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基于直线加速器的立体定向体部放射治疗在寡转移疾病治疗中的应用

Linear accelerator-based stereotactic body radiation therapy in the treatment of oligometastatic disease.

作者信息

Yamashita Hideomi, Ogita Mami, Aoki Shuri, Abe Osamu, Nakagawa Keiichi

机构信息

Department of Radiology, University of Tokyo Hospital, Tokyo 113-8656, Japan.

出版信息

Mol Clin Oncol. 2020 Aug;13(2):109-114. doi: 10.3892/mco.2020.2065. Epub 2020 Jun 9.

Abstract

The present study reports the clinical outcomes of hypofractionated stereotactic body radiation therapy (SBRT) for oligometastasis (OM) originating from various tumors. Between February 2012 and April 2017, 40 patients with unresectable OM were treated with SBRT. Of these patients, 92% showed a solitary nodal metastasis and the rest had up to three metastases. The dose prescription was 50 Gy in 10 fractions with three-dimensional conformal techniques or volumetric intensity-modulated arc therapy. Median follow-up was 14 months. Of the 40 patients, none showed local progression at the site of SBRT, but 20 patients showed tumor growth at distant sites during follow-up. The 2- and 3-year overall survival rates were 45.1 and 36.1%, respectively. The 2- and 3-year progression-free survival rates were 35.4 and 26.5%, respectively. The interval between diagnosis and detection of OM (<2 vs. >2 years) and primary tumor site (esophagus vs. others) emerged as significant variables affecting survival. Grade 3 subacute and grade 4 chronic toxicities were observed in 1 and 2 patients, respectively. SBRT of 50 Gy in 10 fractions for OM from various primary tumors was shown to lead to good clinical outcomes from the viewpoints of local control and toxicity frequency. However, additional studies are required to identify the patient groups likely to receive maximal benefits from such treatment.

摘要

本研究报告了立体定向体部放射治疗(SBRT)低分割方案治疗源自各种肿瘤的寡转移(OM)的临床结果。2012年2月至2017年4月期间,40例不可切除的OM患者接受了SBRT治疗。在这些患者中,92%表现为孤立性淋巴结转移,其余患者有多达三处转移灶。剂量处方为采用三维适形技术或容积调强弧形治疗,分10次给予50 Gy。中位随访时间为14个月。40例患者中,无人在SBRT部位出现局部进展,但20例患者在随访期间出现远处肿瘤生长。2年和3年总生存率分别为45.1%和36.1%。2年和3年无进展生存率分别为35.4%和26.5%。OM诊断与发现之间的间隔时间(<2年与>2年)以及原发肿瘤部位(食管与其他部位)是影响生存的显著变量。分别有1例和2例患者观察到3级亚急性毒性和4级慢性毒性。从局部控制和毒性发生率的角度来看,对于源自各种原发肿瘤的OM,10次分割给予50 Gy的SBRT显示出良好的临床结果。然而,需要进一步研究以确定可能从此类治疗中获得最大益处的患者群体。

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