Lu Yunyun, Fang Zhengxuying, Tao Linglong, Chuong Michael D, Lu Yi
Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Department of Health Science Center, Medical College of Ningbo University, Ningbo, China.
J Gastrointest Oncol. 2024 Feb 29;15(1):52-62. doi: 10.21037/jgo-23-1011. Epub 2024 Feb 22.
BACKGROUND: Gastrointestinal (GI) cancer is the most frequent kind of cancer to involve the retroperitoneal lymph nodes (RPLNs). Radiotherapy (RT) is common treatment of RPLN metastases in patients with GI cancer, while RT is local. Meanwhile, most patients have extra-retroperitoneal metastases. Immunotherapy plus RT have showed effective in advanced non-small cell lung cancer. However, whether the combination therapy is effective on GI cancer with RPLN metastases. In our study, we would estimate the effect of programmed death-1 (PD-1) inhibition in association with intensity modulated radiation therapy (IMRT). METHODS: Metastatic GI cancer patients with RPLN who were treated at a single institution were retrospectively evaluated from October 2016 to April 2023, who all had measurable lesion and received any therapy of PD-1 inhibitors alone, IMRT alone or PD-1 inhibitors plus IMRT. The follow-ups were assessed by abdominal computed tomography (CT) every 2 or 3 months to progression, dose-limiting toxicity or death. RESULTS: Among the 98 patients, 46 were treated by PD-1 inhibitors combined with IMRT, 26 were by PD-1 inhibitors only and 26 were by IMRT only. Of those, the median age 62 years (range, 25-84 years). Median progression-free survival (PFS) was 7.5 months and median overall survival (OS) was 10.8 months across the 3 therapy groups. Univariate analysis (UVA) indicated that therapy method (P=0.032) and tumor response (P=0.035) were significantly related to PFS. In the PD-1 inhibitors plus IMRT group, 1 patient (2.2%) achieved complete response (CR), 30 (65.2%) had partial remission, and 14 (30.4%) had stable disease. There was no case with CR by IMRT or PD-1 inhibitors alone. Objective response rate (67.4%) and disease control rate (97.8%) were higher in the PD-1 inhibitors combined with IMRT group. In the PD-1 inhibitors plus IMRT and PD-1 inhibitors alone groups, hepatitis B virus (HBV)-positive patients had better OS (P=0.041) on UVA. Meanwhile, in the PD-1 inhibitors plus IMRT group, we observed superior PFS (P=0.041) and OS (P=0.049) in HBV-positive patients on UVA. CONCLUSIONS: PD-1 inhibitors plus IMRT may be a better method for advanced GI cancer patients with RPLN metastases. HBV-positive patients can benefit from either PD-1 inhibitors alone or in combination with IMRT.
背景：胃肠道（GI）癌是最常累及腹膜后淋巴结（RPLN）的癌症类型。放射治疗（RT）是胃肠道癌患者RPLN转移的常见治疗方法，但RT是局部治疗。同时，大多数患者有腹膜后外转移。免疫治疗联合RT已显示对晚期非小细胞肺癌有效。然而，这种联合治疗对伴有RPLN转移的胃肠道癌是否有效。在我们的研究中，我们将评估程序性死亡-1（PD-1）抑制联合调强放射治疗（IMRT）的效果。 方法：对2016年10月至2023年4月在单一机构接受治疗的伴有RPLN转移的转移性胃肠道癌患者进行回顾性评估，这些患者均有可测量病灶且接受了单独使用PD-1抑制剂、单独使用IMRT或PD-1抑制剂联合IMRT的任何一种治疗。每2或3个月通过腹部计算机断层扫描（CT）评估随访情况，直至疾病进展、出现剂量限制性毒性或死亡。 结果：98例患者中，46例接受PD-1抑制剂联合IMRT治疗，26例仅接受PD-1抑制剂治疗，26例仅接受IMRT治疗。其中，中位年龄为62岁（范围25 - 84岁）。3个治疗组的中位无进展生存期（PFS）为7.5个月，中位总生存期（OS）为10.8个月。单因素分析（UVA）表明，治疗方法（P = 0.032）和肿瘤反应（P = 0.035）与PFS显著相关。在PD-1抑制剂联合IMRT组中，1例患者（2.2%）达到完全缓解（CR），30例（65.2%）部分缓解，14例（30.4%）病情稳定。单独使用IMRT或PD-1抑制剂均无CR病例。PD-1抑制剂联合IMRT组的客观缓解率（67.4%）和疾病控制率（97.8%）更高。在PD-1抑制剂联合IMRT组和仅使用PD-1抑制剂组中，UVA显示乙型肝炎病毒（HBV）阳性患者的OS更好（P = 0.041）。同时，在PD-1抑制剂联合IMRT组中，UVA显示HBV阳性患者的PFS（P = 0.041）和OS（P = 0.049）更优。 结论：PD-1抑制剂联合IMRT可能是伴有RPLN转移的晚期胃肠道癌患者的更好治疗方法。HBV阳性患者单独使用PD-1抑制剂或联合IMRT均可获益。
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