Sarah Baker MD, PhD , Curtis Leclerc MSc , Hanna Atmanspacher-Wirth BEng , Yizhou Zhao MD , Devin Schellenberg MD , Haley Clark PhD , Benjamin Mou MD , Mitchell Liu MD , Fred Hsu MD , Tanya Berrang MD , Siavash Atrchian MD , Alanah Bergman PhD , Nick Chng PhD , Quinn Matthews PhD , Jee Suk Chang MD, PhD , Scott Tyldesley MD , Robert Olson MD, MSc
{"title":"超中心肿瘤位置对肺少转移患者预后的影响：单臂II期SABR-5试验的二次分析","authors":"Sarah Baker MD, PhD , Curtis Leclerc MSc , Hanna Atmanspacher-Wirth BEng , Yizhou Zhao MD , Devin Schellenberg MD , Haley Clark PhD , Benjamin Mou MD , Mitchell Liu MD , Fred Hsu MD , Tanya Berrang MD , Siavash Atrchian MD , Alanah Bergman PhD , Nick Chng PhD , Quinn Matthews PhD , Jee Suk Chang MD, PhD , Scott Tyldesley MD , Robert Olson MD, MSc","doi":"10.1016/j.ijrobp.2025.01.031","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose/Objectives</h3><div>There are limited data on outcomes in patients with ultracentral pulmonary oligometastases treated with SABR. The purpose of this study was to determine whether ultracentral location was prognostic for toxicity and survival.</div></div><div><h3>Material and Methods</h3><div>Oligometastatic lung lesions treated on the single-arm phase 2 SABR-5 trial were retrospectively stratified into 2 cohorts: ultracentral tumors (UC), defined as planning target volume overlap or direct tumor abutment to the proximal bronchial tree, esophagus, great vessels, or heart, and nonultracentral tumors. Cohorts were compared with respect to grade ≥ 2 toxicity, progression-free survival (PFS), and overall survival (OS).</div></div><div><h3>Results</h3><div><span>In total, 41 patients with 45 ultracentral metastases and 93 patients with 172 nonultracentral metastases underwent SABR. The most common primary histologies were colorectal (30%), lung (13%), and renal (13%), and these did not differ between groups. Patients with UC had a lower median PFS of 5.8 months compared with 15.8 months in patients with non ultracentral tumors (</span><em>P <</em> .001). OS was also worse in the UC cohort: median 29.0 months versus not yet reached (<em>P <</em> .001). On multivariable regression, UC remained prognostic for worse PFS (hazard ratio 2.18, <em>P =</em> .004) and OS (hazard ratio 3.45, <em>P <</em> .001). Groups had similar rates of local tumor control. Patients with UC had higher 2-year cumulative incidence of polymetastatic progression: 69.2% versus 31.4% (<em>P <</em> .001). The 2-year cumulative incidence of grade ≥ 2 toxicity was 14.6% for patients with UC and 9.8% for patients with nonultracentral tumors (<em>P =</em> .74). There were no grade 4 or 5 toxicities.</div></div><div><h3>Conclusions</h3><div>In this prospective patient cohort, SABR for ultracentral tumor had low toxicity rates and good local control. However, ultracentral location was an adverse prognostic feature for survival. This finding should be validated with larger studies and may be a factor when weighing the benefit versus risk of SABR in patients with pulmonary oligometastases.</div></div>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":"125 1","pages":"Pages 102-111"},"PeriodicalIF":6.5000,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Impact of Ultracentral Tumor Location on Outcomes in Patients with Pulmonary Oligometastases: A Secondary Analysis of the Single-Arm Phase 2 SABR-5 Trial\",\"authors\":\"Sarah Baker MD, PhD , Curtis Leclerc MSc , Hanna Atmanspacher-Wirth BEng , Yizhou Zhao MD , Devin Schellenberg MD , Haley Clark PhD , Benjamin Mou MD , Mitchell Liu MD , Fred Hsu MD , Tanya Berrang MD , Siavash Atrchian MD , Alanah Bergman PhD , Nick Chng PhD , Quinn Matthews PhD , Jee Suk Chang MD, PhD , Scott Tyldesley MD , Robert Olson MD, MSc\",\"doi\":\"10.1016/j.ijrobp.2025.01.031\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose/Objectives</h3><div>There are limited data on outcomes in patients with ultracentral pulmonary oligometastases treated with SABR. The purpose of this study was to determine whether ultracentral location was prognostic for toxicity and survival.</div></div><div><h3>Material and Methods</h3><div>Oligometastatic lung lesions treated on the single-arm phase 2 SABR-5 trial were retrospectively stratified into 2 cohorts: ultracentral tumors (UC), defined as planning target volume overlap or direct tumor abutment to the proximal bronchial tree, esophagus, great vessels, or heart, and nonultracentral tumors. Cohorts were compared with respect to grade ≥ 2 toxicity, progression-free survival (PFS), and overall survival (OS).