寡转移瘤患者体部立体定向放疗的疗效及安全性

Efficacy and safety of stereotactic body radiotherapy in the management of oligometastatic tumor

目的探讨小体积寡转移瘤患者局部立体定向放疗(SBRT)的疗效及安全性。方法收集2011年6月至2016年12月85例转移灶≤5个、预计生存期>3个月、一般状况良好的Ⅳ期寡转移瘤患者,采用3个剂量的SBRT,主要研究终点是局部控制率和毒性反应,次要研究终点是总生存期(OS)和无疾病进展生存期(PFS)。疗效评价采用RECIST 1.1版标准;毒副反应采用RTOG评价标准;Kaplan-Meier法计算生存,Log-rank检验生存差异。结果 85例患者共187处转移灶,中位随访时间为25个月,局部控制率为66.8%(125/187),其中24、30、36 Gy剂量组局部控制率分别为39.0%、79.0%、84.0%,差异有统计学意义(P<0.05)。全组中位PFS为7.8个月(1~25个月),1、2、3年无进展生存率分别为33.3%、25.0%、23.0%;中位OS为25个月,1、2、3年生存率分别为80.5%、75.6%、70.6%。4例患者发生3级以上急性毒副反应,其中2例是肺部转移瘤,2个月后证实为放射性肺炎;另外1例是肝脏转移瘤,放疗时发生严重呕吐、转氨酶升高需入院治疗;还有1例肝、肺、骨多发转移患者发生4级骨髓抑制(白细胞减少为主)。结论寡转移瘤患者在安全治疗范围内可以从局部SBRT放疗中获得较好的局部控制率,不良反应可耐受。

Objective To evaluate the efficacy and safety of stereotactic body radiotherapy for patients with oligometastatic tumor. Methods Eighty-five patients with 1-5 metastatic sites, life expectancy〉3 months, and also good performance status, which hospitalized from June 2011 to December 2016 were enrolled, SBRT therapy were performed for those patients, during this process, es- calated doses of SBRT to all known metastatic sites. The primary end points were local control rate and toxicity. Secondary end points were overall survival（OS） and progression-free survival（PFS）. Tumor response and Local control were defined using EORTC-RECIST Criteria v. 1.1. Acute and late toxicity were scored by the RTOG evaluation criterion. The survial rates were calculated by Kaplan-Meier analysis. The differences among the modalities were evaluated using the Log-rank test. Results A total of 85 patients, 187 metastastic sites complete the treatment, the median follow-up of 25 months, local control rate of the whole team was 66. 8%, local control rate of the three treatment modalities 24, 30, 36Gy were 39.0%, 79.0%, 84%, respetively, showing a significant difference between the groups（P〈0.05） .The medium time of PFS was 7. 8 months. The 1-, 2-, 3-year progression-free survival rate was 33.3%, 25.0%, 23.0%. The medium overall survival time was 25 months. The 1-, 2-, 3-year survival rate was 80. 5% ,75.6% ,70. 6%. Four patients had acute toxic reactions over grade 3, including 2 patients with pulmonary metastasis proved to be radioactive pneumonia 2 months lat- er, and one patient with liver metastases occurred severe vomiting and elevated transaminase, and one patient with liver, lung and bone metastasis occurred grade 4 bone marrow suppression. Conclusion Patients with oligometastatic disease can be identified, in a safe treatment scope, SBRT can achieve good local control rate, with tolerable adverse effects.