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螺旋断层调强大分割放射治疗肺寡转移瘤近期疗效及预后因素分析

陈如君 孙谦 汪庚明 江浩

陈如君, 孙谦, 汪庚明, 江浩. 螺旋断层调强大分割放射治疗肺寡转移瘤近期疗效及预后因素分析[J]. 中华全科医学, 2022, 20(8): 1302-1306. doi: 10.16766/j.cnki.issn.1674-4152.002582
引用本文: 陈如君, 孙谦, 汪庚明, 江浩. 螺旋断层调强大分割放射治疗肺寡转移瘤近期疗效及预后因素分析[J]. 中华全科医学, 2022, 20(8): 1302-1306. doi: 10.16766/j.cnki.issn.1674-4152.002582
CHEN Ru-jun, SUN Qian, WANG Geng-ming, JIANG Hao. Survival and prognostic factors of hypofractionated radiation therapy with helical tomotherapy for pulmonary oligometastases[J]. Chinese Journal of General Practice, 2022, 20(8): 1302-1306. doi: 10.16766/j.cnki.issn.1674-4152.002582
Citation: CHEN Ru-jun, SUN Qian, WANG Geng-ming, JIANG Hao. Survival and prognostic factors of hypofractionated radiation therapy with helical tomotherapy for pulmonary oligometastases[J]. Chinese Journal of General Practice, 2022, 20(8): 1302-1306. doi: 10.16766/j.cnki.issn.1674-4152.002582

螺旋断层调强大分割放射治疗肺寡转移瘤近期疗效及预后因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002582
基金项目: 

安徽省自然科学基金项目 1408085MH190

安徽省高校自然科学基金重点项目 KJ2021A0715

安徽省中央引导地方科技发展资金项目 2020b07030008

详细信息
    通讯作者:

    江浩, E-mail: jianghao1223@163.com

  • 中图分类号: R734.2R730.55

Survival and prognostic factors of hypofractionated radiation therapy with helical tomotherapy for pulmonary oligometastases

  • 摘要:   目的  螺旋断层放疗在保护多病灶、大肿瘤周围的正常组织和器官,降低放疗的毒性反应方面有较大优势。本研究主要分析肺寡转移瘤患者应用螺旋断层调强大分割放射治疗的近期疗效和影响预后的危险因素。  方法  回顾性分析2018年1月1日—2021年6月30日就诊于蚌埠医学院第一附属医院肿瘤放疗科的45例完成螺旋断层大分割放疗的肺寡转移瘤患者资料。采用Kaplan-Meier方法计算总生存(OS)、局部控制(LC)和无进展生存(PFS), 运用Cox比例风险模型明确患者预后的独立影响因素。治疗相关毒性采用美国国家癌症研究所常见不良事件评价标准(CTCAE)5.0版本评价。  结果  截至2021年9月30日,全组患者均完成放疗计划,随访时间为16.0(12.3, 24.2)个月,生物等效剂量为76.8(72.8, 90.0)Gy。1年与2年OS率分别为94.8%、58.1%;1年与2年LC率分别为83.8%、74.1%;1年与2年PFS率分别为57.8%、43.3%。单因素分析显示Karnofsky功能状态评分(KPS)>80分与高LC率有关(P=0.043)。多因素分析显示确诊肺转移前有无远处淋巴结转移患者OS比较差异有统计学意义(P=0.041, HR=3.014, 95% CI:1.043~8.706);是否使用四维计算机断层扫描术定位患者PFS比较差异有统计学意义(P=0.035, HR=2.693, 95% CI=1.072~6.761)。无治疗相关性死亡及≥3级的放射性肺炎发生。  结论  螺旋断层调强大分割放射治疗技术在肺寡转移瘤的治疗上是安全有效的,并且KPS>80分、确诊肺转移前无远处淋巴结转移的患者有较长的生存时间。

     

  • 图  1  患者总生存率、局部控制率和无进展生存率曲线

    Figure  1.  Curves of overall survival, local control, and progression-free survival

    图  2  远处淋巴结转移对患者总生存率的影响

    Figure  2.  Effect of distant lymph node metastasis on overall survival

    图  3  不同定位扫描方式对患者无进展生存率的影响

    Figure  3.  Effect of different localization scanning methods on progression-free survival

    表  1  肺寡转移瘤患者一般情况

    Table  1.   General situation of patients with pulmonary oligometriosis

    项目 例数(%) 项目 例数(%)
    性别 转移器官数
      男性 31(68.9)   1 27(60.0)
      女性 14(31.1)   2 16(35.6)
    肿瘤类型   3 2(4.4)
      头颈部肿瘤 13(28.9) 肺转移灶数
      结直肠癌 9(20.0)   1 21(46.7)
      食管癌 6(13.3)   2 8(17.8)
      软组织肿瘤 5(11.1)   3 6(13.3)
      乳腺癌 3(6.7)   4 3(6.7)
      非小细胞肺癌 3(6.7)   5 7(15.5)
      其他 6(13.3) 肺转移时性
    远处淋巴结转移   同时性 7(15.5)
      是 13(28.9)   异时性 38(84.5)
      否 32(71.1) 病理类型
    4DCT扫描   鳞癌 18(40.0)
      是 26(57.8)   腺癌 15(33.4)
      否 19(42.2)   肉瘤 6(13.3)
      其他 6(13.3)
    下载: 导出CSV

