Spałek Mateusz Jacek, Teterycz Paweł, Borkowska Aneta, Poleszczuk Jan, Rutkowski Piotr
Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland.
Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Ther Adv Med Oncol. 2022 Feb 14;14:17588359211070646. doi: 10.1177/17588359211070646. eCollection 2022.
Selected patients with locally advanced or metastatic soft tissue and bone sarcomas (STBS) may benefit from intensive local treatment, such as stereotactic radiotherapy (SRT). This study aimed to summarize the utilization and outcomes of SRT in STBS and to identify predictive factors for progression and survival.
Consecutive patients with advanced STBS who underwent STBS in a sarcoma tertiary center were identified. We collected tumor- and treatment-related factors. Endpoints comprised time to local progression (TTLP), local progression-free survival (LPFS), time to progression, progression-free survival, and overall survival (OS). The Cox proportional-hazards model was used to identify prognostic factors.
We identified 141 patients who underwent 233 SRTs. Median follow-up was 21 months. Local and distant progression occurred after 19 and 163 SRTs, respectively. SRT for lung metastases was predictive for better TTLP and LPFS (hazard ratio, HR = 0.12, = 0.007 and HR = 0.42, = 0.002, respectively). Bone sarcoma (HR for TTLP = 3.18, = 0.043; HR for LPFS = 1.99, = 0.028) and lower administered dose (HR for TTLP = 0.98, = 0.007; HR for LPFS = 0.99, = 0.012) were predictive for worse TTLP and LPFS. SRT for oligometastases (HR = 0.46, = 0.021) and lung metastases (HR = 0.55, = 0.046) was predictive for better OS, whereas diagnosis of bone sarcoma (HR = 2.05, = 0.029) was predictive for worse OS.
SRT provides excellent local control in STBS patients without significant toxicity. Patients with oligometastatic disease, lung metastases, and soft tissue sarcomas benefit the most from SRT. The dose escalation moderately enhances local control; however, it does not translate into better survival.
部分局部晚期或转移性软组织和骨肉瘤（STBS）患者可能从立体定向放射治疗（SRT）等强化局部治疗中获益。本研究旨在总结SRT在STBS中的应用情况和疗效，并确定进展和生存的预测因素。
纳入在一家肉瘤三级中心接受SRT的晚期STBS连续患者。我们收集了肿瘤和治疗相关因素。观察终点包括局部进展时间（TTLP）、无局部进展生存期（LPFS）、进展时间、无进展生存期和总生存期（OS）。采用Cox比例风险模型确定预后因素。
我们确定了141例接受233次SRT的患者。中位随访时间为21个月。分别在19次和163次SRT后出现局部和远处进展。对肺转移灶进行SRT可预测更好的TTLP和LPFS（风险比，HR = 0.12，P = 0.007和HR = 0.42，P = 0.002）。骨肉瘤（TTLP的HR = 3.18，P = 0.043；LPFS的HR = 1.99，P = 0.028）和较低的给药剂量（TTLP的HR = 0.98，P = 0.007；LPFS的HR = 0.99，P = 0.012）可预测更差的TTLP和LPFS。对寡转移灶（HR = 0.46，P = 0.021）和肺转移灶（HR = 0.55，P = 0.046）进行SRT可预测更好的OS，而骨肉瘤诊断（HR = 2.05，P = 0.029）可预测更差的OS。
SRT可为STBS患者提供良好的局部控制且无明显毒性。寡转移疾病、肺转移和软组织肉瘤患者从SRT中获益最大。剂量递增适度增强了局部控制；然而，这并未转化为更好的生存。
