Département de radiothérapie, institut de cancérologie de Lorraine, 54000 Nancy, France.
Département de biostatistique et data management, institut de cancérologie de Lorraine, 54000 Nancy, France.
Cancer Radiother. 2021 Jun;25(4):350-357. doi: 10.1016/j.canrad.2021.01.004. Epub 2021 Feb 19.
To investigate clinical outcome and predicting factors of local failures in patients with colorectal cancer treated for unresectable liver metastases with stereotactic body radiation therapy (SBRT).
We restrospectively reviewed the medical records of 67 patients treated with the Cyberknife SBRT system for 99 hepatic metastases between January 2007 and December 2015 in our center. In total, 37.5 to 54.0Gy in 3 to 5 fractions were prescribed to the 80% isodose line. Local control (LC), intrahepatic progression incidence, Progression-Free Survival (PFS), Overall Survival (OS) and toxicity were evaluated.
The median follow-up was 47 months (IQR, 28-59 months). The median OS was 53 months, the 2-year OS and PFS rates were 81.4% and 54.0%. The 1- and 2-year LC rates were 86.6% and 72.4%. In the multivariate analysis, the degree of differentiation was the only prognostic factor for LC (HR 0.31, 95% CI, 0.10-0.98, P=0.046). Margin expansion>5mm was not associated with a better LC (HR 0.72, 95% CI, 0.38-1.37, P=0.317). Performans Status≥2 (HR 3.27, 95% CI, 1.07-9.98, P=0.038), chemotherapy for metastases before SBRT (HR 0.36, 95% CI, 0.18-0.75, P=0.006) and regional lymph node at diagnosis (HR 2.19, 95% CI, 1.09-4.43, P=0.029) were independent prognostic factors for OS. We report 2 cases of grade≥3 toxicity (3.0%) - one grade 3 acute nausea and one grade 3 late gastric ulcer.
Stereotactic body radiation therapy is an effective and well-tolerated treatment that allow high LC for liver metastases from colorectal cancer during the first two years. A prescription dose of 45Gy in 3 fractions to the 80% isodose line with a risk adapted schedule to respect Organ At Risk constraints allows a low rate of toxicity.
研究立体定向体部放射疗法（SBRT）治疗不可切除肝转移灶的结直肠癌患者局部失败的临床结果和预测因素。
我们回顾性分析了 2007 年 1 月至 2015 年 12 月期间在我院使用 Cyberknife SBRT 系统治疗 99 例肝转移患者的病历。共给予 37.5 至 54.0Gy，5 次分割，80%等剂量曲线处方剂量。评估局部控制（LC）、肝内进展发生率、无进展生存率（PFS）、总生存率（OS）和毒性。
中位随访时间为 47 个月（IQR，28-59 个月）。中位 OS 为 53 个月，2 年 OS 和 PFS 率分别为 81.4%和 54.0%。1 年和 2 年 LC 率分别为 86.6%和 72.4%。多因素分析显示，分化程度是 LC 的唯一预后因素（HR 0.31，95%CI，0.10-0.98，P=0.046）。边缘扩大>5mm 与更好的 LC 无关（HR 0.72，95%CI，0.38-1.37，P=0.317）。表现状态≥2（HR 3.27，95%CI，1.07-9.98，P=0.038）、SBRT 前转移灶化疗（HR 0.36，95%CI，0.18-0.75，P=0.006）和诊断时区域淋巴结（HR 2.19，95%CI，1.09-4.43，P=0.029）是 OS 的独立预后因素。我们报告了 2 例≥3 级毒性（3.0%）-1 例 3 级急性恶心和 1 例 3 级晚期胃溃疡。
立体定向体部放射疗法是一种有效且耐受性良好的治疗方法，可在头两年内实现结直肠癌肝转移的高 LC。给予 80%等剂量曲线处方剂量 45Gy，3 次分割，根据风险调整方案，以尊重危及器官的限制，可使毒性发生率降低。
