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用于治疗不可切除的结直肠癌肝和/或肺转移的放射增敏化疗(伊立替康)联合立体定向体部放射治疗

Radiosensitizing Chemotherapy (Irinotecan) with Stereotactic Body Radiation Therapy for the Treatment of Inoperable Liver and/or Lung Metastases of Colorectal Cancer.

作者信息

Vaugier Loïg, Mirabel Xavier, Martel-Lafay Isabelle, Racadot Séverine, Carrie Christian, Vendrely Véronique, Mahé Marc-André, Senellart Hélène, Raoul Jean-Luc, Campion Loïc, Rio Emmanuel

机构信息

Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, 44800 St-Herblain, France.

Department of Radiation Oncology, Centre Oscar Lambret, 59000 Lille, France.

出版信息

Cancers (Basel). 2021 Jan 11;13(2):248. doi: 10.3390/cancers13020248.

Abstract

: Stereotactic body radiotherapy (SBRT) is a recognized treatment for colorectal cancer (CRC) metastases. We postulated that local responses could be improved by SBRT with a concomitant radiosensitizing agent (irinotecan). : RADIOSTEREO-CAMPTO was a prospective multi-center phase 2 trial investigating SBRT (40-48 Gy in 4 fractions) for liver and/or lung inoperable CRC oligometastases (≤3), combined with two weekly intravenous infusions of 40 mg/m Irinotecan. Primary outcome was the objective local response rate as per RECIST. Secondary outcomes were early and late toxicities, EORTC QLQ-C30 quality of life, local control and overall survival. : Forty-four patients with 51 lesions (liver = 39, lungs = 12) were included. Median age was 69 years (46-84); 37 patients (84%) had received at least two prior chemotherapy treatments. Median follow-up was 48.9 months. One patient with two lung lesions was lost during follow-up. Assuming maximum bias hypothesis, the objective local response rate in ITT was 86.3% (44/51-95% CI: [76.8-95.7]) or 82.4% (42/51-95% CI: [71.9-92.8]). The observed local response rate was 85.7% (42/49-95% CI: [75.9-95.5]). The 1 and 2-year local (distant) progression-free survivals were 84.2% (38.4%) and 67.4% (21.3%), respectively. The 1 and 2-year overall survivals were 97.5% and 75.5%. There were no severe acute or late reactions. The EORTC questionnaire scores did not significantly worsen during or after treatment. : SBRT with irinotecan was well tolerated with promising results despite heavily pretreated patients.

摘要

立体定向体部放疗(SBRT)是一种公认的用于治疗结直肠癌(CRC)转移的方法。我们推测,联合使用放射增敏剂(伊立替康)的SBRT可以改善局部反应。“RADIOSTEREO-CAMPTO”是一项前瞻性多中心2期试验,研究SBRT(4次分割,40-48 Gy)用于治疗无法手术的肝脏和/或肺部CRC寡转移(≤3个转移灶),并联合每周两次静脉输注40 mg/m²伊立替康。主要结局是根据RECIST标准评估的客观局部缓解率。次要结局包括早期和晚期毒性、欧洲癌症研究与治疗组织(EORTC)QLQ-C30生活质量、局部控制率和总生存率。44例患者共51个病灶(肝脏39个病灶,肺部12个病灶)被纳入研究。中位年龄为69岁(46-84岁);37例患者(84%)此前至少接受过两种化疗。中位随访时间为48.9个月。1例有两个肺部病灶的患者在随访期间失访。假设最大偏倚假设,意向性分析(ITT)中的客观局部缓解率为86.3%(44/51-95%置信区间:[76.8-95.7])或82.4%(42/51-95%置信区间:[71.9-92.8])。观察到的局部缓解率为85.7%(42/49-95%置信区间:[75.9-95.5])。1年和2年的局部(远处)无进展生存率分别为84.2%(38.4%)和67.4%(21.3%)。1年和2年的总生存率分别为97.5%和75.5%。未出现严重的急性或晚期反应。治疗期间及治疗后EORTC问卷评分未显著恶化。尽管患者接受过大量预处理,但联合伊立替康的SBRT耐受性良好,结果令人满意。

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