    表  2  剂量分割模式

    Table  2.   Dose segmentation model

    单次剂量(Gy) 总剂量(Gy) BED(Gy) 病例数 转移灶数
    3.0 48.0~60.0 62.4~78.0 9 15
    4.0 40.0~60.0 56.0~84.0 11 34
    5.0 30.0~60.0 45.0~90.0 11 19
    6.0 48.0~60.0 76.8~96.0 14 34
    下载: 导出CSV

    表  3  影响肺寡转移瘤患者预后的单因素分析

    Table  3.   Univariate analysis of prognostic factors in patients with pulmonary oligometriosis

    项目 例数 OS LC PFS
    2年(%) P 2年(%) P 2年(%) P
    年龄(岁) 0.165 0.603 0.227
      <58 22 71.8 70.4 35.5
      ≥58 23 35.2 82.1 55.8
    KPS评分(分) 0.438 0.043 0.066
      >80 22 67.5 93.8 65.7
      ≤80 23 51.2 55.9 25.1
    性别 0.977 0.519 0.654
      男性 31 60.6 74.6 51.8
      女性 14 53.6 74.3 32.7
    肿瘤类型 0.457 0.457 0.937
      头颈部肿瘤 13 49.2 66.7 50.8
      结直肠癌 9 57.1 85.7 46.7
      其他 23 65.1 79.0 41.1
    肺转移时性 0.543 0.337 0.965
      同时性 7 53.3 66.7 53.6
      异时性 38 58.9 76.1 42.0
    转移器官数 0.075 0.253 0.491
      单个 27 68.8 65.6 40.7
      ≥2 18 44.7 85.1 30.6
    肺转移灶数 0.952 0.184 0.475
      单个 21 48.1 87.4 56.0
      ≥2个 24 66.2 62.5 34.5
    远处淋巴结转移 0.032 0.585 0.583
      有 13 34.3 80.8 44.9
      无 32 72.3 70.3 40.6
    BED(Gy) 0.392 0.192 0.823
      ≤76.8 23 65.0 64.2 42.5
      >76.8 22 43.8 87.8 52.4
    PTV(cm3) 0.348 0.694 0.190
      <54.4 22 62.0 70.0 76.4
      ≥54.4 23 56.3 75.9 38.6
    4DCT定位 0.267 0.521 0.028
      是 26 53.5 83.5 68.3
      否 19 63.7 70.0 25.8
    下载: 导出CSV
  • [1] 付后卫, 何顺朋, 施祥德, 等. 转移瘤动物模型的构建及其检测方法[J]. 中华全科医学, 2017, 15(1): 142-146. doi: 10.16766/j.cnki.issn.1674-4152.2017.01.043

    FU H W, HE S P, SHI D X, et al. Construction and detection of metastases in animal models[J]. Chinese Journal of General Practice, 2017, 15(1): 142-146. doi: 10.16766/j.cnki.issn.1674-4152.2017.01.043
    [2] 雷俊琴, 刘文扬, 金晶. 立体定向放疗用于结直肠癌肝与肺寡转移的研究进展[J]. 中华放射肿瘤学杂志, 2021, 30(12): 1316-1320. doi: 10.3760/cma.j.cn113030-20200330-00145

    LEI J Q, LIU W Y, JIN J. Stereotactic body radiation therapy for liver and lung oligometastases from colorectal cancer: safety, local efficacy and prognostic factors[J]. Chinese Journal of Radiation Oncology, 2021, 30(12): 1316-1320. doi: 10.3760/cma.j.cn113030-20200330-00145
    [3] ANDRUSKA N, STOWE H B, CROCKETT C, et al. Stereotactic radiation for lung cancer: A practical approach to challenging scenarios[J]. J Thorac Oncol, 2021, 16(7): 1075-1085. doi: 10.1016/j.jtho.2021.04.002
    [4] RUERS T, VAN COEVORDEN F, PUNT C J, et al. Local treatment of unresectable colorectal liver metastases: Results of a randomized Phase Ⅱ Trial[J]. J Natl Cancer Inst, 2017, 109(9): djx015. DOI: 10.1093/jnci/djx015.
    [5] 卢振国, 孙君碟, 向作林, 等. 不可手术切除的肝转移癌行50 Gy/10 f分割模式立体定向放疗疗效评估[J]. 中国临床医学, 2020, 27(6): 1007-1010. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202006024.htm

