青少年和青年恶性肿瘤的立体定向消融放疗（SABR）
Stereotactic Ablative Radiation Therapy (SABR) for Adolescent and Young Adult Malignancies.
作者信息
Singh Raj, Bishop Sophia, Jenkins Jan, Davis Joanne, Upadhyay Rituraj, McLaughlin Christopher, Sharma Sanjeev, Baliga Sujith, Palmer Joshua D
机构信息
Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA.
Department of Radiation Oncology, The Radiosurgery Society, San Jose, USA.
出版信息
Cureus. 2024 Aug 14;16(8):e66890. doi: 10.7759/cureus.66890. eCollection 2024 Aug.
BACKGROUND
There are limited studies examining local control (LC) and overall survival (OS) following stereotactic ablative radiation therapy (SABR) for adolescent and young adult (AYA) populations/histologies with local recurrences or metastatic disease.
METHODS
The RSSearch® Patient Registry, an international SABR registry, was evaluated for AYA patients treated with SABR. AYA patients with adult histologies/primaries were excluded. Kaplan-Meier analyses were employed to characterize LC and OS following SABR. Potential prognostic factors were assessed with log-rank tests for initial univariate analysis (UVA). For multivariate analyses (MVA), a Cox proportional hazards multivariate model was utilized.
RESULTS
A total of 19 AYA patients with 39 lesions treated with SABR were identified and included in the analysis. Four lesions (10.3%) were treated with SABR for primary tumor recurrence and 35 lesions were treated for metastatic disease. The median patient age was 34 years (range: 16-39 years). Common lesion locations included lung (11 lesions; 28.2%), non-spinal bone (nine lesions; 23.1%), and spine (six lesions; 15.4%). The median biological effective dose (BED) was 61.5 Gy (range: 26.4-180). One-year LC and OS following SABR were 77.7% (95% CI: 58.5-88.7) and 72.7% (95% CI: 46.3-87.6), respectively. On UVA, BED ≥ 60 Gy was associated with superior one-year LC (94.4% vs. 47.6%; p<0.0001) as were sarcoma primaries (two-year LC: 92.3% vs. 42.2%;p = 0.0002). Central nervous system (CNS) primaries had significantly poorer one-year LC (20% vs 87.5%; p<0.0001) as well as spinal metastases (33.3% vs. 87.0%; p<0.0001). On MVA, BED < 60 Gy was associated with inferior LC (hazard ratio (HR) = 5.51;p = 0.01) with sarcoma primaries associated with superior LC (HR = 0.04;p = 0.008).
CONCLUSION
SABR with BED ≥ 60 Gy resulted in durable LC for AYA patients, particularly those with sarcoma primaries, though poor outcomes were noted in metastatic CNS malignancies.
背景
关于立体定向消融放疗（SABR）治疗局部复发或转移性疾病的青少年和青年（AYA）人群/组织学类型后的局部控制（LC）和总生存期（OS）的研究有限。
方法
对国际SABR注册机构RSSearch®患者注册库中接受SABR治疗的AYA患者进行评估。排除具有成人组织学/原发灶的AYA患者。采用Kaplan-Meier分析来描述SABR后的LC和OS。通过对数秩检验对潜在预后因素进行初步单因素分析（UVA）评估。对于多因素分析（MVA），使用Cox比例风险多变量模型。
结果
共识别出19例接受SABR治疗的AYA患者，共39个病灶，并纳入分析。4个病灶（10.3%）接受SABR治疗是因为原发性肿瘤复发，35个病灶接受治疗是因为转移性疾病。患者中位年龄为34岁（范围：16 - 39岁）。常见病灶部位包括肺（11个病灶；28.2%）、非脊柱骨（9个病灶；23.1%）和脊柱（6个病灶；15.4%）。中位生物等效剂量（BED）为61.5 Gy（范围：26.4 - 180）。SABR后1年的LC和OS分别为77.7%（95%CI：58.5 - 88.7）和72.7%（95%CI：46.3 - 87.6）。在UVA中，BED≥60 Gy与较好的1年LC相关（94.4%对47.6%；p<0.0001），肉瘤原发灶也是如此（2年LC：92.3%对42.2%；p = 0.0002）。中枢神经系统（CNS）原发灶的1年LC明显较差（20%对87.5%；p<0.0001），脊柱转移灶也是如此（33.3%对87.0%；p<0.0001）。在MVA中，BED<60 Gy与较差的LC相关（风险比（HR）= 5.51；p = 0.01），肉瘤原发灶与较好的LC相关（HR = 0.04；p = 0.008）。
结论
BED≥60 Gy的SABR为AYA患者带来了持久的LC，尤其是那些肉瘤原发灶患者，尽管转移性CNS恶性肿瘤的预后较差。
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