Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany.
Clin Lung Cancer. 2019 Nov;20(6):e667-e677. doi: 10.1016/j.cllc.2019.06.024. Epub 2019 Jun 27.
This multicenter study aims to analyze outcome as well as early versus late patterns of recurrence following pulmonary stereotactic body radiotherapy (SBRT) for patients with oligometastatic non-small-cell lung cancer (NSCLC).
This analysis included 301 patients with oligometastatic NSCLC treated with SBRT for 336 lung metastases. Although treatment of the primary tumor consisted of surgical resection, radiochemotherapy, and/or systemic therapy, pulmonary oligometastases were treated with SBRT.
The median follow-up time was 16.1 months, resulting in 2-year overall survival (OS), local control (LC), and distant control (DC) of 62.2%, 82.0%, and 45.2%, respectively. Multivariate analysis identified age (P = .019) and histologic subtype (P = .028), as well as number of metastatic organs (P < .001) as independent prognostic factors for OS. LC was superior for patients with favorable histologic subtype (P = .046) and SBRT with a higher biological effective dose at isocenter (P = .037), whereas DC was inferior for patients with metastases in multiple organs (P < .001) and female gender (P = .027). Early (within 24 months) local or distant progression was observed in 15.3% and 36.5% of the patients. After 24 months, the risk of late local failure was low, with 3- and 4-year local failure rates of only 4.0%, and 7.6%. In contrast, patients remained at a high risk of distant progression with 3- and 4-year failure rates of 13.3% and 24.1%, respectively, with no plateau observed.
SBRT for pulmonary oligometastatic NSCLC resulted in favorable LC and promising OS. The dominant failure pattern is distant with a continuously high risk of disease progression for many years.
本多中心研究旨在分析寡转移性非小细胞肺癌（NSCLC）患者接受立体定向体部放疗（SBRT）后的结果以及早期和晚期复发模式。
本分析纳入了 301 例接受 SBRT 治疗 336 个肺转移灶的寡转移性 NSCLC 患者。尽管治疗原发肿瘤包括手术切除、放化疗和/或全身治疗，但肺寡转移灶采用 SBRT 治疗。
中位随访时间为 16.1 个月，2 年总生存率（OS）、局部控制率（LC）和远处控制率（DC）分别为 62.2%、82.0%和 45.2%。多变量分析发现年龄（P =.019）和组织学亚型（P =.028）以及转移器官数量（P <.001）是 OS 的独立预后因素。LC 对于组织学亚型有利的患者（P =.046）和等中心生物有效剂量较高的 SBRT（P =.037）较好，而 DC 对于多器官转移的患者（P <.001）和女性患者（P =.027）较差。在 15.3%和 36.5%的患者中，24 个月内出现早期（24 个月内）局部或远处进展。24 个月后，局部失败的风险较低，3 年和 4 年局部失败率分别仅为 4.0%和 7.6%。相比之下，远处进展的风险仍然很高，3 年和 4 年的失败率分别为 13.3%和 24.1%，没有出现平台期。
SBRT 治疗肺寡转移性 NSCLC 可获得良好的 LC 和有希望的 OS。主要的失败模式是远处转移，多年来疾病进展的风险持续较高。
