a Department of Radiation and Oncology , Erasmus MC-Cancer Institute , Rotterdam , The Netherlands.
b Department of Pulmonology , Erasmus MC-Cancer Institute , Rotterdam , The Netherlands.
Acta Oncol. 2019 Jan;58(1):74-80. doi: 10.1080/0284186X.2018.1521986. Epub 2018 Oct 3.
Stereotactic body radiotherapy (SBRT) for pulmonary oligometastatic disease achieves excellent treatment outcomes in terms of local control and toxicity. Patients treated with SBRT are often elderly and have multiple co-morbidities. This subset of patients may experience different survival as compared to young and fit patients subjected to radical metastasectomies. The purpose of this retrospective study was to evaluate OS and identify factors associated with OS for inoperable pulmonary oligometastases treated with SBRT.
Criteria used for selection of patients with oligometastases included: metastases limited to ≤2 organs and in total ≤5 metastases at the time of treatment. Peripheral tumors were treated with 51 Gy to 60 Gy in three fractions or a single fraction of 30 Gy. Central tumors received a dose of 45-60 Gy in 5-8 fractions. Survival probabilities were estimated by means of Kaplan-Meier method and the relation between potential prognostic factors and OS was studied by means of Cox regression analyses.
In this study, 327 inoperable pulmonary oligometastases in 206 patients were treated with SBRT from the year 2005 to 2015. Primary sites of pulmonary oligometastases included colorectal carcinoma (n = 118), lung carcinoma (n = 36), melanoma (n = 11), sarcoma (n = 10), breast carcinoma (n = 7), and other tumors sites (n = 24). Median follow-up was 26 months. Median survival was 33 months. The 2-year and 5-year OS rates were 63% and 30%, respectively. On univariate analysis synchronous oligometastases (HR 0.59) and colorectal primary (HR 0.64) were associated with improved OS. On multivariable analysis synchronous oligometastases (HR 0.56), colorectal primary (HR 0.62) and tumor size <3 cm (HR 0.68) were independently associated with OS.
SBRT to pulmonary oligometastases was associated with a 2-year OS of 63%. Tumor size <3 cm and colorectal primary tumors experienced improved OS compared to tumors >3 cm and non-colorectal primary tumors.
立体定向体部放疗（SBRT）治疗肺部寡转移病灶在局部控制和毒性方面取得了优异的治疗效果。接受 SBRT 治疗的患者通常年龄较大，合并多种疾病。与接受根治性转移切除术的年轻和健康患者相比，这部分患者的生存情况可能不同。本回顾性研究的目的是评估不可切除肺部寡转移病灶接受 SBRT 治疗后的总生存期（OS），并确定与 OS 相关的因素。
选择寡转移患者的标准包括：转移病灶局限于≤2 个器官，且治疗时转移灶总数≤5 个。外周肿瘤采用 51-60Gy 3 次分割或单次 30Gy 分割。中央肿瘤接受 45-60Gy 5-8 次分割。采用 Kaplan-Meier 法估计生存率，采用 Cox 回归分析研究潜在预后因素与 OS 的关系。
本研究纳入了 206 例患者的 327 处不可切除肺部寡转移病灶，这些病灶均接受 SBRT 治疗，时间为 2005 年至 2015 年。肺部寡转移的原发部位包括结直肠癌（n=118）、肺癌（n=36）、黑色素瘤（n=11）、肉瘤（n=10）、乳腺癌（n=7）和其他肿瘤部位（n=24）。中位随访时间为 26 个月。中位总生存期为 33 个月。2 年和 5 年 OS 率分别为 63%和 30%。单因素分析显示，同步寡转移（HR=0.59）和结直肠原发灶（HR=0.64）与 OS 改善相关。多因素分析显示，同步寡转移（HR=0.56）、结直肠原发灶（HR=0.62）和肿瘤直径<3cm（HR=0.68）与 OS 独立相关。
SBRT 治疗肺部寡转移病灶的 2 年 OS 率为 63%。肿瘤直径<3cm 和结直肠原发灶的 OS 优于肿瘤直径>3cm 和非结直肠原发灶。
