PDF(Pubmed)
Abstract：
BACKGROUND: Standard treatment options for patients with metastatic urothelial cancer (mUC) include systemic platinum-based chemotherapy, immunotherapy, antibody-drug-conjugates, and targeted therapy. Oligometastatic disease (OMD) may be an intermediate state between localized and generalized cancer. The best treatment strategy for OMD and oligoprogressive (OPD) disease is poorly studied in mUC but local stereotactic body radiation therapy (SBRT) could be an option to avoid or delay systemic treatment. The aim of this study was to assess the efficacy and feasibility of SBRT given in a real-world patient population.
METHODS: All patients with mUC treated with SBRT at Karolinska University Hospital, Stockholm, Sweden between 2009 and 2022 were included in this study. Baseline clinical characteristics, treatment data, SBRT dosimetry data and treatment outcome were collected retrospectively. The study endpoints were local control rate (LCR), progression-free-survival (PFS), overall survival (OS) and feasibility of SBRT.
RESULTS: In total 39 patients were treated with SBRT. The median follow-up was 25.6 months. The LCR was 82%. PFS and OS were 4.1 and 26.2 months, respectively. Treatment was well tolerated; all patients but one (treatment related pain) completed the planned SBRT. Number of metastases irradiated with SBRT was significantly associated with outcome; patients with only one irradiated lesion had more favourable PFS compared to individuals with 2 or more metastases (HR 4.12, 95% CI: 1.81-9.38, p = 0.001). A subgroup of patients (15%) achieved a sustained long-term survival benefit and never required systemic treatments after SBRT.
CONCLUSIONS: SBRT was well tolerated and associated with high LCR. A subpopulation of patients with single metastatic lesion achieved long-term OS and never required subsequent systemic treatment after SBRT. Prospective randomized studies are warranted to discover treatment predictive biomarkers and to investigate the role of SBRT in oligometastatic UC.
METHODS: All patients with mUC treated with SBRT at Karolinska University Hospital, Stockholm, Sweden between 2009 and 2022 were included in this study. Baseline clinical characteristics, treatment data, SBRT dosimetry data and treatment outcome were collected retrospectively. The study endpoints were local control rate (LCR), progression-free-survival (PFS), overall survival (OS) and feasibility of SBRT.
RESULTS: In total 39 patients were treated with SBRT. The median follow-up was 25.6 months. The LCR was 82%. PFS and OS were 4.1 and 26.2 months, respectively. Treatment was well tolerated; all patients but one (treatment related pain) completed the planned SBRT. Number of metastases irradiated with SBRT was significantly associated with outcome; patients with only one irradiated lesion had more favourable PFS compared to individuals with 2 or more metastases (HR 4.12, 95% CI: 1.81-9.38, p = 0.001). A subgroup of patients (15%) achieved a sustained long-term survival benefit and never required systemic treatments after SBRT.
CONCLUSIONS: SBRT was well tolerated and associated with high LCR. A subpopulation of patients with single metastatic lesion achieved long-term OS and never required subsequent systemic treatment after SBRT. Prospective randomized studies are warranted to discover treatment predictive biomarkers and to investigate the role of SBRT in oligometastatic UC.
摘要：
背景：转移性尿路上皮癌（mUC）患者的标准治疗方案包括全身性铂类化疗，免疫疗法，抗体-药物-缀合物，和靶向治疗。轻度转移疾病（OMD）可能是局部和全身性癌症之间的中间状态。在mUC中，OMD和寡进行性（OPD）疾病的最佳治疗策略研究甚少，但局部立体定向放射治疗（SBRT）可能是避免或延迟全身治疗的选择。这项研究的目的是评估在现实世界患者人群中给予SBRT的有效性和可行性。
方法：所有在卡罗林斯卡大学医院接受SBRT治疗的mUC患者，斯德哥尔摩,2009年至2022年的瑞典被纳入本研究。基线临床特征,治疗数据，回顾性收集SBRT剂量学数据和治疗结果。研究终点为局部控制率(LCR)，无进展生存期（PFS），总生存期（OS）和SBRT的可行性。
结果：共39例患者接受SBRT治疗。中位随访时间为25.6个月。LCR为82%。PFS和OS分别为4.1和26.2个月，分别。治疗耐受性良好；除一名患者（治疗相关疼痛）外，所有患者均完成了计划的SBRT。SBRT照射的转移灶数量与预后显着相关；与2个或更多转移灶的患者相比，仅有一个照射灶的患者的PFS更有利（HR4.12，95％CI：1.81-9.38，p=0.001）。一组患者（15％）获得了持续的长期生存益处，并且在SBRT后从未需要全身治疗。
结论：SBRT具有良好的耐受性，并且与高LCR相关。单个转移性病变的患者亚群获得了长期OS，并且在SBRT后从未需要后续的全身治疗。有必要进行前瞻性随机研究以发现治疗预测性生物标志物并研究SBRT在寡转移性UC中的作用。
方法：所有在卡罗林斯卡大学医院接受SBRT治疗的mUC患者，斯德哥尔摩,2009年至2022年的瑞典被纳入本研究。基线临床特征,治疗数据，回顾性收集SBRT剂量学数据和治疗结果。研究终点为局部控制率(LCR)，无进展生存期（PFS），总生存期（OS）和SBRT的可行性。
结果：共39例患者接受SBRT治疗。中位随访时间为25.6个月。LCR为82%。PFS和OS分别为4.1和26.2个月，分别。治疗耐受性良好；除一名患者（治疗相关疼痛）外，所有患者均完成了计划的SBRT。SBRT照射的转移灶数量与预后显着相关；与2个或更多转移灶的患者相比，仅有一个照射灶的患者的PFS更有利（HR4.12，95％CI：1.81-9.38，p=0.001）。一组患者（15％）获得了持续的长期生存益处，并且在SBRT后从未需要全身治疗。
结论：SBRT具有良好的耐受性，并且与高LCR相关。单个转移性病变的患者亚群获得了长期OS，并且在SBRT后从未需要后续的全身治疗。有必要进行前瞻性随机研究以发现治疗预测性生物标志物并研究SBRT在寡转移性UC中的作用。
