评估立体定向放射治疗转移性结直肠癌的疗效：临床结果的回顾性分析
Evaluating the efficacy of stereotactic radiotherapy for metastatic colorectal cancer: A retrospective review of clinical outcomes.
作者信息
Chen Beini, Smith Justin, Chelvarajah Revadhi, Knesl Alexandra, Moodley Parushka, Pryor David, Pinkham Mark B, Mai G Tao, Liu Howard Y, Lee Yoo Young
机构信息
Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
School of Medicine, University of Queensland, Herston, QLD, Australia.
出版信息
J Radiosurg SBRT. 2025;9(3):237-243.
BACKGROUND
Despite advances in systemic therapy, survival in metastatic colorectal cancer (mCRC) remains poor. The utility of stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS), allowing dose escalation to achieve improved local control has risen in the treatment of mCRC. However, local control (LC) and overall survival (OS) varies widely between studies, and prognostic factors are not well defined.
METHODS
We retrospectively assessed LC and OS in patients with mCRC treated with SBRT/SRS between 2014 and 2022.
RESULTS
124 Patients were treated during the study period. Median follow up was 16.4 months (0.2-93.1 months). There were 310 lesions treated with 53% located in the brain, 22% lung, 16% liver, 4% bone, 4% nodal and 1% other. Biologically effective dose (BED10) ranged from 33.6 to 151.2 Gy.LC was 75% (95% CI 67-81%) at 1 year and 65% (95%CI 56-73%) 2 years. On multivariable analysis (MVA), older age (HR 1.04, = 0.001) and tumour volume >2.5 cc (HR 3.13, < 0.001) were associated with worse LC.OS from first course of SBRT/SRS was 68% at 1 year (95%CI 58-76%), and 48% at 2 years (95%CI 38-58%). On MVA, ≥2 or more lines of systemic therapy (HR 3.04, < 0.001) and brain metastases (HR 4.24, = 0.001) were associated with shorter OS. Living long enough to receive ≥2 courses of SBRT/SRS (HR 0.20, = 0.004) was associated with longer OS.
CONCLUSION
This study demonstrates that SBRT and SRS offer effective local control, and LC is associated with tumour volume.
背景
尽管全身治疗取得了进展，但转移性结直肠癌（mCRC）患者的生存率仍然很低。立体定向体部放疗（SBRT）和立体定向放射外科（SRS）能够提高剂量以实现更好的局部控制，在mCRC治疗中的应用有所增加。然而，不同研究之间的局部控制（LC）和总生存期（OS）差异很大，且预后因素尚不明确。
方法
我们回顾性评估了2014年至2022年间接受SBRT/SRS治疗的mCRC患者的LC和OS。
结果
研究期间共治疗了124例患者。中位随访时间为16.4个月（0.2 - 93.1个月）。共治疗了310个病灶，其中53%位于脑，22%位于肺，16%位于肝，4%位于骨，4%位于淋巴结，1%位于其他部位。生物等效剂量（BED10）范围为33.6至151.2 Gy。1年时LC为75%（95%CI 67 - 81%），2年时为65%（95%CI 56 - 73%）。多变量分析（MVA）显示，年龄较大（HR 1.04，P = 0.001）和肿瘤体积>2.5 cc（HR 3.13，P < 0.001）与较差的LC相关。首次SBRT/SRS疗程后的1年OS为68%（95%CI 58 - 76%），2年时为48%（95%CI 38 - 58%）。MVA显示，≥2线或更多线全身治疗（HR 3.04，P < 0.001）和脑转移（HR 4.24，P = 0.001）与较短的OS相关。存活时间足够长以接受≥2疗程SBRT/SRS（HR 0.20，P = 0.004）与较长的OS相关。
结论
本研究表明SBRT和SRS可提供有效的局部控制，且LC与肿瘤体积相关。
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