Department of Radiation Oncology, Medical College of Wisconsin, 8800 West Doyne Ave, Milwaukee, WI, 53226, USA.
Medical Oncology, Medical College of Wisconsin, Wauwatosa, WI, USA.
Radiat Oncol. 2023 Mar 1;18(1):42. doi: 10.1186/s13014-023-02226-3.
Conventional treatment of pulmonary metastatic sarcoma primarily involves surgery, with systemic therapy added in select patients. However, broader applications of radiation therapy techniques have prompted investigation into the use of stereotactic body radiotherapy (SBRT) for treatment of metastatic sarcoma, an attractive non-invasive intervention with potential for lower rates of adverse events than surgery. Current data are limited to retrospective analyses. This study analyzed 2-year local control and overall survival and adverse events in patients prospectively treated with SBRT to pulmonary sarcoma metastases.
Patients prospectively treated with SBRT to the lung for biopsy-proven metastatic sarcoma at a single institution from 2010 to 2022 were included. SBRT dose/fractionation treatment regimens ranged from 34 to 54 Gy in 1-10 fractions using photons. Local recurrence, local progression-free survival (LPFS) and overall survival (OS) were calculated from the end of SBRT. Univariable analysis (UVA) was performed using the log-rank test. Multivariable analysis (MVA) was performed using the Cox proportional hazards model. Adverse events due to SBRT were graded based on the Common Terminology Criteria for Adverse Events, version 4.0.
Eighteen patients with metastatic sarcoma were treated to 26 pulmonary metastases. The median local progression-free survival was not met. The median overall survival was not met. The local control rate at 2 years was 96%. 2-year LPFS was 95.5% and OS was 74%. Three patients (16.7%) developed grade 1 adverse events from SBRT. There were no adverse events attributed to radiation that were grade 2 or higher.
We report prospective data demonstrating that SBRT for sarcoma pulmonary metastases affords a high rate of local control and low toxicity, consistent with prior sarcoma SBRT retrospective data. This study adds to the wealth of information on SBRT in a radioresistant tumor. Though largely limited to retrospective reviews, current data indicate high rates of local control with favorable toxicity profiles. Therefore, SBRT for pulmonary sarcoma metastases may be considered for properly selected patients.
肺转移性肉瘤的常规治疗主要包括手术，对部分患者则会加用系统治疗。然而，放射治疗技术的广泛应用促使人们研究立体定向体部放疗（SBRT）治疗转移性肉瘤，SBRT 作为一种有吸引力的非侵入性干预手段，其不良反应发生率可能低于手术。目前的数据仅限于回顾性分析。本研究分析了单中心 2010 年至 2022 年期间前瞻性接受 SBRT 治疗肺转移肉瘤的患者的 2 年局部控制率、总生存率和不良反应。
纳入在单中心接受 SBRT 治疗经活检证实的肺转移性肉瘤的患者。SBRT 剂量/分割治疗方案范围为 34 至 54Gy，采用光子，分割 1 至 10 次。从 SBRT 结束开始计算局部复发、局部无进展生存期（LPFS）和总生存期（OS）。采用对数秩检验进行单变量分析（UVA）。采用 Cox 比例风险模型进行多变量分析（MVA）。根据通用不良事件术语标准 4.0 对 SBRT 相关不良反应进行分级。
18 名转移性肉瘤患者的 26 个肺转移灶接受了治疗。中位局部无进展生存期未达到。中位总生存期未达到。2 年局部控制率为 96%。2 年 LPFS 为 95.5%，OS 为 74%。3 名患者（16.7%）发生 SBRT 相关 1 级不良反应。无 2 级或更高级别的归因于放疗的不良反应。
我们报告了前瞻性数据，表明 SBRT 治疗肉瘤肺转移可实现高局部控制率和低毒性，与先前的肉瘤 SBRT 回顾性数据一致。本研究增加了关于放射性抵抗肿瘤中 SBRT 的丰富信息。尽管目前的数据主要局限于回顾性研究，但这些数据表明，SBRT 治疗肺转移肉瘤具有较高的局部控制率，且毒性特征良好。因此，对于适当选择的患者，SBRT 治疗肺转移肉瘤可能是一种可行的选择。
