[The conceptual oligometastatic non-small cell lung cancer and therapeutic strategies]

Radiotherapy for oligometastatic tumor improved the prognosis of patients with non-small cell lung cancer (NSCLC)

Background

This study was conducted to investigate if radiotherapy improved the overall survival (OS) of patients with oligometastatic non‐small cell lung cancer (NSCLC).

Methods

From January 2012 to August 2015, 323 NSCLC patients with distant metastasis were administered radiotherapy. Ninety‐five patients with oligometastatic NSCLC who were sensitive to the initial chemotherapy were treated with radiotherapy for the residual lesions. Initial treatment consisted of four to six cycles of induction chemotherapy. If the patients responded to the initial treatment without developing new metastases, the residual sites were radiated at a total dose of 56–66 Gy, including the primary and metastatic sites. OS, progression‐free survival, and sites of progression were assessed. The Kaplan–Meier method was used to estimate the OS and progression‐free survival probabilities.

Results

The median survival of the whole cohort was 15 months (95% confidence interval 6–40) and the median time to progression was 11 months (95% confidence interval 4–24). Sixty‐seven patients had died by the end of follow‐up. The one‐year and two‐year OS rates were 58% and 23%, respectively. Patients progressed either with brain (n = 14), bone (n = 11), lung (n = 10), liver (n = 7), adrenal gland (n = 5), or seven other sites of metastases (n = 3). Acute grade III esophageal toxicity was observed in 17 patients (18%) and grade III pulmonary toxicity in seven patients (7%).

Conclusion

Oligometastatic non‐progressive NSCLC patients may benefit from aggressive radiotherapy to the residual lesions with acceptable toxicity after systemic chemotherapy.

[Deficiencies in the Diagnosis and Treatment of Pulmonary Metastatic Osteosarcoma: A Chinese Multidisciplinary Survey]

背景与目的

骨肉瘤是最常见的骨原发恶性肿瘤，好发于青少年。尽管多学科框架下骨肉瘤的治疗已经取得瞩目成就，然而影响骨肉瘤远期生存的重要因素是肺转移。约有1/2以上患者在其病程的不同时期会发生肺转移，其中10%~15%为同时性肺转移。毋庸置疑，治疗肺转移瘤的首选方法为外科切除，但因骨肉瘤肺转移的诊疗涉及多学科多专业，而由于各学科之间的理念存在差异，因此尚未形成标准化的诊疗模式。本研究通过问卷调查方式旨在了解当前我国骨肉瘤大型医疗中心在此领域中的诊疗模式现况。

方法

2015年9月-2015年11月期间，一项关于骨肉瘤肺转移的诊疗现况问卷在全国骨肉瘤大型诊疗中心范围内开展。根据调查对象所在单位、工作年限、年均收治病例数及医学专业不同，进一步行分层分析。

结果

调查共发放问卷150份，回收有效问卷105份，总应答率为70%。首先，关于骨肉瘤肺转移治疗的核心问题，41.0%的调查对象认同骨肿瘤外科专业在骨肉瘤肺转移多学科诊疗实践中的主导地位；首选肺转移瘤切除术作为转移灶局部控制措施的比例约64%；78.1%的调查对象会推荐患者行肺转移瘤切除术；骨科及胸外科医师较之其他专业更加积极（同骨科专业相比，OR_其他专业=0.02；95%CI：0.00-0.22；P=0.001）；胸外科医师更倾向根据经验决定肺转移瘤切除术的指证，而非受限于病灶具体数目（OR_{胸外科专业}=20.93；95%CI：2.05-213.64；P=0.001）。其次，关于骨肉瘤肺转移影像学诊断方法，约83%首选胸部计算机断层扫描（computed tomography, CT）；约70%的调查对象推荐原发灶切除术后3个月行胸部CT随诊；约68%认为CT诊断准确度90%水平；约92%同时推荐行肺外影像学评估。最后，关于术后生存获益的定义问题，约46%认为肺转移瘤术后生存期超过6个月即为生存获益。

结论

本次问卷调查提供了我国骨肉瘤肺转移诊疗模式的现况信息，其反映出缺少统一规范诊疗模式的不足。调查结果为今后研究方向及国际性临床指南提供了基线数据。