Willmann Jonas, Vlaskou Badra Eugenia, Adilovic Selma, Christ Sebastian M, Ahmadsei Maiwand, Mayinger Michael, Guckenberger Matthias, Andratschke Nicolaus
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Clin Transl Radiat Oncol. 2022 Aug 19;37:12-18. doi: 10.1016/j.ctro.2022.08.008. eCollection 2022 Nov.
Patients who develop oligorecurrent disease may be treated with metastasis-directed stereotactic body radiotherapy (SBRT) to defer the start of systemic therapy and delay its potential side effects. We report oncological outcomes and patterns of failure in patients with oligorecurrent disease treated with SBRT and determine which factors impact the interval to initiation of systemic therapy.
MATERIAL/METHODS: This retrospective study included patients with oligorecurrent disease (≤5 lesions) from any solid organ malignancy, treated with SBRT to all metastases and no systemic therapy for a minimum one month after SBRT between 01/2014 and 12/2019. The Kaplan-Meier method was used to analyze overall survival (OS) and progression-free survival (PFS), and the cumulative incidence of initiation of systemic therapy was analyzed assuming death without systemic therapy as a competing risk. Univariable and multivariable analyses are used to assess predictors of the systemic therapy-free interval.
Among 545 patients treated with SBRT for oligometastatic disease, 142 patients were treated with SBRT only for oligorecurrent disease. The most common primary tumors were lung and gastrointestinal cancer in 47 (33.1 %) and 28 (19.7 %) patients, respectively. After a median follow-up of 25 months, the median PFS and OS was 6.1 months and 48.9 months, respectively. Distant metastases were the most common first failure, and oligometastatic distant failure occured in 86 patients (60.6 %). New metastases were treated with repeat SBRT in 48 patients (33.8 %). The 1- and 2-year cumulative incidence of initiation of systemic therapy was 24.6 % and 36.8 %, respectively. In multivariable analysis, the number of previous lines of systemic therapy and the cumulative volume of metastases were significantly associated with the interval to initiation of systemic therapy.
Selected patients with oligorecurrence achieved favorable OS and low cumulative incidence of initiation of systemic therapy. Prospective studies are warranted to determine how the deferral of systemic therapy impacts OS compared with immediate systemic therapy in combination with SBRT.
发生寡转移复发性疾病的患者可接受针对转移灶的立体定向体部放疗（SBRT），以推迟全身治疗的开始并延缓其潜在副作用。我们报告接受SBRT治疗的寡转移复发性疾病患者的肿瘤学结局和失败模式，并确定哪些因素会影响开始全身治疗的间隔时间。
材料/方法：这项回顾性研究纳入了2014年1月至2019年12月期间来自任何实体器官恶性肿瘤的寡转移复发性疾病（≤5个病灶）患者，这些患者接受了针对所有转移灶的SBRT治疗，且在SBRT后至少一个月未接受全身治疗。采用Kaplan-Meier方法分析总生存期（OS）和无进展生存期（PFS），并在将未接受全身治疗而死亡作为竞争风险的情况下分析开始全身治疗的累积发生率。采用单变量和多变量分析来评估无全身治疗间隔时间的预测因素。
在545例接受SBRT治疗寡转移疾病的患者中，142例仅接受SBRT治疗寡转移复发性疾病。最常见的原发肿瘤分别为肺癌和胃肠道癌，各有47例（33.1%）和28例（19.7%）患者。中位随访25个月后，中位PFS和OS分别为6.1个月和48.9个月。远处转移是最常见的首次失败情况，86例患者（60.6%）发生寡转移远处失败。48例患者（33.8%）对新转移灶再次接受SBRT治疗。开始全身治疗的1年和2年累积发生率分别为24.6%和36.8%。在多变量分析中，既往全身治疗的疗程数和转移灶的累积体积与开始全身治疗的间隔时间显著相关。
部分寡转移复发性疾病患者获得了良好的总生存期和较低的开始全身治疗累积发生率。有必要开展前瞻性研究，以确定与立即进行全身治疗联合SBRT相比，推迟全身治疗对总生存期有何影响。
