Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom.
Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom.
Radiother Oncol. 2024 Jul;196:110288. doi: 10.1016/j.radonc.2024.110288. Epub 2024 Apr 20.
Stereotactic Ablative Radiotherapy (SABR) for the treatment of oligometastatic disease can improve survival and delay the requirement for systemic therapy. The benefits of SABR in oligoprogressive disease are less well-defined. Here, we evaluate the available evidence investigating the efficacy of SABR in the treatment of oligoprogressive disease.
A systematic review was carried out following PRISMA guidelines. Medline and Embase databases were searched using the terms "stereotactic radiotherapy" OR "SABR" OR "Stereotactic Ablative Body Radiotherapy" OR "SBRT" OR "SRT" AND "oligoprogression" in May 2022, June 2023, and February 2024. Studies were excluded where: SABR was used as a radical treatment, a specific oligoprogressive cohort could not be identified, publication was as a conference abstract or where fewer than 10 patients were recruited. Studies treating only brain metastases were also excluded. The site of primary tumour, oligoprogressive sites, rates of overall survival (OS), progression free survival (PFS), local control (LC) and time to next systemic therapy were collected.
Thirty-three full text studies were included. These consisted of single centre and multi-institutional observational studies, case series and phase II trials. Twenty-two studies were related to a specific tumour type: 12 urological cancer (9 prostate, 3 renal cancer), 6 non-small cell lung cancer, 2 colorectal cancer, 2 breast cancer and 11 were studies covering multiple tumour sites (5 studies involving SABR to a single organ and 6 studies involving SABR to multi-organ). Median PFS was >6 months in patients with oligoprogressive prostate, non-small cell lung cancer and renal cancer patients.
SABR appears to have clinical benefit in oligoprogresssive prostate, lung, and renal patients. However, the optimal management of patients with oligoprogressive disease is still somewhat uncertain due to lack of prospective data. This will hopefully become clearer in the near future with the publication of further randomised trials.
立体定向消融放疗（SABR）治疗寡转移疾病可以提高生存率并延迟系统治疗的需求。SABR 在寡进展性疾病中的益处尚未得到明确界定。在这里，我们评估了调查 SABR 治疗寡进展性疾病疗效的现有证据。
根据 PRISMA 指南进行了系统评价。2022 年 5 月、2023 年 6 月和 2024 年 2 月，使用术语“立体定向放疗”或“SABR”或“立体定向消融体放射治疗”或“SBRT”或“SRT”和“寡进展”在 Medline 和 Embase 数据库中进行了搜索。排除了以下情况的研究：SABR 用作根治性治疗、无法确定特定的寡进展队列、出版物为会议摘要或仅招募了不到 10 名患者的研究。仅治疗脑转移的研究也被排除在外。收集了原发肿瘤的部位、寡进展部位、总生存率（OS）、无进展生存率（PFS）、局部控制（LC）和下一次系统治疗时间。
共纳入 33 篇全文研究。这些研究包括单中心和多机构观察性研究、病例系列和 II 期试验。22 项研究与特定肿瘤类型有关：12 项为泌尿系统癌症（9 项前列腺癌、3 项肾癌）、6 项非小细胞肺癌、2 项结直肠癌、2 项乳腺癌和 11 项为涉及多个肿瘤部位的研究（5 项研究涉及单一器官的 SABR，6 项研究涉及多器官的 SABR）。寡进展性前列腺癌、非小细胞肺癌和肾癌患者的中位 PFS 超过 6 个月。
SABR 似乎对寡进展性前列腺癌、肺癌和肾癌患者具有临床获益。然而，由于缺乏前瞻性数据，寡进展性疾病患者的最佳管理仍然有些不确定。随着进一步随机试验的发表，这种情况有望在不久的将来变得更加清楚。
