Stereotactic body radiotherapy for oligo-metastatic liver disease - Influence of pre-treatment chemotherapy and histology on local tumor control
Stereotactic body radiotherapy for oligo-metastatic liver disease - Influence of pre-treatment chemotherapy and histology on local tumor control
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DOI：
10.1016/j.radonc.2017.01.013
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发表时间：
2017-05-01
影响因子：
5.7
通讯作者：
Andratschke, N.
中科院分区：
文献类型：
--
作者：
Klement, R. J.;Guckenberger, M.;Andratschke, N.
前言：立体定向全身放射治疗(SBRT)应用于肝转移瘤的治疗。然而，除了辐射剂量外，影响肿瘤控制概率的因素还没有得到彻底的研究。在此，我们利用德国放射肿瘤学学会的大型多中心数据库，重点研究SBRT前的组织学和化疗对这些因素的影响。方法：在多中心数据库中收集患者、肿瘤和治疗数据后，对363名患者的452例SBRT治疗进行分析。组织学通过半参数和参数脆弱模型中的随机效应来考虑。剂量处方通过换算为最大生物有效剂量(Bedmax)来参数化。结果：在调整组织学因素后，Bedmax是最强的预测Tcp的因素。较大的PTV容量、SBRT前的化疗和简单的运动管理技术可以显著降低Tcp。该模型预测，在没有化疗的情况下，90%的患者在2年内需要209+/-67Gy10次的治疗，但在化疗后需要286+/-78Gy10次。与其他组织学相比，乳腺癌转移对SBRT的反应明显更快，在使用BED的2年内，90%的TCP值可以实现。化疗前和化疗前分别给予157+/-80Gy10或80+/-62Gy10次放疗。结论：在这一大的肝转移瘤队列中，除剂量外，组织学和术前化疗也是影响局部Tcp的重要因素。在调整了之前的化疗后，我们的数据增加了新的证据，即与其他组织学相比，乳腺癌转移对低分割SBRT的反应确实更好。(C)2017爱思唯尔B.V.保留所有权利。
Introduction:, Stereotactic body radiation therapy (SBRT) is applied in the oligometastatic setting to treat liver metastases. However, factors influencing tumor control probability (TCP) other than radiation dose have not been thoroughly investigated. Here we set out to investigate such factors with a focus on the influence of histology and chemotherapy prior to SBRT using a large multi-center database from the German Society of Radiation Oncology.Methods: 452 SBRT treatments in 363 patients were analyzed after collection of patient, tumor and treatment data in a multi-center database. Histology was considered through random effects in semi parametric and parametric frailty models. Dose prescriptions were parametrized by conversion to the maximum biologically effective dose using alpha/beta of 10 Gy (BEDmax).Results: After adjusting for histology, BEDmax was the strongest predictor of TCP. Larger PTV volumes, chemotherapy prior to SBRT and simple motion management techniques predicted significantly lower TCP. The model predicted a BED of 209 +/- 67 Gy(10) necessary for 90% TCP at 2 years with no prior chemotherapy, but 286 +/- 78 Gy(10) when chemotherapy had been given. Breast cancer metastases were significantly more responsive to SBRT compared to other histologies with 90% TCP at 2 years achievable with BED,. of 157 +/- 80 Gy(10) or 80 +/- 62 Gy(10) with and without prior chemotherapy, respectively.Conclusions: Besides dose, histology and pretreatment chemotherapy were important factors influencing local TCP in this large cohort of liver metastases. After adjusting for prior chemotherapy, our data add to the emerging evidence that breast cancer metastases do respond better to hypofractionated SBRT compared to other histologies. (C) 2017 Elsevier B.V. All rights reserved.