立体定向体部放疗（SBRT）治疗肝转移瘤——RSSearch®国际多机构患者注册研究的临床结果。
Stereotactic Body Radiotherapy (SBRT) for liver metastasis - clinical outcomes from the international multi-institutional RSSearch® Patient Registry.
机构信息
Geisinger Health System, 100 N Academy Ave, Danville, PA, 17822, USA.
Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany.
出版信息
Radiat Oncol. 2018 Feb 13;13(1):26. doi: 10.1186/s13014-018-0969-2.
BACKGROUND
Stereotactic body radiotherapy (SBRT) is an emerging treatment option for liver metastases in patients unsuitable for surgery. We investigated factors associated with clinical outcomes for liver metastases treated with SBRT from a multi-center, international patient registry.
METHODS
Patients with liver metastases treated with SBRT were identified in the RSSearch® Patient Registry. Patient, tumor and treatment characteristics associated with treatment outcomes were assessed. Dose fractionations were normalized to BED. Overall survival (OS) and local control (LC) were evaluated using Kaplan Meier analysis and log-rank test.
RESULTS
The study included 427 patients with 568 liver metastases from 25 academic and community-based centers. Median age was 67 years (31-91 years). Colorectal adenocarcinoma (CRC) was the most common primary cancer. 73% of patients received prior chemotherapy. Median tumor volume was 40 cm (1.6-877 cm), median SBRT dose was 45 Gy (12-60 Gy) delivered in a median of 3 fractions [1-5]. At a median follow-up of 14 months (1-91 months) the median overall survival (OS) was 22 months. Median OS was greater for patients with CRC (27 mo), breast (21 mo) and gynecological (25 mo) metastases compared to lung (10 mo), other gastro-intestinal (GI) (18 mo) and pancreatic (6 mo) primaries (p < 0.0001). Smaller tumor volumes (< 40 cm) correlated with improved OS (25 months vs 15 months p = 0.0014). BED ≥ 100 Gy was also associated with improved OS (27 months vs 15 months p < 0.0001). Local control (LC) was evaluable in 430 liver metastases from 324 patients. Two-year LC rates was better for BED ≥ 100 Gy (77.2% vs 59.6%) and the median LC was better for tumors < 40 cm (52 vs 39 months). There was no difference in LC based on histology of the primary tumor.
CONCLUSIONS
In a large, multi-institutional series of patients with liver metastasis treated with SBRT, reasonable LC and OS was observed. OS and LC depended on dose and tumor volume, while OS varied by primary tumor. Future prospective trials on the role of SBRT for liver metastasis from different primaries in the setting of multidisciplinary management including systemic therapy, is warranted.
TRIAL REGISTRATION
Clinicaltrials.gov: NCT01885299 .
背景
立体定向体部放疗（SBRT）是一种治疗不适合手术的肝转移瘤的新兴治疗选择。我们从一个多中心、国际患者登记处研究了与接受 SBRT 治疗的肝转移瘤患者临床结局相关的因素。
方法
从 RSSearch®患者登记处中确定接受 SBRT 治疗的肝转移瘤患者。评估与治疗结局相关的患者、肿瘤和治疗特征。剂量分割被归一化为 BED。使用 Kaplan-Meier 分析和对数秩检验评估总生存（OS）和局部控制（LC）。
结果
该研究纳入了来自 25 个学术和社区为基础的中心的 427 名患有 568 个肝转移瘤的患者。中位年龄为 67 岁（31-91 岁）。结直肠癌（CRC）是最常见的原发癌。73%的患者接受过化疗。中位肿瘤体积为 40cm（1.6-877cm），中位 SBRT 剂量为 45Gy（12-60Gy），分为 3 个分割[1-5]。在中位随访 14 个月（1-91 个月）时，中位总生存（OS）为 22 个月。与肺癌（10 个月）、其他胃肠道（GI）（18 个月）和胰腺癌（6 个月）相比，CRC（27 个月）、乳腺癌（21 个月）和妇科（25 个月）转移瘤患者的中位 OS 更高（p<0.0001）。较小的肿瘤体积（<40cm）与 OS 改善相关（25 个月比 15 个月，p=0.0014）。BED≥100Gy 也与 OS 改善相关（27 个月比 15 个月，p<0.0001）。430 个肝转移瘤中的 324 个患者可评估局部控制（LC）。BED≥100Gy 的 2 年 LC 率更好（77.2%比 59.6%，p<0.0001），肿瘤<40cm 的中位 LC 更好（52 个月比 39 个月）。原发肿瘤的组织学与 LC 无差异。
结论
在一项接受 SBRT 治疗的肝转移瘤患者的大型多机构系列研究中，观察到合理的 LC 和 OS。OS 和 LC 取决于剂量和肿瘤体积，而 OS 则因原发肿瘤而异。在多学科管理（包括系统治疗）的背景下，有必要对来自不同原发肿瘤的肝转移瘤进行 SBRT 的作用进行前瞻性研究。
试验注册
Clinicaltrials.gov：NCT01885299。
Zotero 插件