Schröder Christina, Opitz Isabelle, Guckenberger Matthias, Stahel Rolf, Weder Walter, Förster Robert, Andratschke Nicolaus, Lauk Olivia
Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Front Oncol. 2019 Sep 26;9:961. doi: 10.3389/fonc.2019.00961. eCollection 2019.
Therapy options for patients with oligoprogressive malignant pleural mesothelioma (MPM) are limited. Stereotactic Body Radiotherapy (SBRT) may be a promising therapeutic option, as it delivers a localized ablative dose of radiation and therefore balances efficacy and treatment related toxicities. The intent of this retrospective analysis was to evaluate the feasibility of SBRT for limited pleural recurrences. This retrospective single-institution study is based on the 21 consecutive patients treated with hypofractionated radiotherapy for oligoprogressive MPM. Clinical and radiological data was collected at regular follow-up visits including toxicity, local control and survival. At primary diagnosis, 57% of the patients presented with stage III disease. Initial treatment of MPM consisted of induction chemotherapy ( = 12) prior to a macroscopic complete resection ( = 18). Three patients received additional intracavitary chemotherapy and another three patients were treated with chemotherapy alone without another treatment at the time of first diagnosis. A total of 50 lesions in recurrent MPM were treated with SBRT. The median number of radiotherapy fractions was 5 (range 3-20) with a median dose per fraction of 5 Gy (range 2.5-12.5 Gy). The median total treatment dose was 30 Gy (20-50 Gy) with a median prescription isodose line (IDL) of 65% (65-100%). Median follow-up of all patients from diagnosis was 28 months (range 7-152 months). Analyzing all lesions separately, the 12-months-local control from SBRT was 73.5%. The median progression free survival (PFS) after SBRT was 6 months (range 0-21 months) and the median OS from first first SBRT was 29 months (range 0-61 months). Only one patients experienced above Grade 3 toxicities. This analysis demonstrates the feasibility of a SBRT approach for oligorecurrent MPM. SBRT was well-tolerated even after multiple repetitions and local control was high with a promising median OS.
寡进展性恶性胸膜间皮瘤（MPM）患者的治疗选择有限。立体定向体部放疗（SBRT）可能是一种有前景的治疗选择，因为它能给予局部消融剂量的辐射，从而平衡疗效和治疗相关毒性。这项回顾性分析的目的是评估SBRT治疗局限性胸膜复发的可行性。这项回顾性单机构研究基于21例接受低分割放疗治疗寡进展性MPM的连续患者。在定期随访中收集临床和放射学数据，包括毒性、局部控制和生存情况。初诊时，57%的患者为Ⅲ期疾病。MPM的初始治疗包括在宏观完全切除（n = 18）之前进行诱导化疗（n = 12）。3例患者接受了额外的腔内化疗，另外3例患者在首次诊断时仅接受化疗而未接受其他治疗。复发性MPM中共有50个病灶接受了SBRT治疗。放疗分割次数的中位数为5次（范围3 - 20次），每次分割的中位剂量为5 Gy（范围2.5 - 12.5 Gy）。总治疗剂量的中位数为30 Gy（20 - 50 Gy），中位处方等剂量线（IDL）为65%（65 - 100%）。所有患者从诊断开始的中位随访时间为28个月（范围7 - 152个月）。单独分析所有病灶，SBRT的12个月局部控制率为73.5%。SBRT后的中位无进展生存期（PFS）为6个月（范围0 - 21个月），首次SBRT后的中位总生存期（OS）为29个月（范围0 - 61个月）。只有1例患者出现3级以上毒性反应。该分析证明了SBRT治疗寡复发性MPM的可行性。即使多次重复治疗，SBRT的耐受性也良好，局部控制率高，中位OS前景良好。
