目的:对治疗特征进行系统评价,结果,和治疗相关的毒性的立体定向身体放射治疗(SBRT)的肺寡转移是制定国际立体定向放射外科学会(ISRS)实践指南的基础。
方法:根据PRISMA指南,对≥50例患者/肺转移的回顾性系列进行了系统评价,≥25例患者/肺转移的前瞻性试验,对特定高风险情况的分析,以及2012年至2022年7月在MEDLINE或Embase数据库中使用关键词“肺寡转移”发表的所有随机试验,“肺转移”,“肺转移”,“肺寡转移酶”,“立体定向身体放射治疗(SBRT)”和“立体定向消融身体放射治疗(SBRT)”。加权随机效应模型用于计算合并结果估计值。
结果:在筛选的1884篇文章中,35次分析(27次回顾-,5个潜在的,和3项随机试验)报告了对>3600例患者和>4650例转移的治疗。1年的中位局部控制为90%(范围:57-100%),5年为79%(R:70-96%)。急性毒性≥3的患者为0.5%,晚期毒性≥3的患者为1.8%。共有21项实践建议,涵盖分期和患者选择领域(n=10),SBRT处理(n=10),并进行了随访(n=1),协议率为100%,建议13(83%)除外。
结论:SBRT代表了一种有效的确定的局部治疗方式,结合了高的局部控制率和低的辐射诱导毒性风险。
OBJECTIVE: A systematic review of treatment characteristics, outcomes, and treatment-related toxicities of stereotactic body radiation therapy (SBRT) for pulmonary oligometastases served as the basis for development of this International Stereotactic Radiosurgery Society (ISRS) practice
guideline.
METHODS: In accordance with PRISMA
guidelines, a systematic review was performed of retrospective series with ≥50 patients/lung metastases, prospective trials with ≥25 patients/lung metastases, analyses of specific high-risk situations, and all randomized trials published between 2012 and July 2022 in the MEDLINE or Embase database using the key words \"lung oligometastases\", \"lung metastases\", \"pulmonary metastases\", \"pulmonary oligometastases\", \"stereotactic body radiation therapy (SBRT)\" and \"stereotactic ablative body radiotherapy (SBRT)\". Weighted random effects models were used to calculate pooled outcomes estimates.
RESULTS: Of the 1884 articles screened, 35 analyses (27 retrospective-, 5 prospective, and 3 randomized trials) reporting on treatment of >3600 patients and >4650 metastases were included. The median local control was 90 % (Range: 57-100 %) at 1 year and 79 % (R: 70-96 %) at 5 years. Acute toxicity ≥3 was reported for 0.5 % and late toxicity ≥3 for 1.8 % of patients. A total of 21 practice recommendations covering the areas of staging & patient selection (n = 10), SBRT treatment (n = 10), and follow-up (n = 1) were developed, with agreements rates of 100 %, except for recommendation 13 (83 %).
CONCLUSIONS: SBRT represents an effective definitive local treatment modality combining high local control rates with low risk of radiation-induced toxicities.