一项基于多中心大型回顾性数据库，关于接受立体定向消融放疗的结直肠癌肺转移多转移疾病的预测模型：RED LaIT-SABR研究。
A predictive model of polymetastatic disease from a multicenter large retrospectIve database on colorectal lung metastases treated with stereotactic ablative radiotherapy: The RED LaIT-SABR study.
作者信息
Nicosia Luca, Franceschini Davide, Perrone-Congedi Francesca, Molinari Alessandro, Gerardi Marianna Alessandra, Rigo Michele, Mazzola Rosario, Perna Marco, Scotti Vieri, Fodor Andrei, Iurato Aurelia, Pasqualetti Francesco, Gadducci Giovanni, Chiesa Silvia, Niespolo Rita Marina, Bruni Alessio, Cappelli Anna, D'Angelo Elisa, Borghetti Paolo, Di Marzo Alessandro, Ravasio Andrea, De Bari Berardino, Sepulcri Matteo, Aiello Dario, Mortellaro Gianluca, Sangalli Claudia, Franceschini Marzia, Montesi Giampaolo, Aquilanti Francesco Maria, Lunardi Gianluigi, Valdagni Riccardo, Fazio Ivan, Scarzello Giovanni, Vavassori Vittorio, Maranzano Ernesto, Maria Magrini Stefano, Arcangeli Stefano, Gambacorta Maria Antonietta, Valentini Vincenzo, Paiar Fabiola, Ramella Sara, Di Muzio Nadia Gisella, Loi Mauro, Jereczek-Fossa Barbara Alicja, Casamassima Franco, Osti Mattia Falchetto, Scorsetti Marta, Alongi Filippo
机构信息
Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy.
Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy.
出版信息
Clin Transl Radiat Oncol. 2022 Dec 20;39:100568. doi: 10.1016/j.ctro.2022.100568. eCollection 2023 Mar.
AIM
Stereotactic ablative radiotherapy (SABR) showed increasing survival in oligometastatic patients. Few studies actually depicted oligometastatic disease (OMD) evolution and which patient will remain disease-free and which will rapidly develop a polymetastatic disease (PMD) after SABR. Therefore, apart from the number of active metastases, there are no clues on which proven factor should be considered for prescribing local treatment in OMD. The study aims to identify predictive factors of polymetastatic evolution in lung oligometastatic colorectal cancer patients.
METHODS
This international Ethical Committee approved trial (Prot. Negrar 2019-ZT) involved 23 Centers and 450 lung oligometastatic patients. Primary end-point was time to the polymetastatic conversion (tPMC). Additionally, oligometastases number and cumulative gross tumor volume (cumGTV) were used as combined predictive factors of tPMC. Oligometastases number was stratified as 1, 2-3, and 4-5; cumGTV was dichotomized to the value of 10 cc.
RESULTS
The median tPMC in the overall population was 26 months. Population was classified in the following tPMC risk classes: low-risk (1-3 oligometastases and cumGTV ≤ 10 cc) with median tPMC of 35.1 months; intermediate-risk (1-3 oligometastases and cumGTV > 10 cc), with median tPMC of 13.9 months, and high-risk (4-5 oligometastases, any cumGTV) with median tPMC of 9.4 months (p = 0.000).
CONCLUSION
The present study identified predictive factors of polymetastatic evolution after SABR in lung oligometastatic colorectal cancer. The results demonstrated that the sole metastases number is not sufficient to define the OMD since patients defined oligometastatic from a point of view might rapidly progress to PMD when the cumulative tumor volume is high. A tailored approach in SABR prescription should be pursued considering the expected disease evolution after SABR, with the aim to avoid unnecessary treatment and toxicity in those at high risk of polymetastatic spread, and maximize local treatment in those with a favorable disease evolution.
目的
立体定向消融放疗（SABR）显示可提高寡转移患者的生存率。实际上，很少有研究描述寡转移疾病（OMD）的演变情况，以及哪些患者在接受SABR后将保持无病状态，哪些患者会迅速发展为多转移疾病（PMD）。因此，除了活跃转移灶的数量外，在确定OMD的局部治疗方案时，没有明确的证据表明应考虑哪些因素。本研究旨在确定肺寡转移结直肠癌患者多转移演变的预测因素。
方法
这项经国际伦理委员会批准的试验（协议编号Negrar 2019-ZT）涉及23个中心的450例肺寡转移患者。主要终点是发生多转移转化的时间（tPMC）。此外，转移灶数量和累积肿瘤总体积（cumGTV）被用作tPMC的联合预测因素。转移灶数量分为1个、2 - 3个和4 - 5个；cumGTV以10 cc为界进行二分法划分。
结果
总体人群的中位tPMC为26个月。人群被分为以下tPMC风险类别：低风险（1 - 3个转移灶且cumGTV≤10 cc），中位tPMC为35.1个月；中风险（1 - 3个转移灶且cumGTV>10 cc），中位tPMC为13.9个月；高风险（4 - 5个转移灶，cumGTV任意），中位tPMC为9.4个月（p = 0.000）。
结论
本研究确定了肺寡转移结直肠癌患者接受SABR后多转移演变的预测因素。结果表明，仅转移灶数量不足以定义OMD，因为从转移灶数量角度定义为寡转移的患者，当累积肿瘤体积较大时可能会迅速进展为PMD。在SABR处方中应采用个性化方法，考虑SABR后预期的疾病演变情况，目的是避免在多转移扩散高风险患者中进行不必要的治疗和毒性反应，并在疾病演变良好的患者中最大化局部治疗效果。
Zotero 插件