立体定向体部放疗用于肾细胞癌肺转移——德国“立体定向放疗”工作组的多中心分析
Stereotactic body radiotherapy (SBRT) for pulmonary metastases from renal cell carcinoma-a multicenter analysis of the German working group "Stereotactic Radiotherapy".
作者信息
Hoerner-Rieber Juliane, Duma Marciana, Blanck Oliver, Hildebrandt Guido, Wittig Andrea, Lohaus Fabian, Flentje Michael, Mantel Frederick, Krempien Robert, Eble Michael J, Kahl Klaus Henning, Boda-Heggemann Judit, Rieken Stefan, Guckenberger Matthias
机构信息
Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.
National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.
出版信息
J Thorac Dis. 2017 Nov;9(11):4512-4522. doi: 10.21037/jtd.2017.10.108.
BACKGROUND
Renal cell carcinoma (RCC) is traditionally considered to be radioresistant. Radiotherapy response rates are believed to improve with hypofractionated, high dose stereotactic body radiotherapy (SBRT). However, limited data exist regarding the role of SBRT in the treatment of pulmonary metastases.
METHODS
The working group "Stereotactic Radiotherapy" of the German Society of Radiation Oncology analyzed its multi-institutional database of more than 700 patients who received SBRT for pulmonary metastases. Treatment was performed at 10 centers between 2001 and 2016. Patients with metastatic RCC were included in the study. Tumor characteristics, treatment details, and follow-up data including survival, local control (LC), distant metastases, and toxicity were evaluated.
RESULTS
A total of 46 RCC patients treated with SBRT for 67 lung metastases were identified, who received a median total biologically effective dose (BED) at planning target volume (PTV) isocenter of 117.0 Gy (range, 48.0-189.0 Gy). A median fractional dose of 20.8 Gy at isocenter (range, 6.0-37.9 Gy) was administered in a median number of 3 fractions (1-8 fractions). After a median follow-up time of 28.3 months for all patients, 1- and 3-year LC rates were 98.1% and 91.9%, with corresponding 1- and 3-year overall survival (OS) of 84.3% and 43.8%, respectively. Pulmonary metastases treated with BEDiso ≥130 Gy showed a trend for superior LC (P=0.054). OS was significantly improved in both uni- and multivariate analysis for patients with higher Karnofsky performance scale, lower maximum pulmonary metastasis diameter and lack of post-SBRT systemic therapy due to progression (P=0.014; P=0.049; P=0.006). Only mild acute and late toxicity was reported.
CONCLUSIONS
SBRT for pulmonary metastases from RCC was associated with low treatment-associated toxicity, promising survival, and excellent LC, especially in those patients receiving a BED ≥130 Gy.
背景
肾细胞癌（RCC）传统上被认为对放疗具有抗性。人们认为，采用大分割、高剂量立体定向体部放疗（SBRT）可提高放疗反应率。然而，关于SBRT在治疗肺转移瘤中的作用的数据有限。
方法
德国放射肿瘤学会的“立体定向放疗”工作组分析了其多机构数据库，该数据库包含700多名接受SBRT治疗肺转移瘤的患者。2001年至2016年间，10个中心开展了此项治疗。转移性RCC患者被纳入研究。对肿瘤特征、治疗细节以及包括生存、局部控制（LC）、远处转移和毒性在内的随访数据进行了评估。
结果
共确定了46例接受SBRT治疗67处肺转移瘤的RCC患者，其计划靶体积（PTV）等中心处的中位总生物等效剂量（BED）为117.0 Gy（范围48.0 - 189.0 Gy）。等中心处的中位分次剂量为20.8 Gy（范围6.0 - 37.9 Gy），中位分次次数为3次（1 - 8次）。所有患者的中位随访时间为28.3个月，1年和3年的LC率分别为98.1%和91.9%，相应的1年和3年总生存率（OS）分别为84.3%和43.8%。BEDiso≥130 Gy治疗的肺转移瘤显示出LC更佳的趋势（P = 0.054）。在单因素和多因素分析中，对于卡诺夫斯基功能状态较高、最大肺转移瘤直径较小且因疾病进展未接受SBRT后全身治疗的患者，OS显著改善（P = 0.014；P = 0.049；P = 0.006）。仅报告了轻度的急性和晚期毒性。
结论
RCC肺转移瘤的SBRT与低治疗相关毒性、有前景的生存率和出色的LC相关，尤其是在接受BED≥130 Gy的患者中。
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