Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy.
Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
Radiother Oncol. 2018 Dec;129(3):427-434. doi: 10.1016/j.radonc.2018.06.035. Epub 2018 Jul 9.
While surgery is the preferred option for isolated, operable liver metastases from colorectal cancer (CRC), ablative techniques are endorsed for medically or technically inoperable lesions. Stereotactic body radiotherapy (SBRT) is an alternative ablative local therapy that delivers high RT doses in a few fractions to the cancer, sparing surrounding critical tissue. We have performed a systematic review of published trials to evaluate the efficacy of SBRT as a primary modality therapy for CRC liver oligometastases.
We searched the Cochrane Central Register of Controlled Trials, Pubmed, and EMBASE for publications regarding SBRT for CRC liver metastases. Overall survival (OS: median, 1- and 2-year OS %) was the primary endpoint, and median PFS and one- and two-year local control (LC) were the secondary endpoints. A random-effect model pooled-analysis was performed to calculate the aggregated OS rates at 1 and 2 years as well as the one- and two-year LC.
A total of 18 studies, encompassing 656 patients, were included in the analysis. The pooled one- and two-year OS were 67.18% (95% CI, 42.1-92.2) and 56.5% (95% CI, 36.7-76.2), respectively. Median PFS and OS were 11.5 and 31.5 months. The pooled one-year LC was 67% (95% CI, 43.8-90.2), while the pooled two-year LC was 59.3% (95% CI, 37.2-81.5). Correlation analysis revealed a moderate/poor linear relationship between the SBRT (BED10) dose and LC (p = 0.001, R = 0.47)/OS (p = 0.001, R = 0.29) at 2 years. Mild-moderate and severe liver toxicity were 30.7% and 8.7%.
SBRT for liver oligometastases is an effective option for patients with advanced CRC, with encouraging local control and survival. However, a definitive validation in large randomised studies is required, due to the retrospective or non-randomised nature of the included studies and the limitations of series with different doses/schedules of treatment.
虽然手术是治疗结直肠癌（CRC）孤立性可切除肝转移的首选方法，但消融技术也适用于有医学或技术原因不能手术的病变。立体定向体部放射治疗（SBRT）是一种替代的消融局部治疗方法，它以较少的分次给予癌症高剂量放射治疗，同时保护周围的关键组织。我们对已发表的试验进行了系统评价，以评估 SBRT 作为 CRC 肝寡转移的主要治疗方法的疗效。
我们在 Cochrane 对照试验中心注册库、PubMed 和 EMBASE 中检索了关于 CRC 肝转移 SBRT 的文献。总生存期（OS：中位数、1 年和 2 年 OS%）是主要终点，而中位无进展生存期（PFS）和 1 年及 2 年局部控制率（LC）是次要终点。采用随机效应模型进行汇总分析，以计算 1 年和 2 年的累积 OS 率以及 1 年和 2 年的 LC。
共纳入 18 项研究，共计 656 例患者。汇总分析的 1 年和 2 年 OS 率分别为 67.18%（95%CI，42.1-92.2）和 56.5%（95%CI，36.7-76.2）。中位 PFS 和 OS 分别为 11.5 个月和 31.5 个月。1 年 LC 的汇总率为 67%（95%CI，43.8-90.2），2 年 LC 的汇总率为 59.3%（95%CI，37.2-81.5）。相关性分析显示，SBRT（BED10）剂量与 2 年时的 LC（p=0.001，R=0.47）/OS（p=0.001，R=0.29）之间存在中度/差线性关系。肝脏毒性为轻度至中度 30.7%，重度 8.7%。
SBRT 治疗肝寡转移是晚期 CRC 患者的有效治疗选择，具有令人鼓舞的局部控制和生存获益。然而，由于纳入研究的回顾性或非随机性，以及不同剂量/方案治疗系列的局限性，需要在大型随机研究中进行明确验证。
