Department of Radiation Oncology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
Department of Radiation Oncology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
Int J Radiat Oncol Biol Phys. 2021 Apr 1;109(5):1377-1386. doi: 10.1016/j.ijrobp.2020.11.045. Epub 2021 Jan 12.
Although various studies have reported that stereotactic body radiation therapy (SBRT) for liver metastases has high local control rates and relatively low toxicity, most series included a small number of patients. We aimed to validate these outcomes in a large multi-institution patient cohort treated in accordance with a common protocol.
A shared web-based registry of patients with liver metastases treated with SBRT was developed by 13 centers (12 in the Netherlands and 1 in Belgium). All the centers had previously agreed on the items to be collected, the fractionation schemes, and the organs-at-risk constraints to be applied. Follow-up was performed at the discretion of the centers. Patient, tumor, and treatment characteristics were entered in the registry. Only liver metastases treated individually as independent targets and with at least 1 radiologic follow-up examination were considered for local control analysis. Toxicity of grade 3 or greater was scored according to the Common Terminology Criteria of Adverse Events (v4.03).
Between January 1, 2013, and July 31, 2019, a total of 515 patients were entered in the web-based registry. The median age was 71 years. In total, 668 liver metastases were registered, and 447 were included for local control analysis. The most common primary tumor origin was colorectal cancer (80.3%), followed by lung cancer (8.9%) and breast cancer (4%). The most-used fractionation scheme was 3x18-20 Gy (36.0%), followed by 8x7.5 Gy (31.8%), 5x11-12 Gy (25.5%), and 12x5 Gy (6.7%). The median follow-up time was 1.1 years for local control and 2.3 years for survival. Actuarial 1-year local control was 87%; 1-year overall survival was 84%. Toxicity of grade 3 or greater was found in 3.9% of the patients.
This multi-institutional study confirms the high rates of local control and limited toxicity in a large patient cohort. Stereotactic body radiation therapy should be considered a valuable part of the multidisciplinary approach to treating liver metastases.
虽然多项研究报告称，立体定向体部放射治疗（SBRT）治疗肝转移瘤具有较高的局部控制率和相对较低的毒性，但大多数研究系列纳入的患者数量较少。我们旨在通过一个按照共同方案治疗的大型多机构患者队列来验证这些结果。
13 个中心（荷兰 12 个，比利时 1 个）开发了一个用于治疗肝转移瘤的 SBRT 患者共享的网络注册系统。所有中心都事先就收集的项目、分割方案以及要应用的危险器官限制达成一致。随访由中心自行决定。患者、肿瘤和治疗特征被输入注册系统。只有作为独立靶区单独治疗且至少有 1 次影像学随访检查的肝转移瘤才被纳入局部控制分析。根据不良事件常用术语标准（第 4.03 版）对 3 级或以上毒性进行评分。
2013 年 1 月 1 日至 2019 年 7 月 31 日，共有 515 例患者进入网络注册系统。中位年龄为 71 岁。共登记了 668 个肝转移瘤，其中 447 个被纳入局部控制分析。最常见的原发肿瘤来源是结直肠癌（80.3%），其次是肺癌（8.9%）和乳腺癌（4%）。最常用的分割方案是 3x18-20 Gy（36.0%），其次是 8x7.5 Gy（31.8%）、5x11-12 Gy（25.5%）和 12x5 Gy（6.7%）。局部控制的中位随访时间为 1.1 年，生存随访时间为 2.3 年。1 年局部控制的累积发生率为 87%；1 年总生存率为 84%。3.9%的患者出现 3 级或以上毒性。
这项多机构研究在一个大型患者队列中证实了较高的局部控制率和有限的毒性。立体定向体部放射治疗应被视为治疗肝转移瘤的多学科方法的有价值组成部分。
