Kinj R, Doyen J, Hannoun-Lévi J M, Naghavi A O, Chand M E, Baudin G, Ferrero J M, François E, Evesque L, Borchiellini D, Benezery K, Bondiau P Y
Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France; University of Côte d'Azur, Nice, France.
Clin Oncol (R Coll Radiol). 2021 Jan;33(1):e15-e21. doi: 10.1016/j.clon.2020.06.009. Epub 2020 Jul 5.
Up to 40% of patients who have received radiation for a pelvic malignancy will develop locoregional recurrence in the previously irradiated volume. Stereotactic body radiotherapy (SBRT) has been used in the oligometastatic setting, and provides an ablative approach ideal for reirradiation. The purpose of this study was to evaluate the outcomes after SBRT reirradiation of extraosseous recurrences in the pelvis.
This single institution retrospective study evaluated patients treated with SBRT reirradiation in the pelvis from January 2011 to February 2018. Patients with more than five oligometastatic lesions, >7 cm in size, and recurrence within the prostate were excluded.
In total, 30 patients were treated with SBRT with a median follow-up of 29.4 months. The primary tumour sites were most commonly rectum (30.8%) and prostate (30.8%). The median time interval between irradiation for the primary and SBRT reirradiation was 48 months (3-245). The typical reirradiation treatment was 35 Gy in five fractions, the median gross tumour volume size was 10.2 (0.3-110.5) ml and the most common target was the iliac nodes (40%). There were three (10%) acute grade 3 toxicities and no late grade 3 or more toxicities. At 12/24 months, local relapse-free survival, metastasis-free survival, progression-free survival and overall survival were 67.7%/50.7%, 67%/41.7%, 34.8%/14.9% and 83.2%/62.5%, respectively. On univariate analysis, improved local control was associated with low gross tumour volume (<10 ml) (P = 0.003) and prostate primary (P = 0.02), but was no longer significant on multivariate analysis. The proximity of organ at risk to the target did not significantly correlate with worse toxicity (P = 0.14) or tumour coverage (gross tumour volume: P = 0.8, planning target volume: P = 0.4).
SBRT pelvic reirradiation in oligometastatic patients is a safe and effective treatment modality. Careful consideration should be taken with larger tumour size, as it may be associated with worse oncological and toxicity outcome.
接受盆腔恶性肿瘤放疗的患者中，高达40%会在先前放疗区域出现局部区域复发。立体定向体部放疗（SBRT）已用于寡转移患者，是一种理想的再照射消融方法。本研究旨在评估盆腔骨外复发患者接受SBRT再照射后的疗效。
本单机构回顾性研究评估了2011年1月至2018年2月期间接受盆腔SBRT再照射的患者。排除有超过5个寡转移病灶、直径>7 cm以及前列腺内复发的患者。
共有30例患者接受了SBRT治疗，中位随访时间为29.4个月。原发肿瘤部位最常见的是直肠（30.8%）和前列腺（30.8%）。原发放疗与SBRT再照射之间的中位时间间隔为48个月（3 - 245个月）。典型的再照射方案是5次分割，总剂量35 Gy，中位肿瘤总体积大小为10.2（0.3 - 110.5）ml，最常见的靶区是髂淋巴结（40%）。有3例（10%）急性3级毒性反应，无晚期3级及以上毒性反应。在12/24个月时，局部无复发生存率、无转移生存率、无进展生存率和总生存率分别为67.7%/50.7%、67%/41.7%、34.8%/14.9%和83.2%/62.5%。单因素分析显示，肿瘤总体积小（<10 ml）（P = 0.003）和前列腺原发（P = 0.02）与局部控制改善相关，但多因素分析时不再显著。危及器官与靶区的距离与更差的毒性反应（P = 0.14）或肿瘤覆盖情况（肿瘤总体积：P = 0.8，计划靶体积：P = 0.4）无显著相关性。
寡转移患者的SBRT盆腔再照射是一种安全有效的治疗方式。对于较大肿瘤大小应谨慎考虑，因为这可能与更差的肿瘤学和毒性结果相关。
