Verma Nipun, Laird James H, Moore Nicholas S, Hayman Thomas J, Housri Nadine, Peters Gabrielle W, Knowlton Christin A, Jairam Vikram, Campbell Allison M, Park Henry S
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
Adv Radiat Oncol. 2024 Mar 21;9(6):101500. doi: 10.1016/j.adro.2024.101500. eCollection 2024 Jun.
We investigated whether pulmonary metastases from historically considered radioresistant primaries would have inferior local control after radiation therapy than those from nonradioresistant nonlung primaries, and whether higher biologically effective dose assuming alpha/beta=10 (BED10) would be associated with superior local control.
We identified patients treated with radiation therapy for oligometastatic or oligoprogressive pulmonary disease to 1 to 5 lung metastases from nonlung primaries in 2013 to 2020 at a single health care system. Radioresistant primary cancers included colorectal carcinoma, endometrial carcinoma, renal cell carcinoma, melanoma, and sarcoma. Nonradioresistant primary cancers included breast, bladder, esophageal, pancreas, and head and neck carcinomas. The Kaplan-Meier estimator, log-rank test, and multivariable Cox proportional hazards regression were used to compare local recurrence-free survival (LRFS), new metastasis-free survival, progression-free survival, and overall survival.
Among 114 patients, 73 had radioresistant primary cancers. The median total dose was 50 Gy (IQR, 50-54 Gy) and the median number of fractions was 5 (IQR, 3-5). Median follow-up time was 59.6 months. One of 41 (2.4%) patients with a nonradioresistant metastasis experienced local failure compared with 18 of 73 (24.7%) patients with radioresistant metastasis (log-rank = .004). Among radioresistant metastases, 12 of 41 (29.2%) patients with colorectal carcinoma experienced local failure compared with 6 of 32 (18.8%) with other primaries (log-rank = .018). BED10 ≥100 Gy was associated with decreased risk of local recurrence. On univariable analysis, BED10 ≥100 Gy (hazard ratio [HR], 0.263; 95% CI, 0.105-0.656; = .004) was associated with higher LRFS, and colorectal primary (HR, 3.060; 95% CI, 1.204-7.777; = .019) was associated with lower LRFS, though these were not statistically significant on multivariable analysis. Among colorectal primary patients, BED10 ≥100 Gy was associated with higher LRFS (HR, 0.266; 95% CI, 0.072-0.985; = .047) on multivariable analysis.
Local control after radiation therapy was encouraging for pulmonary metastases from most nonlung primaries, even for many of those classically considered to be radioresistant. Those from colorectal primaries may benefit from testing additional strategies, such as resection or systemic treatment concurrent with radiation.
我们研究了来自传统上被认为对放疗耐药的原发肿瘤的肺转移瘤在放疗后局部控制情况是否比来自非放疗耐药的非肺原发肿瘤的肺转移瘤差，以及假设α/β=10时更高的生物等效剂量（BED10）是否与更好的局部控制相关。
我们在一个医疗系统中确定了2013年至2020年期间接受放射治疗的寡转移或寡进展性肺部疾病患者，这些患者有1至5个来自非肺原发肿瘤的肺转移灶。放疗耐药的原发癌包括结直肠癌、子宫内膜癌、肾细胞癌、黑色素瘤和肉瘤。非放疗耐药的原发癌包括乳腺癌、膀胱癌、食管癌、胰腺癌和头颈癌。采用Kaplan-Meier估计法、对数秩检验和多变量Cox比例风险回归来比较局部无复发生存期（LRFS）、无新转移生存期、无进展生存期和总生存期。
在114例患者中，73例有放疗耐药的原发癌。总剂量中位数为50 Gy（四分位间距，50 - 54 Gy），分割次数中位数为5次（四分位间距，3 - 5次）。中位随访时间为59.6个月。41例（2.4%）有非放疗耐药转移灶的患者中有1例出现局部失败，而73例（24.7%）有放疗耐药转移灶的患者中有18例出现局部失败（对数秩检验P = 0.004）。在放疗耐药转移瘤中，41例结直肠癌患者中有12例（29.2%）出现局部失败，而32例其他原发肿瘤患者中有6例（18.8%）出现局部失败（对数秩检验P = 0.018）。BED10≥100 Gy与局部复发风险降低相关。单变量分析中，BED10≥100 Gy（风险比[HR]，0.263；95%可信区间，0.105 - 0.656；P = 0.004）与更高的LRFS相关，结直肠癌原发灶（HR，3.060；95%可信区间，1.2
