Department of Radiation Oncology.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
Am J Clin Oncol. 2021 Mar 1;44(3):126-130. doi: 10.1097/COC.0000000000000794.
Stereotactic body radiation therapy (SBRT) is increasingly used for patients with recurrent and or metastatic tumors. Sarcomas are generally considered not sensitive to radiotherapy and SBRT may allow for increased biological effectiveness. We report intermediate outcomes and toxicity for pediatric, adolescent, and young adult patients treated with SBRT to sites of recurrent and or metastatic sarcoma.
We queried an Institutional Review Board-approved registry of patients treated with SBRT for metastases from pediatric sarcomas. Patients age 29 and below were assessed for local control, survival, and toxicity.
Thirty-one patients with a total of 88 lesions met eligibility criteria. Median patient age was 17.9 years at treatment. Sixteen patients were treated with SBRT to >1 site of disease. The median dose was 30 Gy in 5 fractions. The median follow-up time was 7.4 months (range: 0.2 to 31.4 mo). Patients were heavily pretreated with systemic therapy. In 57 lesions with >3 months of radiographic follow-up, the 6-month and 12-month local control rates were 88.3%±4.5% and 83.4%±5.5%, respectively. Radiographic local failures were rare (6/57 in-field, 4/57 marginal). Only 1/88 treated lesions was associated with a radiation-related high-grade toxicity; late grade 3 intestinal obstruction in a re-irradiated field while on concurrent therapy (gemcitabine and docetaxel). No acute grade ≥3 toxicity was observed.
SBRT was well tolerated in the majority of patients with favorable local control outcomes. Additional studies will be required to determine the optimal SBRT dose and fractionation, treatment volume, and appropriate concurrent therapies.
立体定向体部放射治疗（SBRT）越来越多地用于复发性和/或转移性肿瘤患者。肉瘤通常被认为对放射治疗不敏感，SBRT 可能会增加生物效应。我们报告了接受 SBRT 治疗复发性和/或转移性肉瘤部位的儿科、青少年和年轻成人患者的中期结果和毒性。
我们查询了机构审查委员会批准的接受 SBRT 治疗转移瘤的患者登记处。年龄在 29 岁及以下的患者评估局部控制、生存和毒性。
31 名患者共有 88 个病变符合入选标准。治疗时患者的中位年龄为 17.9 岁。16 名患者接受了 SBRT 治疗>1 个疾病部位。中位剂量为 30Gy，分 5 次给予。中位随访时间为 7.4 个月（范围：0.2 至 31.4 个月）。患者接受了全身性治疗的大量预处理。在 57 个有>3 个月影像学随访的病变中，6 个月和 12 个月的局部控制率分别为 88.3%±4.5%和 83.4%±5.5%。影像学局部失败很少见（57 个病变中有 6 个在野，57 个病变中有 4 个在边缘）。仅 1/88 个治疗病变与放射性高级别毒性相关；在同时接受治疗（吉西他滨和多西他赛）时，在再照射野中发生迟发性 3 级肠梗阻。未观察到急性 3 级及以上毒性。
SBRT 在大多数患者中耐受性良好，局部控制效果良好。需要进一步研究以确定最佳 SBRT 剂量和分割、治疗体积以及适当的同期治疗。
