Definitive Radiotherapy for Oligometastatic and Oligoprogressive Thyroid Cancer: A Potential Strategy for Systemic Therapy Deferral.

IF 14.8 2区 医学 Q1 ONCOLOGY Journal of the National Comprehensive Cancer Network Pub Date : 2024-12-11 DOI:10.6004/jnccn.2024.7072
Stephanie O Dudzinski, Maria E Cabanillas, Sarah Hamidi, Vicente R Marczyk, Naifa L Busaidy, Ramona Dadu, James Welsh, Mimi I Hu, G Brandon Gunn, Chenyang Wang, Steven G Waguespack, Jack Phan, Thomas H Beckham, Joe Y Chang, Steven I Sherman, Jay P Reddy, Anita K Ying, Michael S O'Reilly, Aileen Chen, Anna Lee, Saumil J Gandhi, Zhongxing Liao, Ethan B Ludmir, Quynh-Nhu Nguyen, Steven H Lin, Mark E Zafereo, Matthew S Ning
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Abstract

Background: Definitive radiotherapy (dRT) has been shown to be an effective option for patients with oligometastatic and oligoprogressive cancers; however, this approach has not been well-studied in metastatic thyroid cancer.

Methods: This retrospective cohort included 119 patients with oligometastatic (34%) and oligoprogressive (66%) metastatic thyroid cancer treated from 2005 to 2024 with 207 dRT courses for 344 sites (50% thoracic, 37% bone, 7.5% brain, 4% abdominopelvic, and 1.5% neck/skull base). Histologies included 61% papillary, 15% poorly differentiated, 13% follicular, and 10% oncocytic, and 114 (96%) patients had radioiodine-refractory disease prior to dRT. Each course involved 1 to 5 sites, with prescriptions intended for definitive control (median BED10, 72 Gy), and palliative RT was excluded. Somatic mutation testing for oncologic drivers was performed in 103 (87%) patients.

Results: Each patient had an average of 3 sites (range, 1-23) treated over 2 courses (range, 1-9). Follow-up from first dRT was a median 2.5 years, with overall survival at 3 and 5 years of 81.5% and 70%, respectively. Actuarial local control per site was 91% at 3 years. Median progression-free survival (PFS) after first course was 17 months (95% CI, 10-24 months), with poorly differentiated histology associated with worse outcomes (hazard ratio [HR], 2.20; 95% CI, 1.24-3.90; P=.007), BRAF mutation with improved PFS (HR, 0.59; 95% CI, 0.37-0.95; P=.029), and no significant findings with respect to systemic therapy. At initial dRT, 92 (77%) patients were not on systemic therapy; and after first dRT, freedom from systemic therapy escalation was a median 4.1 years (95% CI, 1.7-6.5 years), with 2- and 5-year continued deferral rates of 73% and 46%, respectively. Grade 3 toxicities were noted for 1.5% of courses, with no grade 4-5 events observed.

Conclusions: This study underscores the potential of dRT as a feasible strategy for deferring systemic therapy escalation in patients with oligometastatic and oligoprogressive metastatic thyroid cancer, demonstrating that sequential dRT courses impart excellent local control and are safe to deliver repeatedly for multiple distant sites. Further studies are warranted to validate these findings and elucidate the full benefit of dRT as part of a multidisciplinary approach for metastatic thyroid cancer.

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少转移和少进展甲状腺癌的最终放疗:延迟全身治疗的潜在策略。
背景:明确放疗(dRT)已被证明是低转移性和低进展性癌症患者的有效选择;然而,这种方法尚未在转移性甲状腺癌中得到充分研究。方法:该回顾性队列包括119例2005年至2024年期间接受治疗的少转移性(34%)和少进展性(66%)转移性甲状腺癌患者,共207个疗程,344个部位(50%胸腔,37%骨,7.5%脑,4%腹盂,1.5%颈部/颅底)。组织学包括61%的乳头状、15%的低分化、13%的滤泡和10%的嗜瘤细胞,114例(96%)患者在dRT前患有放射性碘难治性疾病。每个疗程涉及1至5个部位,处方用于最终控制(中位BED10, 72 Gy),姑息性放疗被排除在外。103例(87%)患者进行了肿瘤驱动因素的体细胞突变检测。结果:每位患者平均有3个部位(范围,1-23)治疗2个疗程(范围,1-9)。第一次dRT的随访中位数为2.5年,3年和5年的总生存率分别为81.5%和70%。3年时,每个站点的精算局部控制率为91%。首疗程后的中位无进展生存期(PFS)为17个月(95% CI, 10-24个月),组织学分化差与预后较差相关(风险比[HR], 2.20;95% ci, 1.24-3.90;P=.007), BRAF突变伴PFS改善(HR, 0.59;95% ci, 0.37-0.95;P= 0.029),在全身治疗方面没有显著的发现。在初始dRT时,92例(77%)患者未接受全身治疗;第一次dRT后,免于全身治疗升级的中位时间为4.1年(95% CI, 1.7-6.5年),2年和5年的持续延迟率分别为73%和46%。1.5%的疗程出现3级毒性反应,未观察到4-5级毒性反应。结论:本研究强调了dRT作为延迟低转移性和低进展性转移性甲状腺癌患者全身治疗升级的可行策略的潜力,表明顺序的dRT疗程具有良好的局部控制效果,并且对于多个远处部位的重复治疗是安全的。需要进一步的研究来验证这些发现,并阐明dRT作为转移性甲状腺癌多学科治疗方法的一部分的全部益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
20.20
自引率
0.00%
发文量
388
审稿时长
4-8 weeks
期刊介绍: JNCCN—Journal of the National Comprehensive Cancer Network is a peer-reviewed medical journal read by over 25,000 oncologists and cancer care professionals nationwide. This indexed publication delivers the latest insights into best clinical practices, oncology health services research, and translational medicine. Notably, JNCCN provides updates on the NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), review articles elaborating on guideline recommendations, health services research, and case reports that spotlight molecular insights in patient care. Guided by its vision, JNCCN seeks to advance the mission of NCCN by serving as the primary resource for information on NCCN Guidelines®, innovation in translational medicine, and scientific studies related to oncology health services research. This encompasses quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN boasts indexing by prominent databases such as MEDLINE/PubMed, Chemical Abstracts, Embase, EmCare, and Scopus, reinforcing its standing as a reputable source for comprehensive information in the field of oncology.
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