BC Cancer-Centre for the North, Prince George, British Columbia, Canada.
VU University Medical Center, Amsterdam, Netherlands.
Int J Radiat Oncol Biol Phys. 2019 Dec 1;105(5):943-947. doi: 10.1016/j.ijrobp.2019.08.041. Epub 2019 Aug 27.
Randomized data assessing the longitudinal quality of life (QoL) impact of stereotactic ablative radiation therapy (SABR) in the oligometastatic setting are lacking.
We enrolled patients who had a controlled primary malignancy with 1 to 5 metastatic lesions, with good performance status and life expectancy >6 months. We randomized in a 1:2 ratio between standard of care (SOC) treatment (SOC arm) and SOC plus SABR to all metastatic lesions (SABR arm). QoL was measured using the Functional Assessment of Cancer Therapy-General. QoL changes over time and between groups were assessed with linear mixed modeling.
Ninety-nine patients were randomized. Median age was 68 years (range, 43-89), and 60% were male. The most common primary tumor types were breast (n = 18), lung (n = 18), colorectal (n = 18), and prostate (n = 16). Most patients (n = 92) had 1 to 3 metastases. Median follow-up was 26 months. Because of the previously reported inferior survival of the SOC arm, the time for attrition in QoL respondents to <10% of subjects was shorter in the SOC versus SABR arm (30 vs 42 months). In the whole cohort, QoL declined over time after randomization: There were significant declines in total Functional Assessment of Cancer Therapy-General score over time compared with baseline (P < .001) owing to declines in physical and functional subscales (both P < .001), with no declines in social and emotional subscales. However, the magnitudes of decline were small, and clinically meaningful changes were not seen at most time points. Comparison between arms showed no differences in QoL between the SABR and SOC arms in total score (P = .42) or in the physical (P = .98), functional (P = .59), emotional (P = .82), or social (P = .17) subscales.
For patients with oligometastases, average QoL declines slowly over time regardless of treatment approach, although the changes are small in magnitude. The use of SABR, compared with SOC, was not associated with a QoL detriment.
缺乏评估立体定向消融放疗（SABR）在寡转移情况下对生活质量（QoL）长期影响的随机数据。
我们纳入了患有 1 至 5 个转移病灶、表现状态良好且预期寿命 >6 个月的原发性肿瘤得到控制的患者。我们以 1:2 的比例随机分为标准治疗（SOC）治疗组（SOC 组）和 SOC 加 SABR 治疗所有转移病灶组（SABR 组）。使用癌症治疗功能评估一般量表（Functional Assessment of Cancer Therapy-General）测量 QoL。使用线性混合模型评估随时间和组间的 QoL 变化。
99 名患者被随机分组。中位年龄为 68 岁（范围，43-89），60%为男性。最常见的原发肿瘤类型为乳腺癌（n=18）、肺癌（n=18）、结直肠癌（n=18）和前列腺癌（n=16）。大多数患者（n=92）有 1 至 3 个转移病灶。中位随访时间为 26 个月。由于 SOC 组先前报告的生存情况较差，SOC 组中 QoL 应答者流失至<10%受试者的时间短于 SABR 组（30 个月比 42 个月）。在整个队列中，随机分组后 QoL 随时间下降：与基线相比，总癌症治疗功能评估量表得分随时间显著下降（P<.001），这是由于身体和功能子量表下降（均 P<.001），而社会和情感子量表没有下降。然而，下降幅度较小，在大多数时间点都没有看到有临床意义的变化。组间比较显示，SABR 组与 SOC 组在总分（P=.42）或身体（P=.98）、功能（P=.59）、情感（P=.82）或社会（P=.17）子量表上的 QoL 均无差异。
对于寡转移患者，无论治疗方法如何，平均 QoL 随时间缓慢下降，尽管变化幅度较小。与 SOC 相比，使用 SABR 与 QoL 无损害相关。
