Shenker Rachel F, Price Jeremy G, Jacobs Corbin D, Palta Manisha, Czito Brian G, Mowery Yvonne M, Kirkpatrick John P, Boyer Matthew J, Oyekunle Taofik, Niedzwiecki Donna, Song Haijun, Salama Joseph K
Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA.
Department of Radiation Oncology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA.
Cancers (Basel). 2022 May 13;14(10):2403. doi: 10.3390/cancers14102403.
We previously reported on the clinical outcomes of treating oligometastases with radiation using an elective simultaneous integrated boost technique (SIB), delivering higher doses to known metastases and reduced doses to adjacent bone or nodal basins. Here we compare outcomes of oligometastases receiving radiation targeting metastases alone (MA) versus those treated via an SIB.
Oligometastatic patients with ≤5 active metastases treated with either SIB or MA radiation at two institutions from 2013 to 2019 were analyzed retrospectively for treatment-related toxicity, pain control, and recurrence patterns. Tumor metastasis control (TMC) was defined as an absence of progression in the high dose planning target volume (PTV). Marginal recurrence (MR) was defined as recurrence outside the elective PTV but within the adjacent bone or nodal basin. Distant recurrence (DR) was defined as any recurrence that is not within the PTV or surrounding bone or nodal basin. The outcome rates were estimated using the Kaplan-Meier method and compared between the two techniques using the log-rank test.
101 patients were treated via an SIB to 90 sites (58% nodal and 42% osseous) and via MA radiation to 46 sites (22% nodal and 78% osseous). The median follow-up among surviving patients was 24.6 months (range 1.4-71.0). Of the patients treated to MA, the doses ranged from 18 Gy in one fraction (22%) to 50 Gy in 10 fractions (50%). Most patients treated with an SIB received 50 Gy to the treated metastases and 30 Gy to the elective PTV in 10 fractions (88%). No acute grade ≥3 toxicities occurred in either cohort. Late grade ≥3 toxicity occurred in 3 SIB patients (vocal cord paralysis and two vertebral body compression), all related to the high dose PTV and not the elective volume. There was similar crude pain relief between cohorts. The MR-free survival rate at 2 years was 87% (95% CI: 70%, 95%) in the MA group and 98% (95% CI: 87%, 99%) in the SIB group ( = 0.07). The crude TMC was 89% (41/46) in the MA group and 94% (85/90) in the SIB group. There were no significant differences in DR-free survival (65% (95% CI: 55-74%; = 0.24)), disease-free survival (60% (95% CI: 40-75%; = 0.40)), or overall survival (88% (95% CI: 73-95%; = 0.26)), between the MA and SIB cohorts.
Both SIB and MA irradiation of oligometastases achieved high rates of TMC and similar pain control, with a trend towards improved MR-free survival for oligometastases treated with an SIB. Further investigation of this technique with prospective trials is warranted.
我们之前报道了采用选择性同步整合推量技术（SIB）对寡转移灶进行放射治疗的临床结果，该技术向已知转移灶给予更高剂量，向相邻骨骼或淋巴结区域给予较低剂量。在此，我们比较单独针对转移灶进行放射治疗（MA）与通过SIB治疗的寡转移灶的结果。
回顾性分析2013年至2019年在两家机构接受SIB或MA放射治疗的寡转移患者（≤5个活跃转移灶）的治疗相关毒性、疼痛控制和复发模式。肿瘤转移控制（TMC）定义为高剂量计划靶区（PTV）无进展。边缘复发（MR）定义为在选择性PTV外但在相邻骨骼或淋巴结区域内的复发。远处复发（DR）定义为不在PTV或周围骨骼或淋巴结区域内的任何复发。使用Kaplan-Meier方法估计结局率，并使用对数秩检验在两种技术之间进行比较。
101例患者通过SIB治疗90个部位（58%为淋巴结，42%为骨），通过MA放射治疗46个部位（22%为淋巴结，78%为骨）。存活患者的中位随访时间为24.6个月（范围1.4 - 71.0个月）。接受MA治疗的患者，剂量范围从单次18 Gy（22%）到10次50 Gy（50%）。大多数接受SIB治疗的患者在10次分割中给予治疗转移灶50 Gy，选择性PTV 30 Gy（88%）。两个队列均未发生急性≥3级毒性反应。3例SIB患者发生晚期≥3级毒性反应（声带麻痹和两例椎体压缩），均与高剂量PTV相关，而非选择性靶区。两个队列之间的粗略疼痛缓解情况相似。MA组2年无MR生存率为87%（95%CI：70%，95%），SIB组为98%（95%CI：87%，99%）（P = 0.07）。MA组的粗略TMC为89%（41/46），SIB组为94%（85/90）。MA组和SIB组在无DR生存率（65%（95%CI：55 - 74%；P = 0.24））、无病生存率（60%（95%CI：40 - 75%；P = 0.40））或总生存率（88%（95%CI：73 - 95%；P = 0.26））方面无显著差异。
SIB和MA对寡转移灶的照射均实现了较高的TMC率和相似的疼痛控制，SIB治疗的寡转移灶在无MR生存方面有改善趋势。有必要通过前瞻性试验对该技术进行进一步研究。
