立体定向体部放疗（SBRT）治疗肺癌肾上腺转移的短期疗效和临床疗效。
Short-term outcomes and clinical efficacy of stereotactic body radiation therapy (SBRT) in treatment of adrenal gland metastases from lung cancer.
机构信息
Department of Radiation Oncology, Shanghai Changhai Hospital, the Second Military Medical University, Shanghai, 200433, China.
Department of Radiology, Shanghai Changhai Hospital, the Second Military Medical University, Shanghai, 200433, China.
出版信息
Radiat Oncol. 2018 Oct 22;13(1):205. doi: 10.1186/s13014-018-1152-5.
BACKGROUND
To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) in the management of adrenal gland metastases (AGMs) from lung cancer. Moreover, it is the first two-institutional experience and the largest-to-date study to report the safety and efficacy of SBRT for inoperable AGM from lung cancer.
METHODS
In this retrospective study, 30 patients (27 males, 3 females) with 32 AGMs were treated by SBRT from October 2006 to June 2016. Of these, 11 patients were treated with the intent of controlling all known metastatic sites and 19 for palliation of bulky AGMs. Follow-up was performed every 3 months for evaluations of efficacy and safety. Factors predictive of overall survival (OS) and local control (LC) were identified with univariate and then multivariate analysis.
RESULTS
Median follow-up time was 10.7 months (2.9-96.4 months). The complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) rates were 23.3%, 33.3%, 33.3% and 16.7% respectively. The 6-month, 1, and 2-year LC rates were 96.9%, 96.9%, and 72.7% respectively. Additionally, the 6-month, 1, and 2-year OS rates were 85.6%, 58.1%, and 54.0% respectively while 6-month, 1, and 2-year progression free survival (PFS) rates were 39.5%, 24.6%, and 8.2%, respectively. All the patients with cancer-induced pain (8 with abdominal pain and 6 with lumbar back pain) had significant alleviations after SBRT. The treatment was well tolerated with only 1 patient reporting grade-3 diarrhoea. No predictors of OS and LC were found after multivariate analysis, while it was demonstrated that biologic equivalent dose (BED, α/β = 10) ≥85.5Gy (P = 0.007) and gross tumor volume < 30 ml (P = 0.003) correlated with LC only after univariate analysis.
CONCLUSION
SBRT is a safe and effective treatment modality in the management of AGMs from lung cancer with high LC rates and acceptable toxicity.
背景
评估立体定向体放射治疗（SBRT）在肺癌肾上腺转移瘤（AGM）管理中的疗效和安全性。此外，这是首例两家机构的经验，也是迄今为止报告 SBRT 治疗不可切除肺癌 AGM 安全性和疗效的最大研究。
方法
在这项回顾性研究中，2006 年 10 月至 2016 年 6 月期间，30 名（27 名男性，3 名女性）患有 32 个 AGM 的患者接受了 SBRT 治疗。其中，11 名患者的治疗意图是控制所有已知的转移部位，19 名患者的治疗意图是缓解大体积的 AGM。每 3 个月进行一次随访，以评估疗效和安全性。使用单因素和多因素分析确定总生存（OS）和局部控制（LC）的预测因素。
结果
中位随访时间为 10.7 个月（2.9-96.4 个月）。完全缓解（CR）、部分缓解（PR）、稳定疾病（SD）和进展疾病（PD）的比例分别为 23.3%、33.3%、33.3%和 16.7%。6 个月、1 年和 2 年的 LC 率分别为 96.9%、96.9%和 72.7%。此外，6 个月、1 年和 2 年的 OS 率分别为 85.6%、58.1%和 54.0%，而 6 个月、1 年和 2 年的无进展生存率（PFS）分别为 39.5%、24.6%和 8.2%。所有因癌症引起疼痛的患者（8 例腹痛，6 例腰痛）在 SBRT 后均有明显缓解。只有 1 例患者报告出现 3 级腹泻，治疗耐受性良好。多因素分析未发现 OS 和 LC 的预测因素，而单因素分析显示，生物等效剂量（BED，α/β=10）≥85.5Gy（P=0.007）和大体肿瘤体积（GTV）<30ml（P=0.003）与 LC 相关。
结论
SBRT 是治疗肺癌 AGM 的一种安全有效的治疗方法，具有较高的 LC 率和可接受的毒性。
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