肉瘤肺转移的立体定向消融放射治疗：治疗指征和患者选择指南。
Stereotactic ablative radiation therapy for sarcoma lung metastases: indications for treatment and guidance for patient selection.
发表日期：2023 Oct 30
作者：
A S Farooqi, A K Yoder, H Y Lin, D Pasalic, J Erasmus, S Betancourt, C Wernz, D Mitra, M A Zarzour, N Somaiah, A Conley, R Ratan, A Livingston, D M Araujo, C Roland, C Scally, E Keung, S N Gandhi, B A Guadagnolo, Q N Nguyen, A J Bishop
来源：
Int J Radiat Oncol
摘要：
肺部是软组织肉瘤患者最常见的转移部位。立体定向消融放射治疗（SABR）通常用于治疗疾病负担有限的特定肉瘤患者的肺转移。我们试图评估采用 SABR 治疗肺转移的肉瘤患者的结局和失败模式。我们对 2006 年至 2020 年间在三级癌症中心接受治疗的患者进行了回顾性审查。 SABR 时患者的疾病状态被分类为寡发性或寡进展性。 Kaplan-Meier 方法用于估计疾病结果。使用 Cox 比例风险模型进行单变量和多变量分析。我们确定了 70 名接受 SABR 治疗的 STS 患者，其中 98 个转移性肺部病灶。 SABR 治疗后 2 年局部无复发生存率为 83%。在单变量分析中，治疗时对肺转移性疾病所有部位进行全面 SABR 与 PFS 改善相关（HR 0.51 [0.29-0.88]，p=0.02）。在多变量分析中，只有在 SABR 时控制全身性疾病才能改善 PFS（中位 PFS 14 个月 vs 4 个月；HR 0.37 [0.20-0.69]，p=0.002）和 OS（中位 OS 51 个月 vs 14 个月；HR 0.37 [0.20-0.69]，p=0.002） 0.17 [0.08-0.35]，p<0.0001）。SABR 为肉瘤肺转移提供持久的长期 LC。改善结果的最重要预测因素是全身疾病控制。仔细考虑这些因素应有助于指导多学科环境中的决策，以适当选择 SABR 的最佳候选者。版权所有 © 2023。由 Elsevier Inc. 出版。
The lungs are the most common site of metastasis for patients with soft tissue sarcoma. Stereotactic ablative radiation therapy (SABR) is commonly employed to treat lung metastases among select sarcoma patients with limited disease burden. We sought to evaluate outcomes and patterns of failure among sarcoma patients treated with SABR for their lung metastases.We performed a retrospective review of patients treated at a tertiary cancer center between 2006-2020. Patients' disease status at the time of SABR was categorized as either oligorecurrent or oligoprogressive. The Kaplan-Meier method was used to estimate disease outcomes. Uni- and multivariable analyses were conducted using Cox proportional hazards model.We identified 70 STS patients treated with SABR to 98 metastatic lung lesions. Local recurrence-free survival following SABR treatment was 83% at 2 years. On univariable analysis, receipt of comprehensive SABR to all sites of pulmonary metastatic disease at the time of treatment was associated with improved PFS (HR 0.51 [0.29-0.88], p=0.02). On multivariable analysis, only having systemic disease controlled at the time of SABR predicted improved PFS (Median PFS 14 months vs 4 months; HR 0.37 [0.20-0.69], p=0.002) and OS (Median OS 51 months vs 14 months; HR 0.17 [0.08-0.35], p<0.0001).SABR provides durable long-term LC for sarcoma lung metastases. The most important predictor for improved outcomes was systemic disease control. Careful consideration of these factors should help guide decisions in a multidisciplinary setting to appropriately select the optimal candidates for SABR.Copyright © 2023. Published by Elsevier Inc.