</div></div><div><h3>Results</h3><div><span>In total, 41 patients with 45 ultracentral metastases and 93 patients with 172 nonultracentral metastases underwent SABR. The most common primary histologies were colorectal (30%), lung (13%), and renal (13%), and these did not differ between groups. Patients with UC had a lower median PFS of 5.8 months compared with 15.8 months in patients with non ultracentral tumors (</span><em>P <</em> .001). OS was also worse in the UC cohort: median 29.0 months versus not yet reached (<em>P <</em> .001). On multivariable regression, UC remained prognostic for worse PFS (hazard ratio 2.18, <em>P =</em> .004) and OS (hazard ratio 3.45, <em>P <</em> .001). Groups had similar rates of local tumor control. Patients with UC had higher 2-year cumulative incidence of polymetastatic progression: 69.2% versus 31.4% (<em>P <</em> .001). The 2-year cumulative incidence of grade ≥ 2 toxicity was 14.6% for patients with UC and 9.8% for patients with nonultracentral tumors (<em>P =</em> .74). There were no grade 4 or 5 toxicities.</div></div><div><h3>Conclusions</h3><div>In this prospective patient cohort, SABR for ultracentral tumor had low toxicity rates and good local control. However, ultracentral location was an adverse prognostic feature for survival. This finding should be validated with larger studies and may be a factor when weighing the benefit versus risk of SABR in patients with pulmonary oligometastases.</div></div>\",\"PeriodicalId\":14215,\"journal\":{\"name\":\"International Journal of Radiation Oncology Biology Physics\",\"volume\":\"125 1\",\"pages\":\"Pages 102-111\"},\"PeriodicalIF\":6.5000,\"publicationDate\":\"2026-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Radiation Oncology Biology Physics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0360301625000963\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Radiation Oncology Biology Physics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0360301625000963","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/7 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
The Impact of Ultracentral Tumor Location on Outcomes in Patients with Pulmonary Oligometastases: A Secondary Analysis of the Single-Arm Phase 2 SABR-5 Trial
Purpose/Objectives
There are limited data on outcomes in patients with ultracentral pulmonary oligometastases treated with SABR. The purpose of this study was to determine whether ultracentral location was prognostic for toxicity and survival.
Material and Methods
Oligometastatic lung lesions treated on the single-arm phase 2 SABR-5 trial were retrospectively stratified into 2 cohorts: ultracentral tumors (UC), defined as planning target volume overlap or direct tumor abutment to the proximal bronchial tree, esophagus, great vessels, or heart, and nonultracentral tumors. Cohorts were compared with respect to grade ≥ 2 toxicity, progression-free survival (PFS), and overall survival (OS).
Results
In total, 41 patients with 45 ultracentral metastases and 93 patients with 172 nonultracentral metastases underwent SABR. The most common primary histologies were colorectal (30%), lung (13%), and renal (13%), and these did not differ between groups. Patients with UC had a lower median PFS of 5.8 months compared with 15.8 months in patients with non ultracentral tumors (P < .001). OS was also worse in the UC cohort: median 29.0 months versus not yet reached (P < .001). On multivariable regression, UC remained prognostic for worse PFS (hazard ratio 2.18, P = .004) and OS (hazard ratio 3.45, P < .001). Groups had similar rates of local tumor control. Patients with UC had higher 2-year cumulative incidence of polymetastatic progression: 69.2% versus 31.4% (P < .001). The 2-year cumulative incidence of grade ≥ 2 toxicity was 14.6% for patients with UC and 9.8% for patients with nonultracentral tumors (P = .74). There were no grade 4 or 5 toxicities.
Conclusions
In this prospective patient cohort, SABR for ultracentral tumor had low toxicity rates and good local control. However, ultracentral location was an adverse prognostic feature for survival. This finding should be validated with larger studies and may be a factor when weighing the benefit versus risk of SABR in patients with pulmonary oligometastases.
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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