转移性鼻咽癌转移灶定向立体定向体部放射治疗的长期结果。
Long-term outcomes of metastasis-directed stereotactic body radiation therapy in metastatic nasopharyngeal carcinoma.
机构信息
Department of Head and Neck Oncology and Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
出版信息
Cancer Med. 2024 Jan;13(1):e6764. doi: 10.1002/cam4.6764. Epub 2023 Dec 26.
BACKGROUND
The study aims to evaluate the outcomes of metastasis-directed stereotactic body radiation therapy (SBRT) in metastatic nasopharyngeal carcinoma (mNPC).
METHODS
We reviewed all SBRT conducted in patients with mNPC in our institution between 2013 and 2022. Systemic therapy was performed with chemotherapy with or without anti-programmed death-1 (PD-1) therapy. Local treatment delivered with ablative purpose in stereotactic setting with dose/fraction ≥5 Gy was evaluated. Kaplan-Meier analyses were used to determine the rates of local control (LC), progression-free survival (PFS), and overall survival (OS). Univariate and multivariate analyses were performed by Cox regression.
RESULTS
A total of 54 patients with 76 metastatic sites receiving SBRT were analyzed. Median follow-up was 49 months. The 3-year LC, PFS, and OS rates were 89.1%, 29.4%, and 57.9%, respectively. Adding a PD-1 inhibitor to SBRT tended to prolong median OS (50.1 vs. 32.2 months, p = 0.068). Patients receiving a biological effective dose (BED, α/β = 10) ≥ 80 Gy had a significantly longer median OS compared to those who received a lower dose (not reached vs. 29.5 months, p = 0.004). Patients with oligometastases (1-5 metastases) had a better median OS (not reached vs. 29.5 months, p < 0.001) and PFS (34.3 vs. 4.6 months, p < 0.001). Pretreatment EBV-DNA and maintenance therapy were also significant predictors for OS.
CONCLUSIONS
Metastatic NPC patients could benefit from metastases-directed SBRT in combination with systemic therapy.
背景
本研究旨在评估转移性鼻咽癌（mNPC）患者转移灶定向立体定向放射治疗（SBRT）的疗效。
方法
我们回顾了 2013 年至 2022 年间在我院接受 mNPC 患者 SBRT 的所有病例。全身治疗采用化疗联合或不联合抗程序性死亡受体-1（PD-1）治疗。以立体定向消融为目的的局部治疗，剂量/分割≥5Gy，进行评估。采用 Kaplan-Meier 分析评估局部控制率（LC）、无进展生存率（PFS）和总生存率（OS）。采用 Cox 回归进行单因素和多因素分析。
结果
共分析了 54 例 76 个转移灶接受 SBRT 的患者。中位随访时间为 49 个月。3 年 LC、PFS 和 OS 率分别为 89.1%、29.4%和 57.9%。SBRT 联合 PD-1 抑制剂治疗中位 OS 延长（50.1 与 32.2 个月，p=0.068）。生物有效剂量（BED，α/β=10）≥80Gy 的患者中位 OS 明显长于剂量较低的患者（未达到与 29.5 个月，p=0.004）。寡转移（1-5 个转移灶）患者的中位 OS 和 PFS 更好（未达到与 29.5 个月，p<0.001；34.3 与 4.6 个月，p<0.001）。治疗前 EBV-DNA 和维持治疗也是 OS 的显著预测因素。
结论
转移性 NPC 患者可从转移灶定向 SBRT 联合全身治疗中获益。
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