Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, IRCCS, Humanitas University, via Manzoni 56, 20089, Rozzano, MI, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
J Cancer Res Clin Oncol. 2021 May;147(5):1307-1313. doi: 10.1007/s00432-021-03518-5. Epub 2021 Jan 20.
Recently major efforts have been made to define the oligometastatic setting, but for head and neck cancer (HNC) limited data are available. We aimed to evaluate outcome of oligometastatic HNC treated with Stereotactic body radiotherapy (SBRT) as metastasis-directed therapy.
We analyzed patients treated with SBRT on a maximum of five oligometastases from HNC, in up to two organs. Concomitant treatment was allowed. End points were toxicity, local control of treated metastases (LC), progression-free survival (PFS) and overall survival (OS).
48 consecutive patients and 71 lesions were treated. With a follow-up of 20.2 months, most common primary tumors were larynx (29.2%) and salivary glands (29.2%), while common site of metastases was lung (59.1%). Median dose was 48 Gy (21-75) in 3-8 fractions. Treatment was well tolerated, with two patients reporting mild pain and nausea. LC rates at 1 and 2 years were 83.1% and 70.2%. Previous local therapy (HR 4.97; p = 0.002), oligoprogression (HR 4.07; p = 0.031) and untreated metastases (HR 4.19; p = 0.027) were associated with worse LC. PFS at 1 and 2 years were 42.2% and 20.0%. Increasing age (HR 1.03; p = 0.010), non-adenoid cystic carcinoma (HR 2.57; p = 0.034) and non-lung metastases (HR 2.20; p = 0.025) were associated with worse PFS. One- and 2-years OS were 81.0% and 67.1%. Worse performance status (HR 2.91; p = 0.049), non-salivary primary (HR 19.9; p = 0.005), non-lung metastases (HR 2.96; p = 0.040) were correlated with inferior OS.
SBRT can be considered a safe metastasis-directed therapy in oligometastatic HNC. Efficacy of the treatment seems to be higher when administered upfront in the management of metastatic disease; however, selection of patients need to be improved due to the relevant risk of appearance of new metastatic site after SBRT.
最近，人们已经做出了很大努力来定义寡转移的情况，但对于头颈部癌症（HNC），可用的数据有限。我们旨在评估立体定向体部放射疗法（SBRT）作为转移性疾病治疗对头颈部寡转移灶的疗效。
我们分析了在最多两个器官中接受 SBRT 治疗最多 5 个寡转移灶的 HNC 患者。允许同时进行治疗。终点为毒性、治疗转移灶的局部控制（LC）、无进展生存期（PFS）和总生存期（OS）。
48 例连续患者和 71 个病灶接受了治疗。随访 20.2 个月后，最常见的原发肿瘤为喉（29.2%）和唾液腺（29.2%），而转移部位最常见的是肺（59.1%）。中位剂量为 48Gy（21-75），分为 3-8 次。治疗耐受性良好，有 2 例患者报告有轻度疼痛和恶心。1 年和 2 年时的 LC 率分别为 83.1%和 70.2%。先前的局部治疗（HR 4.97；p=0.002）、寡进展（HR 4.07；p=0.031）和未治疗的转移灶（HR 4.19；p=0.027）与较差的 LC 相关。1 年和 2 年的 PFS 分别为 42.2%和 20.0%。年龄增长（HR 1.03；p=0.010）、非腺样囊性癌（HR 2.57；p=0.034）和非肺转移灶（HR 2.20；p=0.025）与较差的 PFS 相关。1 年和 2 年的 OS 分别为 81.0%和 67.1%。较差的表现状态（HR 2.91；p=0.049）、非唾液腺原发肿瘤（HR 19.9；p=0.005）和非肺转移灶（HR 2.96；p=0.040）与较差的 OS 相关。
SBRT 可被视为头颈部寡转移灶的一种安全的转移性疾病治疗方法。当在转移性疾病的管理中作为初始治疗时，该治疗的疗效似乎更高；然而，由于 SBRT 后新转移灶出现的相关风险，需要改进患者的选择。
