Chiloiro Giuditta, Panza Giulia, Boldrini Luca, Romano Angela, Placidi Lorenzo, Nardini Matteo, Galetto Matteo, Votta Claudio, Campitelli Maura, Cellini Francesco, Massaccesi Mariangela, Gambacorta Maria Antonietta
Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Radiat Oncol. 2024 Apr 26;19(1):52. doi: 10.1186/s13014-024-02445-2.
Oligo-progression or further recurrence is an open issue in the multi-integrated management of oligometastatic disease (OMD). Re-irradiation with stereotactic body radiotherapy (re-SBRT) technique could represent a valuable treatment option to improve OMD clinical outcomes. MRI-guided allows real-time visualization of the target volumes and online adaptive radiotherapy (oART). The aim of this retrospective study is to evaluate the efficacy and toxicity profile of MRI-guided repeated SBRT (MRIg-reSBRT) in the OMD setting and propose a re-SBRT classification.
We retrospectively analyzed patients (pts) with recurrent liver metastases or abdominal metastatic lesions between 1 and 5 centimeters from liver candidate to MRIg-reSBRT showing geometric overlap between the different SBRT courses and assessing whether they were in field (type 1) or not (type 2).
Eighteen pts completed MRIg-reSBRT course for 25 metastatic hepatic/perihepatic lesions from July 2019 to January 2020. A total of 20 SBRT courses: 15 Type 1 re-SBRT (75%) and 5 Type 2 re-SBRT (25%) was delivered. Mean interval between the first SBRT and MRIg-reSBRT was 8,6 months. Mean prescribed dose for the first treatment was 43 Gy (range 24-50 Gy, mean BED=93), while 41 Gy (range 16-50 Gy, mean BED=92) for MRIg-reSBRT. Average liver dose was 3,9 Gy (range 1-10 Gy) and 3,7 Gy (range 1,6-8 Gy) for the first SBRT and MRIg-reSBRT, respectively. No acute or late toxicities were reported at a median follow-up of 10,7 months. The 1-year OS and PFS was 73,08% and 50%, respectively. Overall Clinical Benefit was 54%.
MRIg-reSBRT could be considered an effective and safe option in the multi-integrated treatment of OMD.
在寡转移疾病（OMD）的多学科综合管理中，寡进展或进一步复发是一个尚未解决的问题。采用立体定向体部放疗（re-SBRT）技术进行再程放疗可能是改善OMD临床结局的一种有价值的治疗选择。MRI引导能够实时显示靶区体积并实现在线自适应放疗（oART）。本回顾性研究的目的是评估MRI引导下重复SBRT（MRIg-reSBRT）在OMD治疗中的疗效和毒性特征，并提出一种再程SBRT分类方法。
我们回顾性分析了2019年7月至2020年1月期间接受MRIg-reSBRT治疗的复发性肝转移或距肝脏1至5厘米的腹部转移瘤患者，评估不同SBRT疗程之间的几何重叠情况，并判断它们是否在照射野内（1型）或不在照射野内（2型）。
18例患者完成了针对25个转移性肝/肝周病灶的MRIg-reSBRT疗程。共进行了20次SBRT疗程：15次1型再程SBRT（75%）和5次2型再程SBRT（25%）。首次SBRT与MRIg-reSBRT之间的平均间隔为8.6个月。首次治疗的平均处方剂量为43 Gy（范围24 - 50 Gy，平均生物等效剂量[BED]=93），而MRIg-reSBRT的平均处方剂量为41 Gy（范围16 - 50 Gy，平均BED=92）。首次SBRT和MRIg-reSBRT的平均肝脏剂量分别为3.9 Gy（范围1 - 10 Gy）和3.7 Gy（范围1.6 - 8 Gy）。在中位随访10.7个月时，未报告急性或晚期毒性反应。1年总生存率（OS）和无进展生存率（PFS）分别为73.08%和50%。总体临床获益率为54%。
在OMD的多学科综合治疗中，MRIg-reSBRT可被视为一种有效且安全的选择。
