背景:转移性疾病患者的生存期延长对转移定向治疗(MDT)的兴趣进一步增强。
目的:比较肺部MDT模式的数据很少。子叶切除术(SLR)中的结果,立体定向身体放射治疗(SBRT),肺转移瘤的经皮消融术(PA)在局部控制和生存率方面存在差异
方法:对2015年1月至2020年12月在一家癌症中心接受肺部MDT的患者的病历进行了回顾.总生存期(OS),局部进展(LP),并收集毒性结果。使用患者和病变特征来生成具有倾向加权分析的多变量模型。
结果:肺部MDT课程(共644个:243个SLR,274SBRT,纳入了511例患者的127PA),中位随访时间为22个月。45例患者发生了47例LP事件,159名患者死亡。两年OS和LP占80.3%,63.3%,83.8%和9.6%,4.1%,单反11.7%,SBRT,PA,分别。每1厘米的病变大小与OS(风险比[HR]1.24,p=0.003)和LP(HR1.50,p<0.001)较差相关。不同模式的OS没有差异。相对于单反,LP与PA的风险没有差异,尽管SBRT与风险降低相关(HR0.26,p=0.023).严重毒性的发生率很低(2.1-2.6%),各组之间没有差异。
结论:本研究对SLR进行了倾向加权分析,SBRT,和PA,并显示肺MDT模式对OS没有影响。鉴于跨MDT选项的出色本地控制,多学科方法有利于患者分诊和纵向管理.
BACKGROUND: Prolonged survival of patients with metastatic disease has furthered interest in metastasis-directed therapy (MDT).
OBJECTIVE: There is a paucity of data comparing lung MDT modalities. Do outcomes among sublobar resection (SLR), stereotactic body radiation therapy (SBRT), and percutaneous ablation (PA) for lung metastases vary in terms of local control and survival?
METHODS: Medical records of patients undergoing lung MDT at a single cancer center between January 2015 and December 2020 were reviewed. Overall survival, local progression, and toxicity outcomes were collected. Patient and lesion characteristics were used to generate multivariable models with propensity weighted analysis.
RESULTS: Lung MDT courses (644 total: 243 SLR, 274 SBRT, 127 PA) delivered to 511 patients were included with a median follow-up of 22 months. There were 47 local progression events in 45 patients, and 159 patients died. Two-year overall survival and local progression were 80.3% and 63.3%, 83.8% and 9.6%, and 4.1% and 11.7% for SLR, SBRT, and PA, respectively. Lesion size per 1 cm was associated with worse overall survival (hazard ratio, 1.24; P = .003) and LP (hazard ratio, 1.50; P < .001). There was no difference in overall survival by modality. Relative to SLR, there was no difference in risk of local progression with PA; however, SBRT was associated with a decreased risk (hazard ratio, 0.26; P = .023). Rates of severe toxicity were low (2.1%-2.6%) and not different among groups.
CONCLUSIONS: This study performs a propensity weighted analysis of SLR, SBRT, and PA and shows no impact of lung MDT modality on overall survival. Given excellent local control across MDT options, a multidisciplinary approach is beneficial for patient triage and longitudinal management.