Song Youngju, Kim Yeon Joo, Choi Sehoon, Yun Jae Kwang, Ahn Jin-Hee, Kim Jeong Eun, Lee Jong Seok, Kim Wanlim, Do Kyung-Hyun, Chung Hye Won, Lee Geun Dong, Song Si Yeol
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Clin Exp Metastasis. 2024 Dec 16;42(1):2. doi: 10.1007/s10585-024-10320-3.
Recent studies report excellent local control (LC) and favorable toxicities of stereotactic ablative radiotherapy (SABR) for pulmonary metastasis (PM) from sarcoma. This study compared the LC and survival of SABR and metastasectomy for sarcoma PM. We analyzed the LC rates of 54 PMs treated with SABR between 2008 and 2022. For survival analysis, we compared 14 patients who received SABR as first-line treatment with 61 patients who underwent metastatectomy. For SABR-treated PMs, a median total dose of 55 Gy (range, 48-60) was administered over 3-10 fractions. Median follow-up for LC in SABR-treated PMs was 19.2 months (range, 0.8-124.0), and the 2-year LC rate was 92.2%. No patients experienced toxicities of grade 3 or higher. The median age of the patients in the survival analysis was 73 years (range, 42-83) in the SABR group and 54 years (range, 19-78) in the metastasectomy group (p < 0.001). PMs in the "gray zone" were more common in the SABR group (35.7%) than in the metastasectomy group (8.2%) (p = 0.029). The median follow-up for survival analysis was 44.8 months (interquartile range, 21.5-66.4). The 3-year rates of LC and overall survival were 92.3% and 57.3% in the SABR group and 89.2% and 75.9% in the metastasectomy group (p = 0.807, 0.224), respectively. The out-of-field intrapulmonary failure-free survival and extrapulmonary systemic failure-free survival rates at 3 years were not significantly different (p = 0.673, 0.386). SABR for sarcoma PM demonstrated excellent LC with acceptable toxicity. Survival rates of SABR were comparable to those of metastasectomy.
近期研究报告称，立体定向消融放疗（SABR）对肉瘤肺转移（PM）具有出色的局部控制（LC）效果和良好的毒性反应。本研究比较了SABR与转移灶切除术治疗肉瘤PM的局部控制情况和生存率。我们分析了2008年至2022年间接受SABR治疗的54例PM的局部控制率。在生存分析中，我们将14例接受SABR作为一线治疗的患者与61例行转移灶切除术的患者进行了比较。对于接受SABR治疗的PM，中位总剂量为55 Gy（范围48 - 60），分3 - 10次给予。接受SABR治疗的PM的局部控制中位随访时间为19.2个月（范围0.8 - 124.0），2年局部控制率为92.2%。无患者出现3级或更高等级的毒性反应。生存分析中，SABR组患者的中位年龄为73岁（范围42 - 83），转移灶切除组为54岁（范围19 - 78）（p < 0.001）。“灰色区域”的PM在SABR组（35.7%）比转移灶切除组（8.2%）更常见（p = 0.029）。生存分析的中位随访时间为44.8个月（四分位间距21.5 - 66.4）。SABR组的3年局部控制率和总生存率分别为92.3%和57.3%，转移灶切除组为89.2%和75.9%（p = 0.807，0.224）。3年时野外肺内无失败生存率和肺外全身无失败生存率无显著差异（p = 0.673，0.386）。SABR治疗肉瘤PM显示出出色的局部控制效果且毒性可接受。SABR的生存率与转移灶切除术相当。
