Stereotactic Body Radiotherapy for Colorectal Liver Metastases A Pooled Analysis
Stereotactic Body Radiotherapy for Colorectal Liver Metastases A Pooled Analysis
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DOI：
10.1002/cncr.25997
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发表时间：
2011-09-01
期刊：
影响因子：
6.2
通讯作者：
Schefter, Tracey E.
中科院分区：
文献类型：
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作者：
Chang, Daniel T.;Swaminath, Anand;Schefter, Tracey E.
背景技术背景：本研究旨在确定立体定向体部放疗治疗结直肠癌肝转移的合并患者队列的结局。方法：来自3个机构的结直肠肝转移患者如果有1 - 4个病灶，接受1 - 6次立体定向体部放疗，并且在治疗后≥ 3个月进行放射学成像，则被纳入。回顾性分析了2003年8月至2009年5月治疗的65例患者的102处病变。在将时间表转换为生物等效剂量（BED）、单次等效剂量或基于线性二次模型的单次剂量后，使用肿瘤控制概率（TCP）模型估计>90%局部控制所需的3次剂量。结果：47例（72%）患者在立体定向体部放疗前接受了>= 1个化疗方案，27例（42%）患者接受了>= 2个化疗方案。中位随访时间为1.2年（范围：0.3-5.2年）。中位剂量为42戈瑞（戈伊;范围，22-60戈伊）。当通过多变量分析单独评估时，总剂量（P = .0015）、剂量/分次（P = .003）和BED（P = .004）均与病灶局部控制相关。在多变量分析中，非活动性肝外疾病与总生存率（OS; P = 0.046）相关，持续的局部控制密切相关（P = 0.06）。通过在TCP模型中使用单次等效剂量、BED或基于线性二次模型的单次剂量，估计1年局部控制>90%所需的剂量范围为3次46至52戈伊。结论：肝立体定向放射治疗结直肠癌肝转移瘤耐受性好，有效。局部控制和OS之间的强相关性支持控制肝脏疾病，即使是重度预治疗患者。对于立体定向体部放疗的3次分割方案，如果正常组织限制允许，应考虑处方剂量>= 48戈伊。Cancer 2011;117：4060-9. (C)2011年美国癌症协会
BACKGROUND: This study was undertaken to determine outcomes of stereotactic body radiotherapy for colorectal liver metastases in a pooled patient cohort. METHODS: Patients with colorectal liver metastases from 3 institutions were included if they had 1 to 4 lesions, received 1 to 6 fractions of stereotactic body radiotherapy, and had radiologic imaging >= 3 months post-treatment. Sixty-five patients with 102 lesions treated from August 2003 to May 2009 were retrospectively analyzed. A tumor control probability (TCP) model was used to estimate the 3-fraction dose required for >90% local control after converting the schedule into biologically equivalent dose (BED), single-fraction equivalent dose, or linear quadratic model-based single-fraction dose. RESULTS: Forty-seven (72%) patients had >= 1 chemotherapy regimen before stereotactic body radiotherapy, and 27 (42%) patients had >= 2 regimens. The median follow-up was 1.2 years (range, 0.3-5.2 years). The median dose was 42 gray (Gy; range, 22-60 Gy). When evaluated separately by multivariate analysis, total dose (P = .0015), dose/fraction (P = .003), and BED (P = .004) all correlated with local control by lesion. On multivariate analysis, nonactive extrahepatic disease was associated with overall survival (OS; P = .046), and sustained local control was closely correlated (P = .06). By using single-fraction equivalent dose, BED, or linear quadratic model-based single-fraction dose in the TCP model, the estimated dose range needed for 1-year local control >90% is 46 to 52 Gy in 3 fractions. CONCLUSIONS: Liver stereotactic body radiotherapy is well tolerated and effective for colorectal liver metastases. The strong correlation between local control and OS supports controlling hepatic disease even for heavily pretreated patients. For a 3-fraction regimen of stereotactic body radiotherapy, a prescription dose of >= 48 Gy should be considered, if normal tissue constraints allow. Cancer 2011;117:4060-9. (C) 2011 American Cancer Society.