Ribeirão Preto Medical School, University of São Paulo.
Bioscience Institute of University of State from Sao Paulo (UNESP), Botucatu, SP, Brazil.
Am J Clin Oncol. 2020 Aug;43(8):575-581. doi: 10.1097/COC.0000000000000709.
The effectiveness and safety of reirradiation with stereotactic ablative radiotherapy (re-SABR) in patients with recurrence after a previous course of radiation are limited to small series. We carried out a meta-analysis to summarize existing data and identify trends in overall survival (OS), local control (LC), and toxicity after re-SABR in patients with recurrence of lung cancer.
Eligible studies were identified on Medline, Embase, the Cochrane Library, and the proceedings of annual meetings through June 2019. We followed the PRISMA and MOOSE guidelines. A meta-regression analysis was carried out to assess whether there is a relationship between moderator variables and outcomes. A P-value<0.05 was considered significant.
Twenty observational studies with a total of 595 patients treated were included. The 2-year OS and LC were 0.54 (95% confidence interval [CI]: 0.48-0.61) and 0.73 (95% CI: 0.66-0.80), respectively. The rate of any toxicity grade ≥3 was 0.098 (95% CI: 0.06-13.6), with 9 grade 5 toxicity (1.5%). In the meta-regression, the re-SABR dose (P=0.028), tumor size (P=0.031), and time to recurrence (P=0.018) showed an association with survival. For LC, the re-SABR dose (P=0.034) and tumor size (P=0.040) were statistically significant. Any toxicity grade ≥3 showed a relationship with the cumulative dose (P=0.024). Cumulative dose ≤145 versus >145 Gy2 had 3% versus 15% (P=0.013) of any grade ≥3 toxicity.
Re-SABR produces satisfactory LC and OS rates with an acceptable rate of toxicity. The balancing between the re-SABR dose and the tumor location has the potential to reduce severe and fatal toxicity.
在先前接受过放射治疗的患者中，立体定向消融放疗（再 SABR）的再照射的有效性和安全性仅限于小系列。我们进行了一项荟萃分析，以总结现有数据，并确定肺癌复发患者再 SABR 后总生存率（OS）、局部控制率（LC）和毒性的趋势。
在 2019 年 6 月之前，通过 Medline、Embase、Cochrane 图书馆和年会记录，确定了符合条件的研究。我们遵循 PRISMA 和 MOOSE 指南。进行了荟萃回归分析，以评估调节变量与结果之间是否存在关系。P 值<0.05 被认为具有统计学意义。
纳入了 20 项共 595 例患者的观察性研究。2 年 OS 和 LC 分别为 0.54（95%置信区间 [CI]：0.48-0.61）和 0.73（95% CI：0.66-0.80）。任何 3 级以上毒性的发生率为 0.098（95% CI：0.06-13.6），5 级毒性 9 例（1.5%）。在荟萃回归中，再 SABR 剂量（P=0.028）、肿瘤大小（P=0.031）和复发时间（P=0.018）与生存相关。对于 LC，再 SABR 剂量（P=0.034）和肿瘤大小（P=0.040）具有统计学意义。任何 3 级以上毒性与累积剂量呈正相关（P=0.024）。累积剂量≤145Gy2 与>145Gy2 相比，任何 3 级以上毒性的发生率为 3%与 15%（P=0.013）。
再 SABR 产生了令人满意的 LC 和 OS 率，且毒性发生率可接受。再 SABR 剂量与肿瘤位置之间的平衡有可能降低严重和致命毒性。
