Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zürich, Switzerland.
Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Strahlenther Onkol. 2019 Mar;195(3):199-206. doi: 10.1007/s00066-018-01422-5. Epub 2019 Feb 8.
Stereotactic body radiotherapy (SBRT) is increasingly used in metastasized patients receiving targeted/immunotherapy. Information on safety and effectivity of concurrent SBRT and targeted/immunotherapy remains limited, resulting in a lack of consensus on treatment strategies. This study aimed to investigate how SBRT-experienced centers in German-speaking countries combine both therapies.
Patterns-of-care of combined treatment with SBRT and targeted/immunotherapy were assessed in 27 radiation oncology centers (19 German, 1 Austrian and 7 Swiss centers). A survey was performed to analyze the details of SBRT, SBRT planning and combined modality treatment. Consensus was defined as ≥75% agreement among participants.
Most participants (60%) were university centers. SBRT for oligometastases has been performed since the year 2008 (median, range 1997-2016), since then a median of 140 cases (5-1100) of SBRT have been performed. In all, 67% performed concurrent SBRT and targeted agents. BRAF inhibitors and VEGF/EGFR inhibitors (bevacizumab [90%], erlotinib [11%], sorafenib [19%], lapatinib [4%]) were considered a contraindication. Bevacizumab was never given simultaneously with SBRT; other agents were given concurrently in 7-52% of centers. A majority (59%) paused targeted agents 1 week before/after SBRT. Only 1 center reduced SBRT dose when combined with targeted agents.
Although evidence for safety and efficacy of concurrent SBRT and targeted agents is limited, it is regularly performed outside of clinical trials. The survey showed consensus not to combine SBRT with antiangiogenic agents, especially bevacizumab. Furthermore, SBRT with concurrent BRAF inhibitors should be practiced with caution and BRAF inhibitors should be paused at least 1 week before SBRT.
立体定向体放射治疗（SBRT）在接受靶向/免疫治疗的转移性患者中越来越多地使用。关于同时进行 SBRT 和靶向/免疫治疗的安全性和有效性的信息仍然有限，导致治疗策略缺乏共识。本研究旨在调查德语国家的 SBRT 经验丰富的中心如何结合这两种治疗方法。
在 27 个放射肿瘤学中心（19 个德国、1 个奥地利和 7 个瑞士中心）评估了 SBRT 和靶向/免疫联合治疗的治疗模式。进行了一项调查，以分析 SBRT、SBRT 计划和联合治疗模式的细节。共识定义为参与者之间≥75%的一致性。
大多数参与者（60%）为大学中心。寡转移 SBRT 自 2008 年以来一直在进行（中位数，范围 1997-2016），自那时以来，已进行了中位数为 140 例（5-1100）的 SBRT。所有患者中有 67%同时进行 SBRT 和靶向药物治疗。BRAF 抑制剂和 VEGF/EGFR 抑制剂（贝伐单抗[90%]、厄洛替尼[11%]、索拉非尼[19%]、拉帕替尼[4%]）被认为是禁忌证。贝伐单抗从未与 SBRT 同时使用；其他药物在 7-52%的中心同时使用。大多数（59%）在 SBRT 前/后 1 周暂停靶向药物治疗。只有 1 个中心在与靶向药物联合使用时降低了 SBRT 剂量。
尽管同时进行 SBRT 和靶向药物治疗的安全性和有效性证据有限，但它在临床试验之外经常进行。该调查显示，共识是不将 SBRT 与抗血管生成药物（尤其是贝伐单抗）联合使用。此外，应谨慎进行 SBRT 联合 BRAF 抑制剂治疗，并且至少在 SBRT 前 1 周暂停 BRAF 抑制剂治疗。
