BACKGROUND & PURPOSE Stereotactic ablative radiation therapy (SABR) is an emerging treatment option for patients with pulmonary metastases; identifying patients who would benefit from SABR can improve outcomes. MATERIALS & METHODS We retrospectively analyzed local failure (LF), distant failure (DF), overall survival (OS), and toxicity in 317 patients with 406 pulmonary metastases treated with SABR in January 2006-September 2017 at a tertiary cancer center. RESULTS Median follow-up time was 23 months. Primary adrenal, colorectal, sarcoma, or pancreatic ("less responsive") tumors led to high rates of LF. LF rates for patients with less responsive vs. responsive tumors were 4.6% vs. 1.6% at 12 months and 12.8% vs. 3.9% at 24 months (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.11-0.73; Log-Rank P = 0.0087). A nomogram for 24-month local control was created using Cox multivariate factors (surgical history, planning target volume, primary disease site, lung lobe location). Treating patients with ≤3 pulmonary metastases vs. >3 pulmonary metastases was associated with improved 24-month (74.2% vs. 59.3%) and 48-month (47.7% vs. 35.1%) OS (HR 0.66, 95% CI 0.47-0.95; Log-Rank P = 0.043), and reduced 12-month (22.5% vs. 50.8%) and 24-month (31.8% vs. 61.4%) intrathoracic DF (HR 0.53, 95% CI 0.38-0.74; Log-Rank P < 0.0001). The most common toxicity was asymptomatic pneumonitis (14.8%). Six patients had grade 3 events (5 pneumonitis, 1 brachial plexus). CONCLUSIONS SABR for pulmonary metastases was effective and well tolerated. Irradiating limited intrathoracic sites of disease led to improved OS and intrathoracic DM. Higher SABR doses or surgery could be considered for less radio-responsive primary tumors.

中文翻译：

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肺转移瘤的立体定向消融放射治疗：提高总体生存率并识别局部失败高风险的亚组

背景和目的立体定向消融放射治疗 (SABR) 是肺转移患者的一种新兴治疗选择。确定可以从 SABR 中受益的患者可以改善结果。材料与方法 我们回顾性分析了 2006 年 1 月至 2017 年 9 月在三级癌症中心接受 SABR 治疗的 317 例 406 例肺转移患者的局部失败 (LF)、远处失败 (DF)、总生存期 (OS) 和毒性。结果 中位随访时间为 23 个月。原发性肾上腺、结肠直肠、肉瘤或胰腺（“反应性较差”）肿瘤导致高 LF 发生率。12 个月时反应较差与反应性肿瘤患者的 LF 率为 4.6% 与 1.6%，24 个月时为 12.8% 与 3.9%（风险比 [HR] 0.29，95% 置信区间 [CI] 0.11-0.73；对数秩 P = 0.0087）。使用 Cox 多变量因素（手术史、计划目标体积、原发病部位、肺叶位置）创建 24 个月局部控制的列线图。治疗 ≤ 3 处肺转移与 > 3 处肺转移的患者与改善 24 个月（74.2% 对 59.3%）和 48 个月（47.7% 对 35.1%）的 OS（HR 0.66，95% CI 0.47- 0.95；Log-Rank P = 0.043），减少 12 个月（22.5% 对 50.8%）和 24 个月（31.8% 对 61.4%）胸内 DF（HR 0.53，95% CI 0.38-0.74；Log-等级 P < 0.0001)。最常见的毒性是无症状性肺炎（14.8%）。6 名患者出现 3 级事件（5 例肺炎，1 例臂丛神经）。结论 SABR 治疗肺转移瘤有效且耐受性良好。对有限的胸内疾病部位进行照射可改善 OS 和胸内 DM。