Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea.
Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea.
Thorac Cancer. 2018 Dec;9(12):1671-1679. doi: 10.1111/1759-7714.12880. Epub 2018 Oct 8.
We compared the treatment outcomes of stereotactic body radiotherapy (SBRT) and metastasectomy in patients with pulmonary metastases.
Twenty-one patients received SBRT (total radiation doses 60 Gy in 3 fractions or 48 Gy in 4 fractions) and 30 underwent metastasectomy, most (93.3%) with wedge resection. The patients were followed for a median of 13.7 months. The tumor size in the SBRT group was larger than in the metastasectomy group (median 2.5 vs. 1.25 cm; P = 0.015). Patients with synchronous metastases were more likely to be treated with SBRT than with metastasectomy (P = 0.006).
There was no significant difference in the local control rates of the treatment groups (P = 0.163). Progression-free survival (PFS) was longer in the metastasectomy than in the SBRT group (P = 0.02), with one and two-year PFS rates of 51.1% and 46% versus 23.8% and 11.9%, respectively. The one and two-year overall survival (OS) rates were 95% and 81.8% in the metastasectomy group and 79.5% and 68.2%, in the SBRT group, respectively. In multivariate analysis, synchronous metastasis was related to poor PFS, and tumor size was the most significant factor affecting OS. There were no significant differences in PFS and OS between treatment groups after dividing patients according to the presence or absence of synchronous metastases.
SBRT is considered a suitable local modality against pulmonary metastases; however, patients with synchronous metastases are only likely to obtain a small benefit from local treatment with either SBRT or surgery.
我们比较了立体定向体部放疗（SBRT）和肺转移瘤切除术的治疗效果。
21 例患者接受 SBRT（总放射剂量 60 Gy/3 次或 48 Gy/4 次），30 例患者接受肺转移瘤切除术，其中大多数（93.3%）为楔形切除术。患者中位随访时间为 13.7 个月。SBRT 组的肿瘤大小大于肺转移瘤切除术组（中位数 2.5 厘米比 1.25 厘米；P = 0.015）。同步转移的患者更有可能接受 SBRT 治疗而不是肺转移瘤切除术（P = 0.006）。
两组治疗的局部控制率无显著差异（P = 0.163）。肺转移瘤切除术组的无进展生存率（PFS）较长（P = 0.02），1 年和 2 年 PFS 率分别为 51.1%和 46%，而 SBRT 组分别为 23.8%和 11.9%。肺转移瘤切除术组的 1 年和 2 年总生存率（OS）分别为 95%和 81.8%，SBRT 组分别为 79.5%和 68.2%。多变量分析显示，同步转移与 PFS 差有关，肿瘤大小是影响 OS 的最显著因素。根据有无同步转移将患者分组后，两组间的 PFS 和 OS 无显著差异。
SBRT 被认为是治疗肺转移瘤的一种合适的局部方法；然而，对于同步转移的患者，SBRT 或手术局部治疗仅可能获得较小的获益。
