在线性支气管内超声插入靶标引导下对超中央胸腔少转移性疾病进行立体定向放射治疗的可行性、安全性和疗效。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2024-09-25 DOI:10.1016/j.radonc.2024.110547

Calvin Sidhu , Colin Tang , Alison Scott , Hema Yamini Ramamurty , Lokesh Yagnik , Sue Morey , Martin Phillips , Angela Jacques , Rajesh Thomas

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引用次数: 0

摘要

背景与目的：对寡转移灶进行局部治疗可提高生存率并改善预后。立体定向体放射治疗（SBRT）已成为寡转移灶的一种治疗方法，但在超中央（UC）区域使用这种疗法会导致严重的毒性和死亡率。惰性标记（FM）可用于提高 SBRT 的准确性，并可通过线性支气管内超声（EBUS）支气管镜插入胸腔中央。FM引导的SBRT治疗UC胸腔寡转移瘤的效果尚不清楚：这是一项单中心回顾性研究，调查了线性 EBUS 插入调频和随后调频引导的 SBRT 治疗 UC-寡转移疾病的可行性、安全性和疗效。此外，还对调频装置进行了运动分析：30名门诊患者接受了32次EBUS-调频插入手术，成功率100%，无重大手术死亡率或发病率。轻微并发症是调频延迟移位，发生率为 4.8%。20 名患者在 UC 调频引导下完成了 SBRT 治疗，99.9% 的分次治疗成功。SBRT的中位剂量为40 Gy，中位分次为8次。大部分不良反应为一级，没有发生与 SBRT 相关的死亡事件。SBRT的局部控制率为95%，1年和3年的总生存率分别为90%和56.3%。SBRT 治疗后的中位总生存期为 43.6 个月。根据记录，UC区域的调频移动在上-下轴最大：结论：在UC胸腔少见转移性疾病中结合线性EBUS取样和调频插入是可行且安全的。使用调频引导对少转移灶进行 UC-SBRT 治疗，发现并发症极少，治疗后 3 年的存活率中等。

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Feasibility, safety and outcomes of stereotactic radiotherapy for ultra-central thoracic oligometastatic disease guided by linear endobronchial ultrasound-inserted fiducials

Background & purpose

Local treatment of oligometastases has been found to improve survival and prognosis. Stereotactic body radiotherapy (SBRT) has emerged as a treatment option for oligometastases but its use in ultra-central (UC) areas can cause significant toxicity and mortality. Fiducial markers (FM) can be used to improve SBRT accuracy, and can be inserted in the central thorax using linear endobronchial ultrasound (EBUS) bronchoscopy. Outcomes of FM-guided SBRT for UC thoracic oligometastases is unknown.

Methods

A single-centre retrospective study investigating the feasibility, safety and outcomes of both linear EBUS-inserted FMs and subsequent FM-guided SBRT for UC-oligometastatic disease. Motion analyses of FMs were also performed.

Results

Thirty outpatients underwent 32 EBUS-FM insertion procedures with 100 % success, and no major procedural mortality or morbidity. Minor complications were 4.8 % incidence of delayed FM-displacement. UC FM-guided SBRT was completed in 20 patients with 99.9 % fractions delivered. Median SBRT dose delivered was 40 Gy over a median of 8 fractions. Majority of adverse events were Grade 1 and there was no SBRT-related mortality. Local control with SBRT was 95 %, with overall survival at 1-year and 3-years of 90 % and 56.3 % respectively. Median overall survival after SBRT was 43.6 months. FM movements in UC areas were recorded being greatest in the superior-inferior axis.

Conclusion

Combined linear EBUS sampling and FM-insertion in UC thoracic oligometastatic disease is feasible and safe. UC-SBRT to oligometastases using FM guidance was found to have minimal complications and associated with moderate survival up to 3 years post-treatment.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.