立体定向放疗和分次立体定向放疗治疗肺寡转移瘤患者。
Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases.
机构信息
Department of Radiation Oncology and Radiotherapy, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
出版信息
BMC Cancer. 2020 May 11;20(1):404. doi: 10.1186/s12885-020-06892-4.
BACKGROUND
Patients with oligometastatic disease can potentially be cured by using an ablative therapy for all active lesions. Stereotactic body radiotherapy (SBRT) is a non-invasive treatment option that lately proved to be as effective and safe as surgery in treating lung metastases (LM). However, it is not clear which patients benefit most and what are the most suitable fractionation regimens. The aim of this study was to analyze treatment outcomes after single fraction radiosurgery (SFRS) and fractionated SBRT (fSBRT) in patients with lung oligometastases and identify prognostic clinical features for better survival outcomes.
METHODS
Fifty-two patients with 94 LM treated with SFRS or fSBRT between 2010 and 2016 were analyzed. The characteristics of primary tumor, LM, treatment, toxicity profiles and outcomes were assessed. Kaplan-Meier and Cox regression analyses were used for estimation of local control (LC), overall survival (OS) and progression-free survival.
RESULTS
Ninety-four LM in 52 patients were treated using SFRS/fSBRT with a median of 2 lesions per patient (range: 1-5). The median planning target volume (PTV)-encompassing dose for SFRS was 24 Gy (range: 17-26) compared to 45 Gy (range: 20-60) in 2-12 fractions with fSBRT. The median follow-up time was 21 months (range: 3-68). LC rates at 1 and 2 years for SFSR vs. fSBRT were 89 and 83% vs. 75 and 59%, respectively (p = 0.026). LM treated with SFSR were significantly smaller (p = 0.001). The 1 and 2-year OS rates for all patients were 84 and 71%, respectively. In univariate analysis treatment with SFRS, an interval of ≥12 months between diagnosis of LM and treatment, non-colorectal cancer histology and BED < 100 Gy were significantly associated with better LC. However, none of these parameters remained significant in the multivariate Cox regression model. OS was significantly better in patients with negative lymph nodes (N0), Karnofsky performance status (KPS) > 70% and time to first metastasis ≥12 months. There was no grade 3 acute or late toxicity.
CONCLUSIONS
Longer time to first metastasis, good KPS and N0 predicted better OS. Good LC and low toxicity rates were achieved after short SBRT schedules.
背景
对于寡转移疾病患者，使用消融疗法治疗所有活动性病变，可能会达到根治的效果。立体定向体部放疗（SBRT）是一种非侵入性的治疗选择，最近已被证明与手术一样有效和安全，可用于治疗肺转移瘤（LM）。然而，尚不清楚哪些患者获益最大，以及最适合的分割方案是什么。本研究旨在分析单分割放射外科手术（SFRS）和分割 SBRT（fSBRT）治疗肺寡转移患者的治疗结果，并确定更好生存结果的预后临床特征。
方法
分析了 2010 年至 2016 年间接受 SFRS 或 fSBRT 治疗的 52 例 94 个 LM 患者的特征。评估了原发肿瘤、LM、治疗、毒性特征和结局。使用 Kaplan-Meier 和 Cox 回归分析评估局部控制（LC）、总生存期（OS）和无进展生存期。
结果
52 例患者的 94 个 LM 采用 SFRS/fSBRT 治疗，每位患者的中位数为 2 个病灶（范围：1-5）。SFRS 的中位计划靶区（PTV）覆盖剂量为 24Gy（范围：17-26），而 fSBRT 的剂量为 45Gy（范围：20-60），分 2-12 次。中位随访时间为 21 个月（范围：3-68）。SFRSR 与 fSBRT 的 1 年和 2 年 LC 率分别为 89%和 83%，75%和 59%（p=0.026）。接受 SFRS 治疗的 LM 明显更小（p=0.001）。所有患者的 1 年和 2 年 OS 率分别为 84%和 71%。单因素分析显示，SFRS 治疗、LM 诊断与治疗之间间隔≥12 个月、非结直肠癌组织学和 BED<100Gy 与更好的 LC 显著相关。然而，在多因素 Cox 回归模型中，这些参数均无统计学意义。有阴性淋巴结（N0）、卡氏功能状态评分（KPS）>70%和首次转移时间≥12 个月的患者 OS 显著更好。无 3 级急性或迟发性毒性。
结论
首次转移时间较长、KPS 较好和 N0 预测 OS 更好。短 SBRT 方案可获得良好的 LC 和低毒性发生率。
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