Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan.
Radiation Oncology.
Am J Clin Oncol. 2023 Jun 1;46(6):263-270. doi: 10.1097/COC.0000000000001000. Epub 2023 Mar 14.
Lung metastases are the most common form of distant failure for patients diagnosed with sarcoma with metastasectomy considered for some patients with limited metastatic disease and good performance status. Alternatives to surgery such as stereotactic body radiation therapy (SBRT) can be considered, though data are limited. We present outcomes after SBRT for sarcoma lung metastases.
Fifty sarcoma patients with 109 lung metastases were treated with SBRT between 2005 and 2021. Outcomes evaluated included local control (LC), overall survival (OS), and toxicity including lung pneumonitis/fibrosis, chest wall toxicity, dermatitis, brachial plexus, and esophageal toxicity. Systemic therapy receipt before and after SBRT was recorded.
SBRT schedules were divided into 3 cohorts: 30 to 34 Gy/1fx (n=10 [20%]), 48 to 50 Gy/4 to 5fx (n=24[48%]), and 60 Gy/5fx (n=16[32%]). With a median follow-up of 19.5 months, 1/3-year LC rates were 96%/88% and 1/3-year OS 77%/50%, respectively. There was no differences between the 3 regimens in terms of LC, OS, or toxicity. Size >4 cm was a predictor of worse LC ( P =0.031) and worse OS ( P = 0.039) on univariate analysis. The primary pattern of failure was new metastases (64%) of which the majority were in the contralateral lung (52%). One-year chemotherapy-free survival was 85%. Overall, 76% of patients did not require chemotherapy initiation or change of chemotherapy regimen after lung SBRT. Toxicity was reported in 16% of patients overall, including 25%, 20%, and 14% in the 30 to 34 Gy/1fx, 48 to 50 Gy/4 to 5fx, and 60 Gy/5fx cohorts, respectively.
SBRT outcomes for lung metastases from sarcoma demonstrate high rates of LC and are similar with different dose/fractionation regimens. Lung SBRT is associated with prolonged chemotherapy-free survival. Prospective validation of these results is warranted.
肺转移是肉瘤患者远处失败的最常见形式，对于一些转移性疾病有限且表现状态良好的患者，可考虑进行转移切除术。对于手术以外的治疗方法，如立体定向体部放射治疗（SBRT），也可以考虑，尽管数据有限。我们报告了 SBRT 治疗肉瘤肺转移的结果。
2005 年至 2021 年间，50 例肉瘤患者的 109 个肺转移灶接受了 SBRT 治疗。评估的结果包括局部控制（LC）、总生存（OS）和毒性，包括肺肺炎/纤维化、胸壁毒性、皮炎、臂丛神经毒性和食管毒性。记录 SBRT 前后接受的系统治疗情况。
SBRT 方案分为 3 个队列：30 至 34Gy/1fx（n=10[20%]）、48 至 50Gy/4 至 5fx（n=24[48%]）和 60Gy/5fx（n=16[32%]）。中位随访 19.5 个月后，1/3 年 LC 率分别为 96%/88%和 1/3 年 OS 率分别为 77%/50%。在 LC、OS 或毒性方面，这 3 种方案之间没有差异。大小>4cm 是局部控制不良（P=0.031）和总生存不良（P=0.039）的单因素分析预测因素。主要失败模式为新的转移（64%），其中大部分位于对侧肺（52%）。1 年无化疗生存率为 85%。总体而言，76%的患者在接受肺部 SBRT 后无需开始或改变化疗方案。总的来说，16%的患者出现了毒性反应，30 至 34Gy/1fx、48 至 50Gy/4 至 5fx 和 60Gy/5fx 队列的患者分别有 25%、20%和 14%出现毒性反应。
肉瘤肺转移的 SBRT 结果显示出较高的 LC 率，且不同剂量/分割方案的结果相似。肺部 SBRT 与延长无化疗生存时间相关。需要前瞻性验证这些结果。
