Department of Radiation Oncology, University of California San Francisco, California.
Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.
Int J Radiat Oncol Biol Phys. 2020 May 1;107(1):48-61. doi: 10.1016/j.ijrobp.2020.01.017. Epub 2020 Jan 27.
To perform a systematic review and pooled meta-analysis of adrenal metastasis stereotactic body radiation therapy (SBRT) outcomes, treatment characteristics, and toxicity to define the efficacy and propose guidelines for intervention.
We performed a comprehensive literature search of the Embase and PubMed databases of studies reporting outcome or toxicity data for photon-based SBRT of adrenal metastases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then conducted a meta-analysis to estimate pooled overall response, local control (LC), and overall survival and analyzed these outcomes in the context of dosimetric parameters and toxicity using metaregression.
Thirty-nine studies published between 2009 and 2019 reporting outcomes on 1006 patients were included. The median follow-up was 12 months, and the median biological equivalent dose (BED10, alpha/beta = 10) was 67 Gy. The pooled overall response was 54.6% (95% confidence interval [CI], 46.5%-62.5%). The pooled 1- and 2-year rates of LC were 82% (95% CI, 74%-88%) and 63% (95% CI, 50%-74%), respectively, and the pooled 1- and 2-year overall survival rates were 66% (95% CI, 57%-74%) and 42% (95% CI, 31%-53%), respectively. There was a strong positive association between SBRT dose and 1- and 2-year LC (P < .0001, P = .0002) and an association with 2-year OS (P = .03). Based on a metaregression of dose and LC, BED10 of 60 Gy, 80 Gy, and 100 Gy predicted 1-year LC of 70.5%, 84.8%, and 92.9% and 2-year LC of 47.8%, 70.1%, and 85.6%, respectively. The overall rate of grade 3 or higher toxicity was 1.8%.
SBRT of adrenal metastases provides good 1-year LC with an excellent safety profile, and dose escalation may be associated with improved LC. Prospective studies are needed to validate these findings and determine whether there are subsets of patients for whom adrenal metastasis-directed SBRT may confer a survival advantage.
对立体定向体部放射治疗（SBRT）肾上腺转移瘤的结果、治疗特点和毒性进行系统回顾和荟萃分析，以确定疗效，并提出干预指南。
我们按照系统评价和荟萃分析的首选报告项目的规定，对 Embase 和 PubMed 数据库进行了全面的文献检索，以检索报告光子 SBRT 治疗肾上腺转移瘤的结果或毒性数据的研究。然后，我们进行了荟萃分析，以估计总体反应、局部控制（LC）和总生存率的汇总，并使用元回归分析这些结果与剂量学参数和毒性之间的关系。
共纳入了 2009 年至 2019 年期间发表的 39 项研究，这些研究共报告了 1006 例患者的结果。中位随访时间为 12 个月，中位生物等效剂量（BED10，α/β=10）为 67Gy。汇总的总体反应率为 54.6%（95%置信区间，46.5%-62.5%）。1 年和 2 年的 LC 率分别为 82%（95%置信区间，74%-88%）和 63%（95%置信区间，50%-74%），1 年和 2 年的总生存率分别为 66%（95%置信区间，57%-74%）和 42%（95%置信区间，31%-53%）。SBRT 剂量与 1 年和 2 年 LC 之间存在很强的正相关（P<0.0001，P=0.0002），与 2 年 OS 相关（P=0.03）。基于剂量和 LC 的元回归分析，BED10 为 60Gy、80Gy 和 100Gy 预测 1 年 LC 分别为 70.5%、84.8%和 92.9%，2 年 LC 分别为 47.8%、70.1%和 85.6%。总的 3 级或更高毒性发生率为 1.8%。
肾上腺转移瘤的 SBRT 提供了良好的 1 年 LC，具有极好的安全性，并且剂量递增可能与改善 LC 相关。需要前瞻性研究来验证这些发现，并确定是否有特定的患者亚群，肾上腺转移定向 SBRT 可能为其带来生存优势。
