Sublobar Resection, Stereotactic Body Radiation Therapy, and Percutaneous Ablation Provide Comparable Outcomes for Lung Metastasis-Directed Therapy.

Autor:	Gits HC; Departments of Radiation Oncology, Mayo Clinic, Rochester, MN., Khosravi Flanigan MA; General Surgery, Mayo Clinic, Rochester, MN., Kapplinger JD; Radiology, Mayo Clinic, Rochester, MN., Reisenauer JS; Thoracic Surgery, Mayo Clinic, Rochester, MN., Eiken PW; Radiology, Mayo Clinic, Rochester, MN., Breen WG; Departments of Radiation Oncology, Mayo Clinic, Rochester, MN., Vu LH; Pulmonary and Critical Care Medicine, and Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN., Welch BT; Radiology, Mayo Clinic, Rochester, MN., Harmsen WS; Pulmonary and Critical Care Medicine, and Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN., Day CN; Pulmonary and Critical Care Medicine, and Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN., Olivier KR; Departments of Radiation Oncology, Mayo Clinic, Rochester, MN., Park SS; Departments of Radiation Oncology, Mayo Clinic, Rochester, MN., Garces YI; Department of Radiation Oncology, Mayo Clinic, Northfield, MN., Hallemeier CL; Departments of Radiation Oncology, Mayo Clinic, Rochester, MN., Merrell KW; Departments of Radiation Oncology, Mayo Clinic, Rochester, MN., Ashman JB; Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ., Schild SE; Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ., Grams MP; Departments of Radiation Oncology, Mayo Clinic, Rochester, MN., Lucido JJ; Departments of Radiation Oncology, Mayo Clinic, Rochester, MN., Shen KR; Thoracic Surgery, Mayo Clinic, Rochester, MN., Cassivi SD; Thoracic Surgery, Mayo Clinic, Rochester, MN., Wigle D; Thoracic Surgery, Mayo Clinic, Rochester, MN., Nichols FC; Thoracic Surgery, Mayo Clinic, Rochester, MN., Blackmon S; Thoracic Surgery, Mayo Clinic, Rochester, MN., Tapias LF; Thoracic Surgery, Mayo Clinic, Rochester, MN., Callstrom MR; Radiology, Mayo Clinic, Rochester, MN., Owen D; Departments of Radiation Oncology, Mayo Clinic, Rochester, MN. Electronic address: Owen.Dawn@mayo.edu.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2024 May; Vol. 165 (5), pp. 1247-1259. Date of Electronic Publication: 2023 Dec 14.
DOI:	10.1016/j.chest.2023.12.013
Abstrakt:	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 sublobar 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, 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. Interpretation: 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. Competing Interests: Financial/Nonfinancial Disclosures None declared. (Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu