Lucy A van Werkhoven, Maaike T W Milder, Mischa S Hoogeman, Erik van Werkhoven, Remi A Nout, Joost J Nuyttens
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引用次数: 0
Abstract
Purpose: This study reports on the clinical outcomes of the single-arm phase-2 STEAL trial investigating online adaptive stereotactic body radiation therapy (SBRT) for abdominal-pelvic lymph node (A-P LN) oligometastases.
Methods and materials: Patients with oligometastatic A-P LN were enrolled and treated to a total dose of 45 Gy in 5 fractions on the CyberKnife. For each patient, a library of 3 plans was created using a pretreatment diagnostic computed tomography (CT) scan and the treatment planning CT scan. Following a decision tree, the radiation therapy technologist (RTT) selected the best plan of the day, ie, the plan with the highest target coverage without exceeding organs at risk constraints. The primary endpoint was local control (LC), and the secondary endpoints were toxicity and overall survival.
Results: In total, 52 patients were included, and 55 online adaptive treatments were performed. The primary tumor was prostate adenocarcinoma in 19 patients (37%), colorectal in 17 (33%), and had a different origin in 16 patients (31%). After a median follow-up of 38.5 months, LC at 1 year was 96% and 80% at 3 years; 20 patients had died, resulting in a median overall survival of 4.1 years. No grade ≥4 toxicity was observed. One patient (2%) developed a grade 3 ureteral stenosis.
Conclusions: CT-guided online adaptive SBRT for A-P LN oligometastases using an RTT-only library of plans strategy is feasible, safe, and resulted in an excellent LC with a low toxicity rate.
目的:本研究报告了单臂ii期STEAL试验的临床结果,该试验研究了在线适应性立体定向放疗(SBRT)治疗腹盆腔淋巴结(A-P LN)寡转移的效果。方法:选取低转移性a - p LN患者,在射波刀上分5次给予总剂量45gy的治疗。对于每位患者,使用治疗前诊断CT扫描和治疗计划CT扫描创建了一个包含三个计划的库。根据决策树,放疗技师(RTT)选择当天的最佳计划,即在不超过OAR约束的情况下目标覆盖率最高的计划。主要终点是局部控制(LC),次要终点是毒性和总生存期(OS)。结果:共纳入52例患者,进行在线适应性治疗55例。原发肿瘤为前列腺癌19例(37%),结直肠癌17例(33%),其他来源16例(31%)。中位随访38.5个月后,1年时局部控制率为96%,3年时为80%;20例患者死亡,平均生存期为4.1年。未见≥4级毒性。1例(2%)发生3级输尿管狭窄。结论:ct引导下的在线自适应SBRT治疗a - p LN寡转移瘤,仅使用RTT计划库策略是可行的,安全的,并且具有良好的局部控制和低毒副率。
期刊介绍:
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.