Kowalchuk Roman O, Waters Michael R, Richardson K Martin, Spencer Kelly M, Larner James M, Kersh C R
University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA.
University of Virginia, Department of Radiation Oncology, Charlottesville, VA, USA.
Rep Pract Oncol Radiother. 2020 Nov-Dec;25(6):987-993. doi: 10.1016/j.rpor.2020.09.010. Epub 2020 Oct 2.
This study reports a single-institutional experience treating liver metastases with stereotactic body radiation therapy (SBRT).
107 patients with 169 lesions were assessed to determine factors predictive for local control, radiographic response, and overall survival (OS). Machine learning techniques, univariate analysis, and the Kaplan-Meier method were utilized.
Patients were treated with a relatively low median dose of 30 Gy in 3 fractions. Fractions were generally delivered once weekly. Median biologically effective dose (BED) was 60 Gy, and the median gross tumor volume (GTV) was 12.16 cc. Median follow-up was 7.36 months. 1-year local control was 75% via the Kaplan-Meier method. On follow-up imaging, 43%, 40%, and 17% of lesions were decreased, stable, and increased in size, respectively. 1-year OS was 46% and varied by primary tumor, with median OS of 34.3, 25.1, 12.5, and 4.6 months for ovarian, breast, colorectal, and lung primary tumors, respectively. Breast and ovarian primary patients had better OS (p < 0.0001), and lung primary patients had worse OS (p = 0.032). Higher BED values, the number of hepatic lesions, and larger GTV were not predictive of local control, radiographic response, or OS. 21% of patients suffered from treatment toxicity, but no grade ≥3 toxicity was reported.
Relatively low-dose SBRT for liver metastases demonstrated efficacy and minimal toxicity, even for patients with large tumors or multiple lesions. This approach may be useful for patients in whom higher-dose therapy is contraindicated or associated with high risk for toxicity. OS depends largely on the primary tumor.
本研究报告了单机构应用立体定向体部放疗（SBRT）治疗肝转移瘤的经验。
对107例有169个病灶的患者进行评估，以确定预测局部控制、影像学反应和总生存期（OS）的因素。采用了机器学习技术、单因素分析和Kaplan-Meier方法。
患者接受的中位剂量相对较低，为30 Gy，分3次给予。分次剂量通常每周给予1次。中位生物等效剂量（BED）为60 Gy，中位肿瘤总体积（GTV）为12.16 cc。中位随访时间为7.36个月。通过Kaplan-Meier方法得出1年局部控制率为75%。在随访影像学检查中，分别有43%、40%和17%的病灶大小减小、稳定和增大。1年总生存率为46%，并因原发肿瘤而异，卵巢、乳腺、结直肠和肺原发肿瘤的中位总生存期分别为34.3、25.1、12.5和4.6个月。乳腺和卵巢原发患者的总生存期较好（p < 0.0001），肺原发患者的总生存期较差（p = 0.032）。较高的BED值、肝脏病灶数量和较大的GTV并不能预测局部控制、影像学反应或总生存期。21%的患者出现治疗毒性，但未报告≥3级毒性。
相对低剂量的SBRT治疗肝转移瘤显示出疗效且毒性最小，即使对于肿瘤较大或有多个病灶的患者也是如此。这种方法可能对那些高剂量治疗禁忌或毒性风险高的患者有用。总生存期很大程度上取决于原发肿瘤。
