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Abstract：
UNASSIGNED: The growing use of stereotactic body radiotherapy (SBRT) in metastatic cancer has led to its use in varying anatomic locations. The objective of this study was to review our institutional SBRT experience for axillary metastases (AM), focusing on outcomes and process.
UNASSIGNED: Patients treated with SBRT to AM from 2014 to 2022 were reviewed. Cumulative incidence functions were used to estimate the incidence of local failure (LF), with death as competing risk. Kaplan-Meier method was used to estimate progression-free (PFS) and overall survival (OS). Univariate regression analysis examined predictors of LF.
UNASSIGNED: We analyzed 37 patients with 39 AM who received SBRT. Patients were predominantly female (60 %) and elderly (median age: 72). Median follow-up was 14.6 months. Common primary cancers included breast (43 %), skin (19 %), and lung (14 %). Treatment indication included oligoprogression (46 %), oligometastases (35 %) and symptomatic progression (19 %). A minority had prior overlapping radiation (18 %) or surgery (11 %). Most had prior systemic therapy (70 %).Significant heterogeneity in planning technique was identified; a minority of patient received 4-D CT scans (46 %), MR-simulation (21 %), or contrast (10 %). Median dose was 40 Gy (interquartile range (IQR): 35-40) in 5 fractions, (BED10 = 72 Gy). Seventeen cases (44 %) utilized a low-dose elective volume to cover remaining axilla.At first assessment, 87 % had partial or complete response, with a single progression. Of symptomatic patients (n = 14), 57 % had complete resolution and 21 % had improvement. One and 2-year LF rate were 16 % and 20 %, respectively. Univariable analysis showed increasing BED reduced risk of LF. Median OS was 21.0 months (95 % [Confidence Interval (CI)] 17.3-not reached) and median PFS was 7.0 months (95 % [CI] 4.3-11.3). Two grade 3 events were identified, and no grade 4/5.
UNASSIGNED: Using SBRT for AM demonstrated low rates of toxicity and LF, and respectable symptom improvement. Variation in treatment delivery has prompted development of an institutional protocol to standardize technique and increase efficiency. Limited followup may limit detection of local failure and late toxicity.
UNASSIGNED: Patients treated with SBRT to AM from 2014 to 2022 were reviewed. Cumulative incidence functions were used to estimate the incidence of local failure (LF), with death as competing risk. Kaplan-Meier method was used to estimate progression-free (PFS) and overall survival (OS). Univariate regression analysis examined predictors of LF.
UNASSIGNED: We analyzed 37 patients with 39 AM who received SBRT. Patients were predominantly female (60 %) and elderly (median age: 72). Median follow-up was 14.6 months. Common primary cancers included breast (43 %), skin (19 %), and lung (14 %). Treatment indication included oligoprogression (46 %), oligometastases (35 %) and symptomatic progression (19 %). A minority had prior overlapping radiation (18 %) or surgery (11 %). Most had prior systemic therapy (70 %).Significant heterogeneity in planning technique was identified; a minority of patient received 4-D CT scans (46 %), MR-simulation (21 %), or contrast (10 %). Median dose was 40 Gy (interquartile range (IQR): 35-40) in 5 fractions, (BED10 = 72 Gy). Seventeen cases (44 %) utilized a low-dose elective volume to cover remaining axilla.At first assessment, 87 % had partial or complete response, with a single progression. Of symptomatic patients (n = 14), 57 % had complete resolution and 21 % had improvement. One and 2-year LF rate were 16 % and 20 %, respectively. Univariable analysis showed increasing BED reduced risk of LF. Median OS was 21.0 months (95 % [Confidence Interval (CI)] 17.3-not reached) and median PFS was 7.0 months (95 % [CI] 4.3-11.3). Two grade 3 events were identified, and no grade 4/5.
UNASSIGNED: Using SBRT for AM demonstrated low rates of toxicity and LF, and respectable symptom improvement. Variation in treatment delivery has prompted development of an institutional protocol to standardize technique and increase efficiency. Limited followup may limit detection of local failure and late toxicity.
摘要：
■在转移性癌症中越来越多地使用立体定向身体放射疗法（SBRT），导致其在不同的解剖位置使用。这项研究的目的是回顾我们对腋窝转移（AM）的机构SBRT经验，注重结果和过程。
■回顾了2014年至2022年接受SBRT至AM治疗的患者。累积发生率函数用于估计局部故障(LF)的发生率，将死亡作为竞争风险。使用Kaplan-Meier方法估计无进展生存期(PFS)和总生存期(OS)。单变量回归分析检测了LF的预测因子。
■我们分析了37例接受SBRT的39AM患者。患者主要为女性（60％）和老年人（中位年龄：72）。中位随访时间为14.6个月。常见的原发癌包括乳腺癌（43%），皮肤（19％），和肺（14％）。治疗指征包括少进展（46%），寡转移（35％）和症状进展（19％）。少数人先前有重叠放射（18％）或手术（11％）。大多数人以前接受过全身治疗（70％）。确定了计划技术的显着异质性；少数患者接受了4-DCT扫描（46％），MR模拟（21%），或对比度（10％）。中位剂量为40Gy（四分位距（IQR）：35-40），分5个部分，（BED10=72Gy）。17例（44％）使用低剂量选择性容量来覆盖剩余的腋窝。在第一次评估时,87%有部分或完全反应，一个单一的进步。有症状的患者（n=14），57%有完整的决议，21%有进步。一年和两年的LF率分别为16%和20%，分别。单变量分析显示增加BED降低了LF的风险。中位OS为21.0个月（95%[置信区间（CI）]17.3-未达到），中位PFS为7.0个月（95%[CI]4.3-11.3）。确定了两个3级事件，没有4/5级。
■对AM使用SBRT证明毒性和LF率低，和可观的症状改善。治疗交付的变化促使制定了机构协议，以标准化技术并提高效率。有限的随访可能会限制局部失效和晚期毒性的检测。
■回顾了2014年至2022年接受SBRT至AM治疗的患者。累积发生率函数用于估计局部故障(LF)的发生率，将死亡作为竞争风险。使用Kaplan-Meier方法估计无进展生存期(PFS)和总生存期(OS)。单变量回归分析检测了LF的预测因子。
■我们分析了37例接受SBRT的39AM患者。患者主要为女性（60％）和老年人（中位年龄：72）。中位随访时间为14.6个月。常见的原发癌包括乳腺癌（43%），皮肤（19％），和肺（14％）。治疗指征包括少进展（46%），寡转移（35％）和症状进展（19％）。少数人先前有重叠放射（18％）或手术（11％）。大多数人以前接受过全身治疗（70％）。确定了计划技术的显着异质性；少数患者接受了4-DCT扫描（46％），MR模拟（21%），或对比度（10％）。中位剂量为40Gy（四分位距（IQR）：35-40），分5个部分，（BED10=72Gy）。17例（44％）使用低剂量选择性容量来覆盖剩余的腋窝。在第一次评估时,87%有部分或完全反应，一个单一的进步。有症状的患者（n=14），57%有完整的决议，21%有进步。一年和两年的LF率分别为16%和20%，分别。单变量分析显示增加BED降低了LF的风险。中位OS为21.0个月（95%[置信区间（CI）]17.3-未达到），中位PFS为7.0个月（95%[CI]4.3-11.3）。确定了两个3级事件，没有4/5级。
■对AM使用SBRT证明毒性和LF率低，和可观的症状改善。治疗交付的变化促使制定了机构协议，以标准化技术并提高效率。有限的随访可能会限制局部失效和晚期毒性的检测。
