Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, 01120, Adana, Turkey.
Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.
Strahlenther Onkol. 2022 Oct;198(10):940-948. doi: 10.1007/s00066-022-01962-x. Epub 2022 Jun 13.
This study aimed to analyze the prognostic factors associated with overall survival (OS) and progression-free survival (PFS) in patients with bone-only metastatic renal cell carcinoma (RCC) who have five or fewer lesions treated with stereotactic body radiotherapy (SBRT).
The clinical data of 54 patients with 70 bone metastases undergoing SBRT treated between 2013 and 2020 with a dose of at least 5 Gy per fraction and a biologically effective dose (BED) of at least 90 Gy were retrospectively evaluated.
The majority of lesions were located in the spine (57.4%) and had only one metastasis (64.8%). After a median follow-up of 22.4 months, the 1‑ and 2‑year OS rates were 84.6% and 67.3%, respectively, and median OS was 43.1 months. The 1‑ and 2‑year PFS rates and median PFS were 63.0%, 38.9%, and 15.3 months, respectively. In SBRT-treated lesions, the 1‑year local control (LC) rate was 94.9%. Age, metastasis localization, and number of fractions of SBRT were significant prognostic factors for OS in univariate analysis. In multivariate analysis, patients with spinal metastasis had better OS compared to their counterparts, and patients who received single-fraction SBRT had better PFS than those who did not. No patient experienced acute or late toxicities of grade 3 or greater.
Despite excellent LC at the oligometastatic site treated with SBRT, disease progression was observed in nearly half of patients 13 months after metastasis-directed local therapy, particularly as distant disease progression other than the treated lesion, necessitating an effective systemic treatment to improve treatment outcomes.
本研究旨在分析接受立体定向体部放疗（SBRT）治疗的仅有骨转移且转移灶数少于 5 个的局限性转移性肾细胞癌（RCC）患者的总生存（OS）和无进展生存（PFS）的预后因素。
回顾性分析了 2013 年至 2020 年间接受 SBRT 治疗的 54 例 70 处骨转移患者的临床资料，SBRT 单次分割剂量至少为 5Gy，生物有效剂量（BED）至少为 90Gy。
大多数转移灶位于脊柱（57.4%），仅有一处转移灶（64.8%）。中位随访 22.4 个月后，1 年和 2 年 OS 率分别为 84.6%和 67.3%，中位 OS 为 43.1 个月。1 年和 2 年 PFS 率和中位 PFS 分别为 63.0%、38.9%和 15.3 个月。SBRT 治疗的病灶中，1 年局部控制（LC）率为 94.9%。在单因素分析中，年龄、转移灶定位和 SBRT 分割次数是 OS 的显著预后因素。多因素分析显示，脊柱转移患者的 OS 优于非脊柱转移患者，单次 SBRT 分割的患者 PFS 优于未接受 SBRT 分割的患者。无患者发生 3 级或以上急性或迟发性毒性反应。
尽管 SBRT 治疗寡转移灶局部控制良好，但在局部治疗后近一半的患者在 13 个月时发生疾病进展，特别是除治疗病灶外的远处疾病进展，需要有效的全身治疗来改善治疗结果。
