Feb 3.
Improvements in systemic therapy for metastatic colorectal cancer (CRC) have markedly extended survival, rendering local control of metastases to critical organs of increasing importance, especially in the oligometastatic setting where the disease may not yet have acquired the ability to widely disseminate. While surgical resection remains the gold standard for oligometastases in many organs, stereotactic body radiation therapy (SBRT) presents a non-invasive alternative for achieving local control.
A literature review was performed to identify and summarize the findings of key prospective and retrospective studies that have shaped the field of SBRT for oligometastases to the lung, liver, and spine with a focus on oligometastases from CRC in particular.
Modern dose-escalated SBRT regimens can achieve 1-year local control rates of 77-100%, 90-100%, and 81-95% for oligometastases involving the lung, liver, and spine, respectively. Rates of grade 3 or greater toxicity with contemporary SBRT techniques are consistently low at <10% in the lung, <5% in the liver, and <2%/8% for neurologic/non-neurologic toxicity in the spine, respectively.
SBRT appears safe and effective for treating oligometastases involving the lung, liver, and spine. Randomized trials comparing SBRT to surgical resection and other local therapeutic modalities for the treatment of CRC oligometastases bear consideration.
转移性结直肠癌（CRC）全身治疗的改善显著延长了生存期，使得对转移灶累及关键器官的局部控制变得愈发重要，尤其是在寡转移的情况下，此时疾病可能尚未获得广泛播散的能力。虽然手术切除仍是许多器官寡转移灶的金标准，但立体定向体部放疗（SBRT）是实现局部控制的一种非侵入性替代方法。
进行了一项文献综述，以识别和总结那些塑造了针对肺、肝和脊柱寡转移灶的SBRT领域的关键前瞻性和回顾性研究的结果，尤其关注来自CRC的寡转移灶。
现代剂量递增的SBRT方案对于累及肺、肝和脊柱的寡转移灶，1年局部控制率分别可达77 - 100%、90 - 100%和81 - 95%。采用当代SBRT技术时，3级或更高级别毒性发生率一直较低，在肺部<10%，在肝脏<5%，在脊柱中神经毒性/非神经毒性分别<2%/8%。
SBRT对于治疗累及肺、肝和脊柱的寡转移灶似乎是安全有效的。比较SBRT与手术切除及其他局部治疗方式用于治疗CRC寡转移灶的随机试验值得考虑。
