Comparison of the Long-term Survival Outcome of Surgery versus Stereotactic Body Radiation Therapy as Initial Local Treatment for Pulmonary Oligometastases from Colorectal Cancer: A Propensity Score Analysis.

IF 6.4 1区 医学 Q1 ONCOLOGY International Journal of Radiation Oncology Biology Physics Pub Date : 2025-01-01 Epub Date: 2024-08-03 DOI:10.1016/j.ijrobp.2024.07.2324
Yaqi Wang, Xin Dong, Shi Yan, Bing Liu, Xiang Li, Shaolei Li, Chao Lv, Xinrun Cui, Ye Tao, Rong Yu, Nan Wu
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Abstract

Purpose: Optimal local treatment for pulmonary oligometastases from colorectal cancer (CRC) remains unclear. We aimed to compare the long-term survival outcomes between surgery and stereotactic body radiation therapy (SBRT) as the initial local treatment for CRC pulmonary oligometastases.

Materials and methods: We retrospectively reviewed 335 consecutive patients who initially underwent surgery or SBRT for CRC pulmonary metastases from 2011 to 2022, and 251 patients (173 surgery and 78 SBRT) were ultimately included. Freedom from intrathoracic progression (FFIP), progression-free survival (PFS), and overall survival (OS) were compared using stabilized inverse probability of treatment weighting (sIPTW) analysis. In addition, patterns of intrathoracic progression and subsequent treatment were analyzed.

Results: Median follow-up was 61.6 months for surgery and 54.4 months for SBRT. After sIPTW adjustment, significant differences emerged in both FFIP and PFS between surgery and SBRT (FFIP: hazard ratio [HR] = 0.50, 95% confidence interval [CI], 0.31-0.79; PFS: HR = 0.56, 95% CI, 0.36-0.87). The 3- and 5-year FFIP rates were 58.6% and 54.8%, respectively, after surgery, and 34.6% and 31.3%, respectively, after SBRT (P = .006). The 3- and 5-year PFS rates were 49.4% and 45.2%, respectively, after surgery, and 28.8% and 26.1%, respectively, after SBRT (P = .010). However, OS was not significantly affected by treatment approach (HR = 0.93, 95% CI, 0.49-1.76). The 3- and 5-year OS rates were 85.9% and 73.1%, respectively, after surgery, and 78.9% and 68.7%, respectively, after SBRT (P = .849). Recurrence at the treated site was more prevalent after SBRT than after surgery (33.3% vs 16.9%), whereas new intrathoracic tumors occurred more frequently after surgery than after SBRT (71.8% vs 43.1%). Both groups chose radiation therapy as the primary local salvage treatment.

Conclusions: Notwithstanding the significant differences in FFIP and PFS between surgery and SBRT, the long-term survival of patients with CRC pulmonary oligometastases did not depend on the initial choice of the local treatment approach.

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手术与立体定向体外放射治疗作为结直肠癌肺寡转移灶初始局部治疗的长期生存结果比较:倾向评分分析
目的:结直肠癌(CRC)肺少转移灶的最佳局部治疗方法仍不明确。我们旨在比较手术和立体定向体放射治疗(SBRT)作为 CRC 肺寡转移灶初始局部治疗的长期生存结果:我们回顾性研究了2011年至2022年期间连续接受手术或SBRT治疗的335例CRC肺转移瘤患者,最终纳入251例患者(173例手术,78例SBRT)。采用稳定化治疗逆概率加权(sIPTW)分析法比较了胸内进展自由度(FFIP)、无进展生存期(PFS)和总生存期(OS)。此外,还分析了胸内进展和后续治疗的模式:手术治疗的中位随访时间为61.6个月,SBRT治疗的中位随访时间为54.4个月。经sIPTW调整后,手术和SBRT的FFIP和PFS均有显著差异(FFIP:危险比[HR] = 0.50,95%置信区间[CI],0.31-0.79;PFS:HR = 0.56,95%置信区间[CI],0.36-0.87)。手术后的3年和5年FFIP率分别为58.6%和54.8%,SBRT后分别为34.6%和31.3%(P = 0.006)。手术后的3年和5年PFS率分别为49.4%和45.2%,SBRT后分别为28.8%和26.1%(P = 0.010)。然而,OS受治疗方法的影响不大(HR = 0.93,95% CI,0.49-1.76)。手术后3年和5年的OS率分别为85.9%和73.1%,SBRT后分别为78.9%和68.7%(P = 0.849)。SBRT术后治疗部位的复发率高于手术后(33.3%对16.9%),而手术后胸内肿瘤的新发率则高于SBRT术后(71.8%对43.1%)。两组患者均选择放疗作为主要的局部挽救治疗:结论:尽管手术和SBRT在FFIP和PFS方面存在显著差异,但CRC肺寡转移患者的长期生存率并不取决于最初选择的局部治疗方法。
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来源期刊
CiteScore
11.00
自引率
7.10%
发文量
2538
审稿时长
6.6 weeks
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.
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