Deck Jared, Eastwick Gary, Sima Jody, Raymond Amanda, Bogart Jeffrey, Aridgides Paul
Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA.
Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA.
Onco Targets Ther. 2019 May 15;12:3723-3727. doi: 10.2147/OTT.S194812. eCollection 2019.
To report a case series of 3 pediatric patients treated with Stereotactic Body Radiation Therapy (SBRT) for lung metastases. Three patients (ages 9, 11, and 21) received SBRT for rhabdoid tumor, Ewing sarcoma, and Wilms tumor histologies, respectively. SBRT doses were 37.5-50 Gy in 3-5 fractions treating twelve lesions. Three patients (ages 9, 11, and 21) received photon SBRT for pulmonary metastases. The patients were as follows: 1) 21-year-old male with favorable histology Wilms tumor and 1 lesion treated, 2) 11-year-old female with Ewing sarcoma and 1 lesion treated for relapse after previous whole lung radiation (15 Gy), and 3) 9-year-old female with rhabdoid tumor of the left thigh with 10 lesions treated over a two-year period. Median dose delivered was 40 Gy (range, 37.5-50 Gy), delivered in a median of 4 fractions (range, 4-5) of a median of 10 Gy per fraction (range, 9.4-10 Gy). Within a minimum follow-up of 1.9 years (range 1.9-4 years), local control for all 13 treated metastases is 100% without any observed acute toxicities. One possible late toxicity (grade 2 rib fracture) developed 1.3 years following SBRT for treatment of a peripheral lesion (rhabdoid tumor) in an area of disease progression and was managed conservatively. Two patients are surviving 2.9 years (Wilms tumor) and 1.9 years (Ewing sarcoma) after SBRT, and one (rhabdoid tumor) expired 2 years after her final course (4 years after initial SBRT). Two patients (rhabdoid tumor and Ewing sarcoma) suffered disease progression outside of the treated lesions and one patient (Wilms tumor) is without evidence of disease and has not required whole lung irradiation or further systemic therapy. SBRT appears effective and well tolerated for pediatric lung metastases, however further studies are warranted.
报告3例接受立体定向体部放射治疗（SBRT）的小儿肺转移瘤患者的病例系列。3例患者（年龄分别为9岁、11岁和21岁）分别因横纹肌样瘤、尤因肉瘤和肾母细胞瘤组织学类型接受SBRT治疗。SBRT剂量为37.5 - 50 Gy，分3 - 5次照射12个病灶。3例患者（年龄分别为9岁、11岁和21岁）接受光子SBRT治疗肺转移瘤。患者情况如下：1）21岁男性，组织学类型良好的肾母细胞瘤，治疗1个病灶；2）11岁女性，尤因肉瘤，在先前全肺放疗（15 Gy）后复发，治疗1个病灶；3）9岁女性，左大腿横纹肌样瘤，在两年内治疗10个病灶。中位给予剂量为40 Gy（范围37.5 - 50 Gy），中位分4次给予（范围4 - 5次），每次中位剂量为10 Gy（范围9.4 - 10 Gy）。在至少1.9年（范围1.9 - 4年）的随访期内，所有13个接受治疗的转移灶局部控制率为100%，未观察到任何急性毒性反应。1例可能的晚期毒性反应（2级肋骨骨折）在SBRT治疗外周病灶（横纹肌样瘤）1.3年后出现，该区域为疾病进展部位，采取保守治疗。2例患者在SBRT后分别存活2.9年（肾母细胞瘤）和1.9年（尤因肉瘤），1例（横纹肌样瘤）在最后一次治疗后2年（初始SBRT后4年）死亡。2例患者（横纹肌样瘤和尤因肉瘤）在治疗病灶外出现疾病进展，1例患者（肾母细胞瘤）无疾病证据，无需全肺照射或进一步的全身治疗。SBRT对小儿肺转移瘤似乎有效且耐受性良好，然而仍需进一步研究。
