Background: Pulmonary metastasectomy and stereotactic ablative radiotherapy (SABR) are both guideline-recommended treatments for selected patients with oligometastatic colorectal pulmonary metastases. However, there is limited evidence comparing these local treatment modalities in similar patient groups. Methods: We retrospectively reviewed records of consecutive patients treated for colorectal pulmonary metastases with surgical metastasectomy or SABR from 2012 to 2019 at two Dutch referral hospitals that had different approaches toward the local treatment of colorectal pulmonary metastases, one preferring surgery, the other preferring SABR. Two comparable patient groups were identified based on tumor and treatment characteristics. Results: The metastasectomy group comprised 40 patients treated for 69 metastases, and the SABR group had 60 patients who were treated for 90 metastases. Median follow-up was 38 months (IQR: 26–67) in the surgery group and 46 months (IQR: 30–79) in the SABR group. Median OS was 58 months (CI: 20–94) in the metastasectomy group and 70 months (CI: 29–111) in the SABR group (p= 0.23). Five-year local recurrence-free survival (LRFS) was 44% after metastasectomy and 30% after SABR (p= 0.16). Median progression-free survival (PFS) was 15 months (CI: 3–26) in the metastasectomy group and 10 months (CI: 6–13) in the SABR group (p= 0.049). Local recurrence rate was 12.5/7.2% of patients/metastases respectively after metastasectomy and 38.3/31.1% after SABR (p< 0.001). Lower BED Gy10was correlated with an increased likelihood of recurrence (p= 0.025). Clavien Dindo grade III-V complication rates were 2.5% after metastasectomy and 0% after SABR (p= 0.22). Conclusion: In this retrospective cohort study, pulmonary metastasectomy and SABR had comparable overall survival, local recurrence-free survival, and complication rates, despite patients in the SABR group having a significantly lower progression-free survival and local control rate. These data would support a randomized controlled trial comparing surgery and SABR in operable patients with radically resectable colorectal pulmonary metastases.
背景：对于部分寡转移性结直肠癌肺转移患者，肺转移瘤切除术与立体定向消融放疗（SABR）均为指南推荐的治疗方案。然而，在相似患者群体中比较这两种局部治疗方式的证据尚不充分。方法：本研究回顾性分析了2012年至2019年间，在荷兰两家对结直肠癌肺转移局部治疗策略存在差异的转诊医院（一家倾向手术，另一家倾向SABR）连续接受肺转移瘤切除术或SABR治疗的患者资料。根据肿瘤特征与治疗参数，我们筛选出两个具有可比性的患者队列。结果：手术组包含40例患者共69个转移灶，SABR组包含60例患者共90个转移灶。手术组中位随访时间为38个月（四分位距：26-67），SABR组为46个月（四分位距：30-79）。手术组中位总生存期为58个月（置信区间：20-94），SABR组为70个月（置信区间：29-111）（p=0.23）。肺转移瘤切除术后的5年局部无复发生存率为44%，SABR组为30%（p=0.16）。手术组中位无进展生存期为15个月（置信区间：3-26），SABR组为10个月（置信区间：6-13）（p=0.049）。肺转移瘤切除术后患者/病灶局部复发率分别为12.5%/7.2%，SABR组为38.3%/31.1%（p<0.001）。较低的BED Gy10值与复发风险增加相关（p=0.025）。手术组Clavien-Dindo III-V级并发症发生率为2.5%，SABR组为0%（p=0.22）。结论：本回顾性队列研究显示，尽管SABR组患者的无进展生存期与局部控制率显著较低，但肺转移瘤切除术与SABR在总生存期、局部无复发生存期及并发症发生率方面具有可比性。这些数据为在可手术根治性切除的结直肠癌肺转移患者中开展手术与SABR比较的随机对照试验提供了依据。
Colorectal Pulmonary Metastases: Pulmonary Metastasectomy or Stereotactic Radiotherapy?
肿瘤(癌症)患者之家