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运动管理中的精准性:寡转移肺和肝转移瘤立体定向体部放疗的长期局部控制及预后洞察

Precision in Motion Management: Long-Term Local Control and Prognostic Insights in SBRT for Oligometastatic Lung and Liver Metastases.

作者信息

Dirkx Silke, Van Laere Sven, Gevaert Thierry, De Ridder Mark

机构信息

Department of Radiotherapy, Research Centre for Digital Medicine, VUB-UZ Brussel, 1090 Brussels, Belgium.

出版信息

Cancers (Basel). 2025 Jan 17;17(2):296. doi: 10.3390/cancers17020296.

Abstract

: Inadequate dosing and respiratory motion contribute to local recurrence for oligometastatic disease (OMD). While short-term LC rates are well-documented, data on long-term LC remain limited. This study investigated long-term LC after stereotactic body radiotherapy (SBRT), using respiratory motion management techniques. This retrospective study took place at UZ Brussel with follow-up until Oct 2024. It analyzed oligometastatic patients treated with SBRT between Jul 2012 and Feb 2017. Treatment involved delivering 50 Gy in 10 fractions on the 80% isodose line, building on data from a prior prospective study. Lesion movement was managed using internal target volume (ITV) or dynamic tumor tracking (DTT) with marker. The primary endpoint of the study was long-term LC and identifying variables associated with it using a Cox proportional hazards model. : A total of 100 patients were treated for a total of 211 metastatic lesions. Lesions were predominantly in the lungs (74%) and treated using ITV (88%). LC rates at 1, 3, 5, and 10 years were 76.5%, 53.8%, 38.1%, and 36.3%, respectively. Improved LC was observed in locations other than lung and liver (HR: 0.309; = 0.024) and with increasing age (HR: 0.975; < 0.010). Worse LC was seen in liver lesions (HR: 1.808; = 0.103) and systemic therapy post-radiotherapy (HR: 3.726; < 0.001). No significant associations were found with tumor size or tumor motion, nor between the two motion management strategies used (DTT and ITV). : Appropriate motion management is key in LC for OMD. No significant difference in LC was found between both techniques. Lesion location, patient age, and systemic therapy post-radiotherapy were prognostic factors for LC.

摘要

剂量不足和呼吸运动是寡转移性疾病(OMD)局部复发的原因。虽然短期局部控制(LC)率已有充分记录,但长期LC的数据仍然有限。本研究使用呼吸运动管理技术,调查了立体定向体部放疗(SBRT)后的长期LC情况。这项回顾性研究在布鲁塞尔大学医院进行,随访至2024年10月。它分析了2012年7月至2017年2月期间接受SBRT治疗的寡转移性患者。治疗方案是根据先前一项前瞻性研究的数据,在80%等剂量线上分10次给予50 Gy。使用内部靶区(ITV)或带标记的动态肿瘤追踪(DTT)来管理病灶运动。该研究的主要终点是长期LC,并使用Cox比例风险模型确定与之相关的变量。

共有100名患者接受了治疗,总共211个转移病灶。病灶主要位于肺部(74%),并使用ITV进行治疗(88%)。1年、3年、5年和10年的LC率分别为76.5%、53.8%、38.1%和36.3%。在肺和肝以外的部位观察到LC改善(风险比:0.309;P = 0.024),且随着年龄增长LC改善(风险比:0.975;P < 0.010)。肝部病灶的LC较差(风险比:1.808;P = 0.103),放疗后进行全身治疗的LC也较差(风险比:3.726;P < 0.001)。未发现与肿瘤大小或肿瘤运动有显著关联,两种运动管理策略(DTT和ITV)之间也无显著关联。

适当的运动管理是OMD的LC的关键。两种技术在LC方面未发现显著差异。病灶位置、患者年龄和放疗后全身治疗是LC的预后因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1276/11763669/08f3453caa00/cancers-17-00296-g001.jpg

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