Patel Pretesh R, Kirkpatrick John, Salama Joseph K, Nelson John, Broadwater Gloria, Allen Karen, Clough Robert, Yin Fang-Fang, Wang Zhiheng, Chang Zheng, Kelsey Christopher, Ghafoori A Paiman
Department Radiation Oncology, Duke University Medical Center, Box 3085, Durham, NC 27710, USA.
Naval Medical Center Portsmouth, John Paul Jones Circle, Portsmouth, VA 23708, USA.
J Radiosurg SBRT. 2014;3(2):123-129.
We analyzed factors associated with inferior local control following stereotactic ablative body radiotherapy (SABR) for palliation of metastases. We reviewed records of patients receiving SABR for metastases at Duke University from 2006-2010. Biologically effective dose (BED) was calculated using the linear-quadratic model. Toxicity was assessed by CTCAE v4.0. The Kaplan-Meier method was used to estimate overall survival (OS) and local control (LC) within subgroups (primary or salvage SABR). Univariate (UVA) and multivariate (MVA) regression analysis was used. Fifty and 33 patients received primary and salvage SABR, respectively. 105 lesions were treated (52 spine, 27 lung, 7 liver, 11 other); 67 primary SABR and 38 salvage. Median clinical follow-up was 11.1 months and 10.3 months with imaging of the treated lesion. One patient received SABR x3 and died from toxicity. 88% of symptomatic patients improved after SABR. 1-year LC and OS were 83% and 50%, respectively. Primary SABR had higher BED and was associated with improved LC on UVA (HR 3.0, p=0.01) and MVA (p=0.02); treatment site and histology were not. SABR results in effective palliation of metastases regardless of prior treatment. In the absence of prior EBRT, SABR can be delivered with higher BED and may be associated with better outcomes.
我们分析了立体定向消融体部放疗（SABR）治疗转移瘤姑息治疗后局部控制不佳的相关因素。我们回顾了2006年至2010年在杜克大学接受SABR治疗转移瘤的患者记录。使用线性二次模型计算生物等效剂量（BED）。采用CTCAE v4.0评估毒性。采用Kaplan-Meier方法估计亚组（初次或挽救性SABR）内的总生存期（OS）和局部控制率（LC）。使用单因素（UVA）和多因素（MVA）回归分析。分别有50例和33例患者接受了初次和挽救性SABR。共治疗了105个病灶（52个脊柱、27个肺部、7个肝脏、11个其他部位）；67例初次SABR和38例挽救性SABR。对治疗病灶进行影像学检查时，中位临床随访时间分别为11.1个月和10.3个月。1例患者接受了3次SABR治疗并死于毒性反应。88%的有症状患者在SABR治疗后症状改善。1年的LC和OS分别为83%和50%。初次SABR的BED更高，在UVA（HR 3.0，p = 0.01）和MVA（p = 0.02）分析中与改善的LC相关；治疗部位和组织学则不然。无论先前治疗如何，SABR都能有效缓解转移瘤。在没有先前体外放射治疗（EBRT）的情况下，SABR可以给予更高的BED，并且可能与更好的结果相关。
