Anand Anil Kumar, Kakkar Neha, Immanuel Vivek, Pannu Jyoti, Chaudhoory Amal Roy, Malhotra Heigrujam, Kumar Tarun
Department of Radiation Oncology, Fortis Memorial Research Institute, Gurugram, Haryana 122002, India.
Division of Medical Physics, Fortis Memorial Research Institute, Gurugram, Haryana 122002, India.
BJR Open. 2024 Nov 27;6(1):tzae042. doi: 10.1093/bjro/tzae042. eCollection 2024 Jan.
To evaluate the outcome of patients with cranial (C) and extra-cranial (EC) oligometastases treated with stereotactic radiosurgery (SRS)/stereotactic body radiotherapy (SBRT) and standard of care systemic therapy.
During the period 2018-2022, patients who received SBRT or SRS for oligometastases (≤5 lesions) in addition to systemic therapy were evaluated. PET-CT was done to categorize them as C or EC oligometastases. Local control, distant progression, progression-free survival (PFS), overall survival (OS), and toxicity of the treatment were recorded.
43 patients received SBRT/SRS to 88 oligometastatic lesions. Eighteen patients had C metastases, 23 had EC metastases and 2 patients had both. 40/43 patients had received systemic therapy. At a median follow-up of 13 months, median PFS was 14 months and 1 and 2 years OS was 83.2% and 67.4%. Local control with SRS was 92.8% and with SBRT was 86.3%. Distant failure in C vs EC oligometastases was seen in 12/14 vs 7/20 patients ( = 0.03). Median PFS was 30 months for EC and 6 months for C oligometastases ( = 0.003). 1 and 2 years OS was 89.6% and 82.7% for EC and 77.6% and 48.5% for C oligometastases ( = 0.21). One patient had grade 3 and 3 patients had grade 1 toxicity.
SRS and SBRT yielded high rates of local control with low toxicity. Compared to EC, patients with C oligometastases had higher distant relapses, poorer PFS, and a trend towards worse survival. More studies with separate enrolment of patients with C and EC oligometastases are needed.
Outcome of patients with C oligometastases is poorer than EC metastases and hence the studies should be separately done in these 2 groups to assess the benefit of SRS/SBRT.
评估接受立体定向放射外科治疗（SRS）/立体定向体部放射治疗（SBRT）及标准护理全身治疗的颅（C）和颅外（EC）寡转移患者的治疗结果。
在2018年至2022年期间，对除全身治疗外还接受SBRT或SRS治疗寡转移（≤5个病灶）的患者进行评估。进行PET-CT检查以将他们分类为C或EC寡转移。记录局部控制、远处进展、无进展生存期（PFS）、总生存期（OS）和治疗毒性。
43例患者接受SBRT/SRS治疗88个寡转移病灶。18例患者有C转移，23例有EC转移，2例两者均有。40/43例患者接受了全身治疗。中位随访13个月时，中位PFS为14个月，1年和2年OS分别为83.2%和67.4%。SRS的局部控制率为92.8%，SBRT为86.3%。C与EC寡转移患者的远处失败率分别为12/14和7/20（P = 0.03）。EC寡转移患者的中位PFS为30个月，C寡转移患者为6个月（P = 0.003）。EC寡转移患者的1年和2年OS分别为89.6%和82.7%，C寡转移患者为77.6%和48.5%（P = 0.21）。1例患者出现3级毒性，3例患者出现1级毒性。
SRS和SBRT产生了高局部控制率且毒性低。与EC相比，C寡转移患者有更高的远处复发率、更差的PFS，且有生存更差的趋势。需要对C和EC寡转移患者分别进行更多研究。
C寡转移患者的治疗结果比EC转移患者差，因此应在这两组中分别进行研究以评估SRS/SBRT的益处。
