Background: Liver resection remains the gold standard treatment for colorectal cancer (CRC) liver metastases, while stereotactic body radiotherapy (SBRT) offers an alternative for patients with unresectable metastases. However, the precise indications for SBRT, optimal radiation doses, and treatment regimens have yet to be definitively established. Methods: A total of 91 patients with 152 lesions underwent SBRT, receiving a total dose ranging from 40 to 60 Gy delivered in 4–5 fractions per lesion, with a median dose of 50 Gy. Results: The three-year local control (LC) and overall survival (OS) rates were 62.6% and 45.1%, respectively. No cases of Grade ≥ 3 toxicity were observed. Factors negatively affecting LC included metastasis diameter ≥ 2.7 cm and number of metastases ≥ 3, with hazard ratios (HR) of 2.73 and 2.24, respectively. A biologically effective dose (BED) of ≥137.7 Gy was associated with a significant improvement in local control (LC) (HR 0.25), a finding that was also confirmed by the inverse probability of treatment weighting (IPTW) analysis. Significant predictors for poorer OS included RAS gene mutations, metastasis diameter ≥ 2.6 cm, and synchronous metastases, with HRs of 2.27, 2.03, and 2.11, respectively. Landmark analysis demonstrated that local recurrence within 12 months after SBRT significantly reduced OS (HR 2.68). Conclusions: SBRT is a safe and effective method for achieving local control of CRC liver oligometastases. Further research is warranted to optimize treatment protocols and refine patient selection criteria.
背景：肝切除术仍是结直肠癌肝转移的标准治疗手段，而立体定向体部放疗为不可切除转移灶患者提供了替代方案。然而，立体定向体部放疗的确切适应症、最佳放射剂量及治疗方案尚未明确。方法：共91例患者的152个病灶接受立体定向体部放疗，单病灶总剂量40-60 Gy分4-5次照射，中位剂量50 Gy。结果：三年局部控制率和总生存率分别为62.6%和45.1%，未观察到≥3级毒性反应。转移灶直径≥2.7 cm（风险比2.73）及转移灶数量≥3个（风险比2.24）是局部控制率的负向影响因素。生物有效剂量≥137.7 Gy与局部控制率显著改善相关（风险比0.25），该结果经逆概率加权分析验证。RAS基因突变（风险比2.27）、转移灶直径≥2.6 cm（风险比2.03）及同时性转移（风险比2.11）是总生存率降低的显著预测因子。界标分析显示立体定向体部放疗后12个月内局部复发显著降低总生存率（风险比2.68）。结论：立体定向体部放疗是实现结直肠癌肝寡转移局部控制的安全有效方法，需进一步研究以优化治疗方案并完善患者选择标准。
肿瘤(癌症)患者之家