Huo Bin, Ji Zhe, He Chuang, Yang Wanying, Ma Yanli, Huo Xiaodong, Wang Zhe, Zhao Xinxin, Dai Jinchao, Wang Haitao, Chen Guanglie, Wang Ruoyu, Song Yuqing, Zhang Kaixian, Huang Xuequan, Chai Shude, Wang Junjie
Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin, China.
Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.
Front Oncol. 2023 Feb 7;12:957497. doi: 10.3389/fonc.2022.957497. eCollection 2022.
To evaluate the safety and efficacy of stereotactic ablative brachytherapy (SABT) as a salvage therapy for patients with recurrent chest wall cancer (rCWC) who have previously received external beam radiotherapy (EBRT) or surgery.
Between November 2013 and October 2020, a total of 130 patients (including 75 men with a median age of 63 years) with rCWC treated with SABT were enrolled in this multicenter retrospective study. There were 97 cases of non-small-cell lung carcinoma, 24 cases of breast cancer, and 9 cases of thymic cancer. Of the patients included, 102 patients previously received surgery and 58 patients received EBRT, with systemic treatment progressing after recurrence. None of them were suitable or refused to undergo salvage EBRT or surgery again.
During the 22 (4-70)-month median patient follow-up, 59 patients died. The local control (LC) rates at 6, 12, 24, and 36 months were 88.3%, 74.3%, 50.4%, and 36.7%, respectively. The 1-, 2- and 3-year survival rates were 85%, 56%, and 42%, respectively. The median overall survival was 26 months (95% CI, 18.9-33.1 months). The pain relief rate was 81%, and the median to remission time was 10 days. Univariate and multivariate analyses showed that independent prognostic factors for LC included tumor size and postoperative D90. On the other hand, independent prognostic factors for survival include the Karnofsky performance status (KPS) score, tumor size, and D90 19 patients (14.6%) developed grade I/II skin reaction complications. No grade III or severer complications occurred.
SABT is safe and effective as a salvage therapy for rCWC following EBRT/surgery. For patients with a KPS score greater than 80, prescribed dose greater than 130 Gy, and tumor size less than 4 cm may bring better results.
评估立体定向消融近距离放射治疗（SABT）作为挽救性治疗手段，用于既往接受过外照射放疗（EBRT）或手术的复发性胸壁癌（rCWC）患者的安全性和有效性。
2013年11月至2020年10月期间，本多中心回顾性研究共纳入130例接受SABT治疗的rCWC患者（包括75例男性，中位年龄63岁）。其中非小细胞肺癌97例，乳腺癌24例，胸腺癌9例。纳入患者中，102例患者既往接受过手术，58例患者接受过EBRT，复发后全身治疗进展。他们均不适合或拒绝再次接受挽救性EBRT或手术。
在患者中位随访22（4 - 70）个月期间，59例患者死亡。6、12、24和36个月时的局部控制（LC）率分别为88.3%、74.3%、50.4%和36.7%。1年、2年和3年生存率分别为85%、56%和42%。中位总生存期为26个月（95%CI，18.9 - 33.1个月）。疼痛缓解率为81%，中位缓解时间为10天。单因素和多因素分析显示，LC的独立预后因素包括肿瘤大小和术后D90。另一方面，生存的独立预后因素包括卡氏功能状态（KPS）评分、肿瘤大小和D90。19例患者（14.6%）发生I/II级皮肤反应并发症。未发生III级或更严重的并发症。
SABT作为EBRT/手术后rCWC的挽救性治疗是安全有效的。对于KPS评分大于80、处方剂量大于130 Gy且肿瘤大小小于4 cm的患者可能会带来更好的结果。
