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Abstract：
BACKGROUND: Stereotactic body radiotherapy (SBRT) is increasingly used to treat disease in the oligometastatic (OM) setting due to mounting evidence demonstrating its efficacy and safety. Given the low population representation in prospective studies, we performed a systematic review and meta-analysis of outcomes of HNC patients with extracranial OM disease treated with SBRT.
METHODS: A systematic review was conducted with Cochrane, Medline, and Embase databases queried from inception to August 2022 for studies with extracranial OM HNC treated with stereotactic radiotherapy. Polymetastatic patients (>five lesions), mixed-primary cohorts failing to report HNC separately, lack of treatment to all lesions, nonquantitative endpoints, and other definitive treatments (surgery, conventional radiotherapy, and radioablation) were excluded. The meta-analysis examined the pooled effects of 12- and 24-month local control (LC) per lesion, progression-free survival (PFS), and overall survival (OS). Weighted random-effects were assessed using the DerSimonian and Laird method, with heterogeneity evaluated using the I2 statistic and Cochran Qtest. Forest plots were generated for each endpoint.
RESULTS: Fifteen studies met the inclusion criteria (639 patients, 831 lesions), with twelve eligible for quantitative synthesis with common endpoints and sufficient reporting. Fourteen studies were retrospective, with a single prospective trial. Studies were small, with a median of 32 patients (range: 6-81) and 63 lesions (range: 6-126). The OM definition varied, with a maximum of two to five metastases, mixed synchronous and metachronous lesions, and a few studies including oligoprogressive lesions. The most common site of metastasis was the lung. Radiation was delivered in 1-10 fractions (20-70 Gy). The one-year LC (LC1), reported in 12 studies, was 86.9% (95% confidence interval [CI]: 79.3-91.9%). LC2 was 77.9% (95% CI: 66.4-86.3%), with heterogeneity across studies. PFS was reported in five studies, with a PFS1 of 43.0% (95% CI: 35.0-51.4%) and PFS2 of 23.9% (95% CI: 17.8-31.2%), with homogeneity across studies. OS was analyzed in nine studies, demonstrating an OS1 of 80.1% (95% CI: 74.2-85.0%) and OS2 of 60.7% (95% CI: 51.3-69.4%). Treatment was well tolerated with no reported grade 4 or 5 toxicities. Grade 3 toxicity rates were uniformly below 5% when reported.
CONCLUSIONS: SBRT offers excellent LC and promising OS, with acceptable toxicities in OM HNC. Durable PFS remains rare, highlighting the need for effective local or systemic therapies in this population. Further investigations on concurrent and adjuvant therapies are warranted.
METHODS: A systematic review was conducted with Cochrane, Medline, and Embase databases queried from inception to August 2022 for studies with extracranial OM HNC treated with stereotactic radiotherapy. Polymetastatic patients (>five lesions), mixed-primary cohorts failing to report HNC separately, lack of treatment to all lesions, nonquantitative endpoints, and other definitive treatments (surgery, conventional radiotherapy, and radioablation) were excluded. The meta-analysis examined the pooled effects of 12- and 24-month local control (LC) per lesion, progression-free survival (PFS), and overall survival (OS). Weighted random-effects were assessed using the DerSimonian and Laird method, with heterogeneity evaluated using the I2 statistic and Cochran Qtest. Forest plots were generated for each endpoint.
RESULTS: Fifteen studies met the inclusion criteria (639 patients, 831 lesions), with twelve eligible for quantitative synthesis with common endpoints and sufficient reporting. Fourteen studies were retrospective, with a single prospective trial. Studies were small, with a median of 32 patients (range: 6-81) and 63 lesions (range: 6-126). The OM definition varied, with a maximum of two to five metastases, mixed synchronous and metachronous lesions, and a few studies including oligoprogressive lesions. The most common site of metastasis was the lung. Radiation was delivered in 1-10 fractions (20-70 Gy). The one-year LC (LC1), reported in 12 studies, was 86.9% (95% confidence interval [CI]: 79.3-91.9%). LC2 was 77.9% (95% CI: 66.4-86.3%), with heterogeneity across studies. PFS was reported in five studies, with a PFS1 of 43.0% (95% CI: 35.0-51.4%) and PFS2 of 23.9% (95% CI: 17.8-31.2%), with homogeneity across studies. OS was analyzed in nine studies, demonstrating an OS1 of 80.1% (95% CI: 74.2-85.0%) and OS2 of 60.7% (95% CI: 51.3-69.4%). Treatment was well tolerated with no reported grade 4 or 5 toxicities. Grade 3 toxicity rates were uniformly below 5% when reported.
