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

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

蚌埠医学院第一附属医院肿瘤放疗科，安徽蚌埠 233004

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
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出版历程
- 收稿日期: 2022-01-02
- 网络出版日期: 2022-09-26

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

Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

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。
- 肺寡转移 /
- 螺旋断层放射治疗 /
- 大分割放射治疗 /
- 预后因素
Abstract: Objective Helical tomography (HT) has great advantages in protecting the normal tissues and organs around multiple lesions and large tumours and reducing the toxicity of radiotherapy. The aim of this study was to analyse treatment outcomes after hypofractionated stereotactic radiation therapy with HT for pulmonary oligometastases and identify prognostic factors for better survival outcomes. Methods The data of 45 patients with lung oligometastases who completed helical tomographic hypofractionation radiotherapy in the Department of tumor radiotherapy, the First Affiliated Hospital of Bengbu Medical College from January 1, 2018 to June, 30, 2021 were retrospectively analyzed. Kaplan-Meier was used to estimate overall survival (OS), local control rate (LCR) and progression-free survival (PFS). The Cox proportional hazards model was used to determine the independent prognostic factors of the patients. Treatment-related toxicity was evaluated using common terminology criteria for adverse events (CTCAE) version 5.0. Results Follow-up was performed until September 30, 2021. All patients completed the treatment plan during a median follow-up of 16.0 (12.3, 24.2) months. The median biological effective dose was 76.8 (72.8, 90.0) Gy. The 1-year and 2-year OS rates were 94.8% and 58.1%, respectively. The 1-year and 2-year local control rates were 83.8% and 74.1%, respectively. The 1-year and 2-year PFS rates were 57.8% and 43.3%, respectively. The Karnofsky performance status (KPS)>80 before treatment was significantly associated with better LCR in univariate analysis (P=0.043). Multivariate analysis showed that distant lymph node metastasis before diagnosis of lung metastases was associated with better OS (P=0.041, HR=3.014, 95% CI: 1.043-8.706); 4D computed tomography remained an independent factor significantly associated with better PFS (P=0.035, HR=2.693, 95% CI: 1.072-6.761). No treatment-related deaths and grade≥3 toxicities occurred. Conclusion Hypofractionated stereotactic radiation therapy with HT for lung oligometastases is safe and effective. Patients with KPS>80 and no distant lymph node metastasis before diagnosis of lung metastasis has a longer survival time.
- Pulmonary oligometastases /
- Helical tomotherapy /
- Hypofractionated radiotherapy /
- Prognostic factors

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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

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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)

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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

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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
项目	例数	2年(%)	P值	2年(%)	P值	2年(%)	P值
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

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