Makita Kenji, Hamamoto Yasushi, Kanzaki Hiromitsu, Kataoka Masaaki, Yamamoto Shuhei, Nagasaki Kei, Ishikawa Hirofumi, Takata Noriko, Tsuruoka Shintaro, Uwatsu Kotaro, Kido Teruhito
Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan.
Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan.
Mol Clin Oncol. 2022 Sep 15;17(5):152. doi: 10.3892/mco.2022.2585. eCollection 2022 Nov.
Advancement in systemic therapy has increased the importance of local control (LC) of bone metastatic sites treated with radiotherapy in intermediate-term survivors (surviving ≥1 year). To establish individualized radiotherapy for bone metastases, factors affecting LC of bone metastases treated with traditional fractionated moderate dose palliative radiotherapy (FMRT) in intermediate-term survivors were evaluated. Between January 2010 and December 2019, 317 lesions in 240 patients treated with FMRT for bone metastases surviving for at least 1 year and followed-up with CT for at least 6 months were reviewed retrospectively. The median survival and radiographic follow-up times were 24 months (range, 12-123 months) and 20 months (range, 1-119 months), respectively. The median FMRT dose [biologically effective dose (BED)10] was 39.0 Gy (range, 28.0-71.7 Gy). Multivariate analysis revealed that age (≥70 years), non-vertebral bone metastasis, bone metastasis from moderate and unfavorable primary tumor sites (esophageal, colorectal, hepatobiliary/pancreatic, kidney/ureter and sarcoma/melanoma cancers), and no administration of post-FMRT bone-modifying agents (BMAs) were unfavorable factors for LC of bone metastasis. The 2-year LC rates for FMRT doses (BED10) ≤39.0 Gy and >39.0 Gy were 90 and 87%, respectively. The 2-year LC rates of patients administered and not administered post-FMRT antineoplastic agents (ATs) were 91 and 78%, respectively. The sites of bone metastasis and primary tumors, and post-FMRT BMAs were factors associated with LC of bone metastasis in long-term survivors. However, a FMRT dose (BED10) ≥39.0 Gy and post-FMRT ATs were not significant factors.
全身治疗的进展增加了局部控制（LC）对中期生存者（存活≥1年）接受放疗的骨转移部位的重要性。为了制定针对骨转移的个体化放疗方案，我们评估了影响中期生存者接受传统分割中等剂量姑息性放疗（FMRT）治疗的骨转移局部控制的因素。回顾性分析了2010年1月至2019年12月期间240例接受FMRT治疗骨转移且存活至少1年并接受CT随访至少6个月的患者的317个病灶。中位生存期和影像学随访时间分别为24个月（范围12 - 123个月）和20个月（范围1 - 119个月）。FMRT的中位剂量[生物等效剂量（BED）10]为39.0 Gy（范围28.0 - 71.7 Gy）。多因素分析显示，年龄（≥70岁）、非椎体骨转移、原发肿瘤部位为中度和不良部位（食管癌、结直肠癌、肝胆胰癌、肾/输尿管癌以及肉瘤/黑色素瘤）以及FMRT后未使用骨改良剂（BMA）是骨转移局部控制的不利因素。FMRT剂量（BED10）≤39.0 Gy和>39.0 Gy的2年局部控制率分别为90%和87%。FMRT后接受和未接受抗肿瘤药物（AT）治疗的患者2年局部控制率分别为91%和78%。骨转移部位、原发肿瘤以及FMRT后的BMA是长期生存者骨转移局部控制的相关因素。然而，FMRT剂量（BED10）≥39.0 Gy和FMRT后使用AT并非显著因素。
