立体定向机器人全身放射治疗寡发性肺转移瘤患者。
Stereotactic robotic body radiotherapy for patients with oligorecurrent pulmonary metastases.
机构信息
Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Radiation Oncology, University Hospital of Liège, Avenue de L'Hòpital 1, 4000, Liège, Belgium.
出版信息
BMC Cancer. 2020 May 8;20(1):402. doi: 10.1186/s12885-020-06906-1.
BACKGROUND
Our aim is to report treatment efficacy and toxicity of patients treated by robotic (Cyberknife®) stereotactic body radiotherapy (SBRT) for oligorecurrent lung metastases (ORLM). Additionally we wanted to evaluate influence of tumor, patient and treatment related parameters on local control (LC), lung and distant progression free- (lung PFS/Di-PFS) and overall survival (OS).
METHODS
Consecutive patients with up to 5 ORLM (confirmed by FDG PET/CT) were included in this study. Intended dose was 60Gy in 3 fractions (prescribed to the 80% isodose volume). Patients were followed at regular intervals and tumor control and toxicity was prospectively scored. Tumor, patient and treatment data were analysed using competing risk- and Cox regression.
RESULTS
Between May 2010 and March 2016, 104 patients with 132 lesions were irradiated from primary lung carcinoma (47%), gastro-intestinal (34%) and mixed primary histologies (19%). The mean tumor volume was 7.9 cc. After a median follow up of 22 months, the 1, 2 and 3 year LC rate (per lesion) was 89.3, 80.0 and 77.8% respectively. The corresponding (per patient) 1, 2 and 3 years lung PFS were 66.3, 50.0, 42.6%, Di-PFS were 80.5, 64.4, 60.6% and OS rates were 92.2, 80.9 and 72.0% respectively. On univariable analysis, gastro-intestinal (GI) as primary tumor site showed a significant superior local control versus the other primary tumor sites. For OS, significant variables were primary histology and primary tumor site with a superior OS for patients with metastases of primary GI origin. LC was significantly affected by the tumor volume, physical and biologically effective dose coverage. Significant variables in multivariable analysis were BED prescription dose for LC and GI as primary site for OS. The vast majority of patients developed no toxicity or grade 1 acute and late toxicity. Acute and late grade 3 radiation pneumonitis (RP) was observed in 1 and 2 patients respectively. One patient with a centrally located lesion developed grade 4 RP and died due to possible RT-induced pulmonary hemorrhage.
CONCLUSIONS
SBRT is a highly effective local therapy for oligorecurrent lung metastases and could achieve long term survival in patients with favourable prognostic features.
背景
我们的目的是报告接受机器人（Cyberknife®）立体定向体放射治疗（SBRT）治疗寡发性肺转移瘤（ORLM）的患者的治疗效果和毒性。此外，我们还评估了肿瘤、患者和治疗相关参数对局部控制（LC）、肺和远处无进展生存（lung PFS/Di-PFS）和总生存（OS）的影响。
方法
连续纳入了最多 5 个 OLRM（通过 FDG PET/CT 证实）的患者。靶区剂量为 60Gy/3 次（处方剂量为 80%等剂量曲线包绕体积）。患者定期随访，前瞻性地对肿瘤控制和毒性进行评分。使用竞争风险和 Cox 回归分析肿瘤、患者和治疗相关数据。
结果
2010 年 5 月至 2016 年 3 月，104 例患者共 132 个病灶接受了治疗，其中原发肺癌（47%）、胃肠道（34%）和混合原发组织学（19%）。肿瘤平均体积为 7.9cc。中位随访 22 个月后，每处病灶的 1、2 和 3 年 LC 率分别为 89.3%、80.0%和 77.8%。相应的（每例患者）1、2 和 3 年的肺 PFS 分别为 66.3%、50.0%、42.6%，Di-PFS 分别为 80.5%、64.4%、60.6%，OS 率分别为 92.2%、80.9%和 72.0%。单变量分析显示，胃肠道（GI）作为原发肿瘤部位与其他原发肿瘤部位相比具有显著的局部控制优势。对于 OS，显著的变量是原发组织学和原发肿瘤部位，GI 起源的转移患者的 OS 较好。LC 显著受肿瘤体积、物理和生物有效剂量覆盖的影响。多变量分析中显著的变量是 LC 的 BED 处方剂量和 OS 的 GI 作为原发部位。绝大多数患者没有发生毒性或 1 级急性和晚期毒性。1 例患者出现急性和 1 例患者出现晚期 3 级放射性肺炎（RP）。1 例中央性病变患者发生 4 级 RP，可能因 RT 诱导的肺出血而死亡。
结论
SBRT 是治疗寡发性肺转移瘤的一种非常有效的局部治疗方法，可为具有有利预后特征的患者带来长期生存。
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