Franzese Ciro, Vernier Veronica, Franceschini Davide, Comito Tiziana, Navarria Pierina, Clerici Elena, Teriaca Maria Ausilia, Massaro Maria, Di Cristina Luciana, Marini Beatrice, Galdieri Carmela, Mancosu Pietro, Tomatis Stefano, Scorsetti Marta
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090, Milan, Italy.
Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
J Cancer Res Clin Oncol. 2023 Sep;149(12):10495-10503. doi: 10.1007/s00432-023-04964-z. Epub 2023 Jun 6.
Delivering stereotactic ablative radiotherapy (SABR) in patients with multiple oligometastases represents a challenge for clinical and technical reasons. We aimed to evaluate the outcome of patients affected by multiple oligometastases treated with SABR and the impact of tumor volume on survival.
We included all the patients treated with single course SABR for 3 to 5 extracranial oligometastases. All patients were treated with the volumetric modulated arc therapy (VMAT) technique with ablative intent. End-points of the analysis were overall survival (OS), progression free survival (PFS), local control (LC) and toxicity.
136 patients were treated from 2012 to 2020 on 451 oligometastases. Most common primary tumor was colorectal cancer (44.1%) followed by lung cancer (11.8%). A total of 3, 4 and 5 lesions were simultaneously treated in 102 (75.0%), 26 (19.1%), and 8 (5.9%) patients, respectively. Median total tumor volume (TTV) was 19.1 cc (range 0.6-245.1). With a median follow-up of 25.0 months, OS at 1 and 3 years was 88.4% and 50.2%, respectively. Increasing TTV was independent predictive factor of worse OS (HR 2.37, 95% CI 1.18-4.78, p = 0.014) and PFS (HR 1.63, 95% CI 1.05-2.54; p = 0.028). Median OS was 80.6 months if tumor volume was ≤ 10 cc (1 and 3 years OS rate 93.6% and 77.5%, respectively), and 31.1 months if TTV was higher than 10 cc (1 and 3 years OS rate 86.7% and 42.3%, respectively). Rates of LC at 1 and 3 years were 89.3% and 76.5%. In terms of toxicity, no grade 3 or higher toxicity was reported both in the acute and late settings.
We demonstrated the impact of tumor volume on survival and disease control of patients affected by multiple oligometastases treated with single course SABR.
由于临床和技术原因，对多发寡转移瘤患者进行立体定向消融放疗（SABR）具有挑战性。我们旨在评估接受SABR治疗的多发寡转移瘤患者的预后以及肿瘤体积对生存的影响。
我们纳入了所有接受单疗程SABR治疗3至5个颅外寡转移瘤的患者。所有患者均采用容积调强弧形放疗（VMAT）技术进行消融治疗。分析的终点指标为总生存期（OS）、无进展生存期（PFS）、局部控制率（LC）和毒性。
2012年至2020年期间，136例患者接受了针对451个寡转移瘤的治疗。最常见的原发肿瘤是结直肠癌（44.1%），其次是肺癌（11.8%）。分别有102例（75.0%）、26例（19.1%）和8例（5.9%）患者同时接受了3个、4个和5个病灶的治疗。肿瘤总体积（TTV）中位数为19.1立方厘米（范围0.6 - 245.1）。中位随访时间为25.0个月，1年和3年的总生存率分别为88.4%和50.2%。TTV增加是OS（风险比[HR] 2.37，95%置信区间[CI] 1.18 - 4.78，p = 0.014）和PFS（HR 1.63，95% CI 1.05 - 2.54；p = 0.028）较差的独立预测因素。如果肿瘤体积≤10立方厘米，中位总生存期为80.6个月（1年和3年总生存率分别为93.6%和77.5%），如果TTV高于10立方厘米，则为31.1个月（1年和3年总生存率分别为86.7%和42.3%）。1年和3年的局部控制率分别为89.3%和76.5%。在毒性方面，急性和晚期均未报告3级或更高等级毒性。
我们证明了肿瘤体积对接受单疗程SABR治疗的多发寡转移瘤患者的生存和疾病控制的影响。