CONCLUSIONS: SBRT offers excellent LC and promising OS, with acceptable toxicities in OM HNC. Durable PFS remains rare, highlighting the need for effective local or systemic therapies in this population. Further investigations on concurrent and adjuvant therapies are warranted.
摘要：
背景：立体定向身体放射治疗（SBRT）越来越多地用于治疗寡转移（OM）环境中的疾病，因为越来越多的证据表明其有效性和安全性。鉴于前瞻性研究中的人口代表性较低，我们对接受SBRT治疗的HNC颅外OM患者的结局进行了系统评价和荟萃分析.
方法：对Cochrane进行了系统评价，Medline,和Embase数据库从开始到2022年8月查询了接受立体定向放射治疗的颅外OMHNC的研究。多转移患者（>5个病灶），混合主要队列未能单独报告HNC，缺乏对所有病变的治疗，非定量终点，和其他明确的治疗方法(手术，常规放射治疗,和放射消融）被排除。荟萃分析检查了每个病变12个月和24个月局部对照（LC）的合并效果，无进展生存期（PFS），总生存率（OS）。使用DerSimonian和Laird方法评估加权随机效应，使用I2统计量和CochranQtest评估异质性。为每个端点生成森林地块。
结果：15项研究符合纳入标准（639例患者，831个病变），12个有资格进行定量合成，具有共同的终点和足够的报告。14项研究是回顾性的，一个单一的前瞻性试验。研究很小，中位数为32例患者（范围：6-81）和63个病变（范围：6-126）。OM的定义各不相同，最多转移两到五个，混合同步和异时病变，和一些研究，包括少进病变。最常见的转移部位是肺。以1-10个部分(20-70Gy)递送辐射。一年期LC（LC1），在12项研究中报道，为86.9%（95%置信区间[CI]：79.3-91.9%）。LC2为77.9%（95%CI：66.4-86.3%），具有不同研究的异质性。在五项研究中报告了PFS，PFS1为43.0%（95%CI：35.0-51.4%），PFS2为23.9%（95%CI：17.8-31.2%），具有不同研究的同质性。在九项研究中分析了OS，OS1为80.1%(95%CI:74.2-85.0%),OS2为60.7%(95%CI:51.3-69.4%)。治疗耐受性良好，没有报告的4或5级毒性。报告时，3级毒性率均匀低于5%。
结论：SBRT提供出色的LC和有前途的OS，在OMHNC中具有可接受的毒性。耐用的PFS仍然很少见，强调在这一人群中需要有效的局部或全身治疗。有必要对并行和辅助治疗进行进一步的研究。
方法：对Cochrane进行了系统评价，Medline,和Embase数据库从开始到2022年8月查询了接受立体定向放射治疗的颅外OMHNC的研究。多转移患者（>5个病灶），混合主要队列未能单独报告HNC，缺乏对所有病变的治疗，非定量终点，和其他明确的治疗方法(手术，常规放射治疗,和放射消融）被排除。荟萃分析检查了每个病变12个月和24个月局部对照（LC）的合并效果，无进展生存期（PFS），总生存率（OS）。使用DerSimonian和Laird方法评估加权随机效应，使用I2统计量和CochranQtest评估异质性。为每个端点生成森林地块。
结果：15项研究符合纳入标准（639例患者，831个病变），12个有资格进行定量合成，具有共同的终点和足够的报告。14项研究是回顾性的，一个单一的前瞻性试验。研究很小，中位数为32例患者（范围：6-81）和63个病变（范围：6-126）。OM的定义各不相同，最多转移两到五个，混合同步和异时病变，和一些研究，包括少进病变。最常见的转移部位是肺。以1-10个部分(20-70Gy)递送辐射。一年期LC（LC1），在12项研究中报道，为86.9%（95%置信区间[CI]：79.3-91.9%）。LC2为77.9%（95%CI：66.4-86.3%），具有不同研究的异质性。在五项研究中报告了PFS，PFS1为43.0%（95%CI：35.0-51.4%），PFS2为23.9%（95%CI：17.8-31.2%），具有不同研究的同质性。在九项研究中分析了OS，OS1为80.1%(95%CI:74.2-85.0%),OS2为60.7%(95%CI:51.3-69.4%)。治疗耐受性良好，没有报告的4或5级毒性。报告时，3级毒性率均匀低于5%。
结论：SBRT提供出色的LC和有前途的OS，在OMHNC中具有可接受的毒性。耐用的PFS仍然很少见，强调在这一人群中需要有效的局部或全身治疗。有必要对并行和辅助治疗进行进一步的研究。
