Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Department of Radiation Oncology, Ningbo Medical Center, Lihuili Eastern Hospital, Ningbo, China.
Radiother Oncol. 2020 Apr;145:178-185. doi: 10.1016/j.radonc.2020.01.010. Epub 2020 Feb 7.
BACKGROUND & PURPOSE: Stereotactic ablative radiation therapy (SABR) is an emerging treatment option for patients with pulmonary metastases; identifying patients who would benefit from SABR can improve outcomes.
MATERIALS & METHODS: We retrospectively analyzed local failure (LF), distant failure (DF), overall survival (OS), and toxicity in 317 patients with 406 pulmonary metastases treated with SABR in January 2006-September 2017 at a tertiary cancer center.
Median follow-up time was 23 months. Primary adrenal, colorectal, sarcoma, or pancreatic ("less responsive") tumors led to high rates of LF. LF rates for patients with less responsive vs. responsive tumors were 4.6% vs. 1.6% at 12 months and 12.8% vs. 3.9% at 24 months (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.11-0.73; Log-Rank P = 0.0087). A nomogram for 24-month local control was created using Cox multivariate factors (surgical history, planning target volume, primary disease site, lung lobe location). Treating patients with ≤3 pulmonary metastases vs. >3 pulmonary metastases was associated with improved 24-month (74.2% vs. 59.3%) and 48-month (47.7% vs. 35.1%) OS (HR 0.66, 95% CI 0.47-0.95; Log-Rank P = 0.043), and reduced 12-month (22.5% vs. 50.8%) and 24-month (31.8% vs. 61.4%) intrathoracic DF (HR 0.53, 95% CI 0.38-0.74; Log-Rank P < 0.0001). The most common toxicity was asymptomatic pneumonitis (14.8%). Six patients had grade 3 events (5 pneumonitis, 1 brachial plexus).
SABR for pulmonary metastases was effective and well tolerated. Irradiating limited intrathoracic sites of disease led to improved OS and intrathoracic DM. Higher SABR doses or surgery could be considered for less radio-responsive primary tumors.
立体定向消融放疗（SABR）是一种治疗肺转移瘤的新兴治疗方法；识别可能从 SABR 中获益的患者可以改善结局。
我们回顾性分析了 2006 年 1 月至 2017 年 9 月在一家三级癌症中心接受 SABR 治疗的 317 例 406 个肺转移瘤患者的局部失败（LF）、远处失败（DF）、总生存（OS）和毒性。
中位随访时间为 23 个月。原发肾上腺、结直肠、肉瘤或胰腺（“反应较差”）肿瘤导致 LF 发生率较高。反应较差和反应较好的肿瘤患者的 LF 率在 12 个月时分别为 4.6%和 1.6%，在 24 个月时分别为 12.8%和 3.9%（风险比[HR]0.29，95%置信区间[CI]0.11-0.73；对数秩 P=0.0087）。使用 Cox 多因素（手术史、计划靶区、原发疾病部位、肺叶位置）创建了 24 个月局部控制的列线图。与治疗≤3 个肺转移灶的患者相比，治疗>3 个肺转移灶的患者 24 个月（74.2%比 59.3%）和 48 个月（47.7%比 35.1%）OS 得到改善（HR0.66，95%CI0.47-0.95；对数秩 P=0.043），12 个月（22.5%比 50.8%）和 24 个月（31.8%比 61.4%）的胸内 DF 减少（HR0.53，95%CI0.38-0.74；对数秩 P<0.0001）。最常见的毒性是无症状性肺炎（14.8%）。6 例患者出现 3 级事件（5 例肺炎，1 例臂丛神经）。
SABR 治疗肺转移瘤有效且耐受性良好。照射有限的胸内病变部位可改善 OS 和胸内 DM。对于反应较差的原发性肿瘤，可以考虑更高的 SABR 剂量或手术。
