He Xiaofeng, Zhang Pengfei, Li Zhiping, Bi Feng, Xu Feng, Wang Xin, Shen Yali, Li Qiu, Qiu Meng
Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University.
Department of Medical Oncology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China.
Medicine (Baltimore). 2018 Oct;97(40):e12601. doi: 10.1097/MD.0000000000012601.
The purpose of the present study was to investigate the efficacy and safety of radiotherapy for patients with oligometastases from colorectal cancer (CRC).This was a retrospective cross-sectional study. Patients with liver and/or lung oligometastatic lesions from CRC treated with curative-intent radiotherapy in West China Hospital, Sichuan University, between 2009 and 2013 were included. Radiotherapy modality included 3-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and stereotactic body radiation therapy (SBRT); simultaneous chemotherapies along with radiotherapy of metastasis were allowed. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Local control (LC) rates, toxicities, and factors of prognostic significance were also assessed.A total of 40 CRC patients with 57 liver and/or lung oligometastatic lesions were included. Most of the patients (95%) had received at least 1 line of previous systemic chemotherapy. Among them, 19 patients with 26 lesions received 3D-CRT with a median dose of 51.5 Gy in 16.1 fractions, 7 patients with 11 lesions received IMRT with a median dose of 49.3 Gy in 10.4 fractions, and 14 patients with 20 lesions received SBRT with a median dose of 56.4 Gy in 6.7 fractions, respectively. The median follow-up time was 34 months (range, 9-86 months). Median OS and PFS for patients were 30.0 months [95% confidence interval (95% CI), 21.3-38.7] and 11.0 months (95% CI, 9-13), respectively. One, 3, and 5 years' LC rates for metastasis were 63.2%, 24.6%, and 16.9%, respectively. In subgroup analysis, patients with metachronous metastases had longer OS (median, 41.0 months; 95% CI, 33.3-48.7) than patients with synchronous lesions (median, 17.0 months; 95% CI, 7.4-26.6, P = .001). All patients tolerated the radiation treatment well, and there was no treatment-related death. Multivariate analysis showed that number of metastasis lesions and simultaneous liver and lung metastases were potential survival predictors.The study demonstrated that curative radiotherapy might be a tolerable and potential alternative for the treatment of patients with liver and/or lung oligometastases from CRC, and patients with metachronous lesions might have better survival than those with synchronous lesions when treated with curative-intent radiotherapy.
本研究的目的是调查放射治疗对结直肠癌（CRC）寡转移患者的疗效和安全性。这是一项回顾性横断面研究。纳入了2009年至2013年期间在四川大学华西医院接受根治性放疗的CRC肝和/或肺寡转移病变患者。放疗方式包括三维适形放疗（3D-CRT）、调强放疗（IMRT）和立体定向体部放疗（SBRT）；允许在转移灶放疗的同时进行化疗。采用Kaplan-Meier法计算总生存期（OS）和无进展生存期（PFS）。还评估了局部控制（LC）率、毒性和预后相关因素。
共纳入40例CRC患者，有57个肝和/或肺寡转移灶。大多数患者（95%）此前至少接受过1线全身化疗。其中，19例患者的26个病灶接受了3D-CRT，中位剂量为51.5 Gy，分16.1次；7例患者的11个病灶接受了IMRT，中位剂量为49.3 Gy，分10.4次；14例患者的20个病灶接受了SBRT，中位剂量为56.4 Gy，分6.7次。中位随访时间为34个月（范围9 - 86个月）。患者的中位OS和PFS分别为30.0个月[95%置信区间（95%CI），21.3 - 38.7]和11.0个月（95%CI，9 - 13）。转移灶的1年、3年和5年LC率分别为63.2%、24.6%和16.9%。亚组分析显示，异时性转移患者的OS（中位值41.0个月；95%CI，33.3 - 48.7）长于同时性病灶患者（中位值17.0个月；95%CI，7.4 - 26.6，P = 0.001）。所有患者对放疗耐受性良好，且无治疗相关死亡。多因素分析显示转移灶数量以及同时存在肝和肺转移是潜在的生存预测因素。
该研究表明，根治性放疗可能是治疗CRC肝和/或肺寡转移患者的一种可耐受的潜在替代方法，接受根治性放疗时，异时性病灶患者可能比同时性病灶患者有更好的生存。