    LU Z G, SUN J D, SHI Z L, et al. Stereotactic body radiotherapy with 50 Gy in 10 fractions for unresectable liver metastasis[J]. Chinese Journal Of Clinical Medicine, 2020, 27(6): 1007-1010. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202006024.htm
    [6] 巴云涛, 王权, 刘海龙, 等. 大分割放疗治疗早期乳腺癌保乳手术后患者的疗效及安全性[J]. 癌症进展, 2020, 18(4): 384-387. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202004016.htm

    BA Y T, WANG Q, LIU H L, et al. Effect and safety of hypofractionated radiotherapy for early breast cancer patients after breast-conserving surgery[J]. Oncology Progress, 2020, 18(4): 384-387. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202004016.htm
    [7] SHARMA A, DUIJM M, OOMEN-DE HOOP E, et al. Survival and prognostic factors of pulmonary oligometastases treated with stereotactic body radiotherapy[J]. Acta Oncol, 2019, 58(1): 74-80. doi: 10.1080/0284186X.2018.1521986
    [8] LIU P, LIU G, WANG G, et al. Comparison of dosimetric gains provided by intensity-modulated radiotherapy, volume-modulated arc therapy, and helical tomotherapy for high-grade glioma[J]. Biomed Res Int, 2020, 2020: 4258989. DOI: 10.1155/2020/4258989.
    [9] FIGLIA V, MAZZOLA R, CUCCIA F, et al. Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: Report of feasibility by a single-center experience[J]. Radiol Med, 2018, 123(6): 406-414. doi: 10.1007/s11547-018-0858-7
    [10] ONO T, NAKAMURA M, HIROSE Y, et al. Estimation of lung tumor position from multiple anatomical features on 4D-CT using multiple regression analysis[J]. J Appl Clin Med Phys, 2017, 18(5): 36-42. doi: 10.1002/acm2.12121
    [11] LI G, LIU Y, NIE X. Respiratory-Correlated (RC) vs. Time-Resolved (TR) Four-Dimensional Magnetic Resonance Imaging (4DMRI) for radiotherapy of thoracic and abdominal cancer[J]. Front Oncol, 2019, 9: 1024. doi: 10.3389/fonc.2019.01024
    [12] 张利伟, 娄志霞, 林琳, 等. 4D-定位CT在胸腹部肿瘤精确放疗中的应用[J]. 影像研究与医学应用, 2019, 3(12): 12-15. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY201912005.htm

    ZHANG L W, LOU Z X, LIN L, et al. Application of 4D-localized CT in accurate radiotherapy of thoracic and abdominal tumors[J]. Journal of Imaging Research and Medical Applications, 2019, 3(12): 12-15. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY201912005.htm
    [13] ZHONG J, SLEVIN F, SCARSBROOK A F, et al. Salvage reirradiation options for locally recurrent prostate cancer: A systematic review[J]. Front Oncol, 2021, 11: 681448. DOI: 10.3389/fonc.2021.681448.
    [14] CAO Y, CHEN H, SAHGAL A, et al. An international pooled analysis of SBRT outcomes to oligometastatic spine and non-spine bone metastases[J]. Radiother Oncol, 2021, 164: 98-103. doi: 10.1016/j.radonc.2021.08.011
    [15] YU J, KIM D H, LEE J, et al. Radiofrequency ablation versus stereotactic body radiation therapy in the treatment of colorectal cancer liver metastases[J]. Cancer Res Treat, 2021. DOI: 10.4143/crt.2021.674.
    [16] LODEWEGES J E, KLINKENBERG T J, UBBELS J F, et al. Long-term outcome of surgery or stereotactic radiotherapy for lung oligometastases[J]. J Thorac Oncol, 2017, 12(9): 1442-1445. doi: 10.1016/j.jtho.2017.05.015
    [17] YAMAMOTO T, NⅡBE Y, MATSUMOTO Y, et al. Analyses of local control and survival after stereotactic body radiotherapy for pulmonary oligometastases from colorectal adenocarcinoma[J]. J Radiat Res, 2020, 61(6): 935-944. doi: 10.1093/jrr/rraa071
    [18] YAMAMOTO T, NⅡBE Y, MATSUMOTO Y, et al. Stereotactic body radiotherapy for pulmonary oligometastases from esophageal cancer: Results and prognostic factors[J]. Anticancer Res, 2020, 40(4): 2065-2072. doi: 10.21873/anticanres.14164
    [19] LARDINOIS I, DEQUANTER D, LECHIEN J R, et al. Survival and treatment outcome of head and neck cancer patients with pulmonary oligometastases[J]. Clin Otolaryngol, 2021, 46(2): 311-317. doi: 10.1111/coa.13668
    [20] SIVA S, BRESSEL M, MAI T, et al. Single-fraction vs multifraction stereotactic ablative body radiotherapy for pulmonary oligometastases (SAFRON Ⅱ): The Trans Tasman Radiation Oncology Group 13.01 Phase 2 randomized cinical trial[J]. JAMA Oncol, 2021, 7(10): 1476-1485. doi: 10.1001/jamaoncol.2021.2939
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出版历程
  • 收稿日期:  2022-01-02
  • 网络出版日期:  2022-09-26

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