医学
肺癌
经皮
危险系数
放射外科
肺
放射科
放射治疗
内科学
外科
置信区间
作者
Hunter C. Gits,Mitra A. Khosravi Flanigan,Jamie D. Kapplinger,Janani Reisenauer,Patrick W. Eiken,William Breen,Linh H. Vu,Brian T. Welch,William S. Harmsen,Courtney N. Day,Kenneth R. Olivier,Sean S. Park,Yolanda I. Garces,Christopher L. Hallemeier,Kenneth W. Merrell,Jonathan B. Ashman,Steven E. Schild,Michael P. Grams,J. Lucido,K. Robert Shen,Stephen D. Cassivi,Dennis A. Wigle,Francis C. Nichols,Shanda H. Blackmon,Luis F. Tapias,Matthew R. Callstrom,Dawn Owen
出处
期刊:Chest
[Elsevier]
日期:2023-12-01
标识
DOI:10.1016/j.chest.2023.12.013
摘要
Background Prolonged survival of patients with metastatic disease has furthered interest in metastasis-directed therapy (MDT). Research Question There is a paucity of data comparing lung MDT modalities. Do outcomes among sub-lobar resection (SLR), stereotactic body radiation therapy (SBRT), and percutaneous ablation (PA) for lung metastases vary in terms of local control and survival? Study Design and Methods Medical records of patients undergoing lung MDT at a single cancer center between January 2015 and December 2020 were reviewed. Overall survival (OS), local progression (LP), 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 LP events in 45 patients, and 159 patients had died. Two-year OS and LP were 80.3%, 63.3%, 83.8% and 9.6%, 4.1%, 11.7% for SLR, SBRT, and PA, respectively. Lesion size per 1 cm was associated with worse OS (hazard ratio [HR] 1.24, p=0.003) and LP (HR 1.50, p<0.001). There was no difference in OS by modality. Relative to SLR, there was no difference in risk of LP with PA, although SBRT was associated with a decreased risk (HR 0.26, p=0.023). Rates of severe toxicity were low (2.1-2.6%) and not different among groups. Interpretation The current study performs a propensity weighted analysis of SLR, SBRT, and PA and shows no impact of lung MDT modality on OS. Given excellent local control across MDT options, a multidisciplinary approach is beneficial for patient triage and longitudinal management.