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Abstract：
BACKGROUND: Pediatric patients with metastatic and/or recurrent solid tumors have poor survival outcomes despite standard-of-care systemic therapy. Stereotactic ablative radiation therapy (SABR) may improve tumor control. We report the outcomes with the use of SABR in our pediatric solid tumor population.
METHODS: This was a single-institutional study in patients < 30 years treated with SABR. The primary endpoint was local control (LC), while the secondary endpoints were progression-free survival (PFS), overall survival (OS), and toxicity. The survival analysis was performed using Kaplan-Meier estimates in R v4.2.3.
RESULTS: In total, 48 patients receiving 135 SABR courses were included. The median age was 15.6 years (interquartile range, IQR 14-23 y) and the median follow-up was 18.1 months (IQR: 7.7-29.1). The median SABR dose was 30 Gy (IQR 25-35 Gy). The most common primary histologies were Ewing sarcoma (25%), rhabdomyosarcoma (17%), osteosarcoma (13%), and central nervous system (CNS) gliomas (13%). Furthermore, 57% of patients had oligometastatic disease (≤5 lesions) at the time of SABR. The one-year LC, PFS, and OS rates were 94%, 22%, and 70%, respectively. No grade 4 or higher toxicities were observed, while the rates of any grade 1, 2, and 3 toxicities were 11.8%, 3.7%, and 4.4%, respectively. Patients with oligometastatic disease, lung, or brain metastases and those who underwent surgery for a metastatic site had a significantly longer PFS. LC at 1-year was significantly higher for patients with a sarcoma histology (95.7% vs. 86.5%, p = 0.01) and for those who received a biological equivalent dose (BED10) > 48 Gy (100% vs. 91.2%, p = 0.001).
CONCLUSIONS: SABR is well tolerated in pediatric patients with 1-year local failure and OS rates of <10% and 70%, respectively. Future studies evaluating SABR in combination with systemic therapy are needed to address progression outside of the irradiated field.
METHODS: This was a single-institutional study in patients < 30 years treated with SABR. The primary endpoint was local control (LC), while the secondary endpoints were progression-free survival (PFS), overall survival (OS), and toxicity. The survival analysis was performed using Kaplan-Meier estimates in R v4.2.3.
RESULTS: In total, 48 patients receiving 135 SABR courses were included. The median age was 15.6 years (interquartile range, IQR 14-23 y) and the median follow-up was 18.1 months (IQR: 7.7-29.1). The median SABR dose was 30 Gy (IQR 25-35 Gy). The most common primary histologies were Ewing sarcoma (25%), rhabdomyosarcoma (17%), osteosarcoma (13%), and central nervous system (CNS) gliomas (13%). Furthermore, 57% of patients had oligometastatic disease (≤5 lesions) at the time of SABR. The one-year LC, PFS, and OS rates were 94%, 22%, and 70%, respectively. No grade 4 or higher toxicities were observed, while the rates of any grade 1, 2, and 3 toxicities were 11.8%, 3.7%, and 4.4%, respectively. Patients with oligometastatic disease, lung, or brain metastases and those who underwent surgery for a metastatic site had a significantly longer PFS. LC at 1-year was significantly higher for patients with a sarcoma histology (95.7% vs. 86.5%, p = 0.01) and for those who received a biological equivalent dose (BED10) > 48 Gy (100% vs. 91.2%, p = 0.001).
CONCLUSIONS: SABR is well tolerated in pediatric patients with 1-year local failure and OS rates of <10% and 70%, respectively. Future studies evaluating SABR in combination with systemic therapy are needed to address progression outside of the irradiated field.
摘要：
背景：患有转移性和/或复发性实体瘤的儿科患者尽管接受了标准的全身治疗，但其生存结果较差。立体定向消融放射治疗（SABR）可以改善肿瘤控制。我们报告了在我们的儿科实体瘤人群中使用SABR的结果。
方法：这是一项针对<30年接受SABR治疗的患者的单机构研究。主要终点是局部控制（LC），而次要终点是无进展生存期（PFS），总生存期（OS），和毒性。在Rv4.2.3中使用Kaplan-Meier估计进行生存分析。
结果：总计，纳入48例接受135个SABR疗程的患者。中位年龄为15.6岁(四分位距，IQR14-23y），中位随访时间为18.1个月（IQR：7.7-29.1）。中位SABR剂量为30Gy(IQR25-35Gy)。最常见的原发性组织学是尤因肉瘤（25％），横纹肌肉瘤（17%），骨肉瘤（13%），和中枢神经系统（CNS）胶质瘤（13％）。此外，57％的患者在SABR时患有寡转移疾病（≤5个病变）。为期一年的LC，PFS,OS率为94%，22%,70%,分别。没有观察到4级或更高的毒性，而任何1、2和3级毒性的发生率都是11.8%，3.7%,和4.4%，分别。患有寡转移疾病的患者，肺，或脑转移和转移部位接受手术的患者的PFS明显更长.1年时，肉瘤组织学患者的LC明显更高（95.7%与86.5%,p=0.01），对于那些接受生物等效剂量（BED10）>48Gy（100％vs.91.2%,p=0.001)。
结论：SABR在1年局部失败且OS率<10%和70%的儿科患者中具有良好的耐受性。分别。需要评估SABR与全身治疗相结合的未来研究，以解决辐照场之外的进展。
方法：这是一项针对<30年接受SABR治疗的患者的单机构研究。主要终点是局部控制（LC），而次要终点是无进展生存期（PFS），总生存期（OS），和毒性。在Rv4.2.3中使用Kaplan-Meier估计进行生存分析。
结果：总计，纳入48例接受135个SABR疗程的患者。中位年龄为15.6岁(四分位距，IQR14-23y），中位随访时间为18.1个月（IQR：7.7-29.1）。中位SABR剂量为30Gy(IQR25-35Gy)。最常见的原发性组织学是尤因肉瘤（25％），横纹肌肉瘤（17%），骨肉瘤（13%），和中枢神经系统（CNS）胶质瘤（13％）。此外，57％的患者在SABR时患有寡转移疾病（≤5个病变）。为期一年的LC，PFS,OS率为94%，22%,70%,分别。没有观察到4级或更高的毒性，而任何1、2和3级毒性的发生率都是11.8%，3.7%,和4.4%，分别。患有寡转移疾病的患者，肺，或脑转移和转移部位接受手术的患者的PFS明显更长.1年时，肉瘤组织学患者的LC明显更高（95.7%与86.5%,p=0.01），对于那些接受生物等效剂量（BED10）>48Gy（100％vs.91.2%,p=0.001)。
结论：SABR在1年局部失败且OS率<10%和70%的儿科患者中具有良好的耐受性。分别。需要评估SABR与全身治疗相结合的未来研究，以解决辐照场之外的进展。
