Department of Radiotherapy, Humanitas Gavazzeni Clinic, Bergamo, Italy.
Radiotherapy and Radiosurgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Milan, Italy.
Pract Radiat Oncol. 2024 Nov-Dec;14(6):e487-e491. doi: 10.1016/j.prro.2024.05.004. Epub 2024 May 28.
There is growing evidence of a role of stereotactic body radiation therapy (SBRT) in the treatment of patients with oligoprogressive pleural mesothelioma (PM). The objective of this study was to investigate the optimal radiation therapy doses and schedules in this setting. The records of patients treated with SBRT (>5 Gy per fraction) for oligoprogression of PM at 2 institutions from June 2014 to September 2022 were reviewed. Patients were divided into 2 groups: "intermediate-dose" SBRT (i-SBRT; total dose, 30-36 Gy in 5-6 fractions) and "high-dose" SBRT (h-SBRT; total dose, 45-50 Gy in 4-8 fractions). The comparison between the 2 groups in terms of local control (LC) and toxicity was the primary endpoint of the study. Overall, 23 patients were treated for 25 pleural lesions. All had received upfront chemotherapy with platinum/pemetrexed. Fifteen patients were treated with i-SBRT and 8 patients with h-SBRT. The median equivalent dose was 40 Gy (range, 40-49.6) in the i-SBRT group and 74.46 Gy (range, 64-88) in the h-SBRT group. Six-month, 1-year, and 2-year LC were 100%, 100%, and 80% in the i-SBRT group and 100%, 100%, and 67% in the h-SBRT group, respectively (p =.94). Only 2 patients (1 for each dose group) had a recurrence in the radiation therapy field, both after experiencing a distant relapse. No severe acute and late toxicities were observed in the i-SBRT group, whereas in the h-SBRT group, 2 patients experienced G2 acute and late thoracic pain and 1 patient experienced G2 acute and G3 chronic thoracic pain. In our experience, SBRT is a safe and effective option for selected patients with oligoprogressive PM. Use of intermediate total doses keeping the dose per fraction high seems to offer an excellent LC, avoiding the risk of severe toxicity.
越来越多的证据表明立体定向体部放疗（SBRT）在治疗寡进展性胸膜间皮瘤（PM）患者中具有作用。本研究的目的是探讨在这种情况下的最佳放疗剂量和方案。回顾了 2014 年 6 月至 2022 年 9 月期间，2 家机构中接受 SBRT（每次分割剂量>5 Gy）治疗寡进展性 PM 的患者的记录。患者分为 2 组：“中剂量”SBRT（i-SBRT；总剂量 30-36 Gy，5-6 次分割）和“高剂量”SBRT（h-SBRT；总剂量 45-50 Gy，4-8 次分割）。本研究的主要终点是比较两组患者的局部控制（LC）和毒性。总体而言，23 例患者共 25 个胸膜病变接受治疗。所有患者均接受过铂类/培美曲塞的一线化疗。15 例患者接受 i-SBRT 治疗，8 例患者接受 h-SBRT 治疗。i-SBRT 组中位等效剂量为 40 Gy（范围为 40-49.6），h-SBRT 组中位等效剂量为 74.46 Gy（范围为 64-88）。i-SBRT 组的 6 个月、1 年和 2 年 LC 率分别为 100%、100%和 80%，h-SBRT 组分别为 100%、100%和 67%（p=.94）。只有 2 例患者（每组 1 例）在放射治疗区域复发，均在远处复发后发生。i-SBRT 组未观察到严重的急性和迟发性毒性，而在 h-SBRT 组，2 例患者出现 G2 级急性和迟发性胸痛，1 例患者出现 G2 级急性和 G3 级慢性胸痛。根据我们的经验，SBRT 是治疗选择的寡进展性 PM 患者的一种安全有效的选择。使用高剂量分割的中等总剂量似乎可以提供极好的 LC，同时避免严重毒性的风险。
