Aujla Khush S, Katz Alan W, Singh Deepinder P, Okunieff Paul, Milano Michael T
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States.
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States.
Front Oncol. 2019 Feb 27;9:111. doi: 10.3389/fonc.2019.00111. eCollection 2019.
We sought to analyze the long-term follow-up of patients treated with hypofractionated, stereotactic radiotherapy (HSRT) for oligometastases from malignancies other than breast or prostate cancer. From 2001 to 2006, 82 cancer patients with 1-5 radiographically apparent metastatic lesions (in 1-3 organs) from primary sites other than breast or prostate cancer, were enrolled on a prospective study of HSRT. Freedom from widespread metastasis (FFWM) was defined from date of enrollment until death, an event (i.e., widespread distant metastasis not amenable to local therapy), or last radiographic study. Local recurrence was scored as an event if pathologically confirmed or if a treated lesion increased by ≥20% using RECIST criteria. Prognostic variables were assessed using Cox regression analysis. The mean age was 61 ± 11 years, with a male to female ratio of 46:36. The most common metastatic sites were liver (50%), lung (48%), thoracic lymph nodes (18%), and bone (5%). Sixty-one patients (74%) had 1 involved organ and 18 (22%) had 1 lesion treated. The preferred dose-fractionation scheduled was 50 Gy in 10 fractions (52 patients). The median follow-up was 1.7 years. Eleven patients lived >5 years, and 6 lived >10 years. The 5-year OS, PFS, FFWM, and LC rates were 13.4, 7.3, 18.3, and 63.4%, and the 10-years OS, PFS, FFWM, and patient LC rates were 7.3, 6.1, 13.4, and 62.2%, respectively. A greater net gross tumor volume (GTV) was significantly adverse for OS ( < 0.01) and LC ( < 0.01). For FFWM, net GTV was not a significant factor ( = 0.14). Four patients remain alive at >13 years from enrollment and treatment, without evidence of active disease. A small subset of select non-breast, non-prostate cancer patients with limited metastasis treated with HSRT are long-term survivors. Net GTV is a significant factor for tumor control and survival. Further research is needed to help better select patients most likely to benefit from local therapy for metastatic disease.
我们试图分析接受大分割立体定向放射治疗（HSRT）的非乳腺癌或前列腺癌寡转移患者的长期随访情况。2001年至2006年，82例患有1 - 5个影像学上明显转移病灶（位于1 - 3个器官）且原发部位非乳腺癌或前列腺癌的癌症患者被纳入HSRT前瞻性研究。无广泛转移生存期（FFWM）定义为从入组日期至死亡、发生某事件（即不适合局部治疗的广泛远处转移）或最后一次影像学检查的时间。如果经病理证实或使用RECIST标准治疗病灶增大≥20%，则将局部复发计为一个事件。使用Cox回归分析评估预后变量。平均年龄为61±11岁，男女比例为46:36。最常见的转移部位是肝脏（50%）、肺（48%）、胸段淋巴结（18%）和骨（5%）。61例患者（74%）有1个受累器官，18例（22%）有1个病灶接受治疗。首选的剂量分割方案是10次分割给予50 Gy（52例患者）。中位随访时间为1.7年。11例患者存活超过5年，6例存活超过10年。5年总生存期（OS）、无进展生存期（PFS）、FFWM和局部控制（LC）率分别为13.4%、7.3%、18.3%和63.4%，10年OS、PFS、FFWM和患者LC率分别为7.3%、6.1%、13.4%和62.2%。更大的肿瘤总体积（GTV）对OS（P < 0.01）和LC（P < 0.01）有显著不利影响。对于FFWM，净GTV不是一个显著因素（P = 0.14）。4例患者自入组和治疗后存活超过13年，无疾病活动证据。一小部分经HSRT治疗的非乳腺癌、非前列腺癌且转移局限的精选患者是长期幸存者。净GTV是肿瘤控制和生存的一个重要因素。需要进一步研究以更好地选择最有可能从转移性疾病的局部治疗中获益的患者。
