ImportanceThe role of stereotactic ablative radiotherapy (SABR) for gynecologic malignant tumors has yet to be clearly defined despite recent clinical uptake.ObjectiveTo evaluate the outcomes of SABR in patients with oligometastatic and oligoprogressive gynecologic cancers.Design, Setting, and ParticipantsIn this retrospective pooled analysis, patients with oligometastatic and oligoprogressive gynecologic cancers receiving SABR at 5 institutions from Canada and the US were studied. Data were collected from January 2011 to December 2020, and data were analyzed from January to December 2023.ExposureStereotactic ablative radiotherapy.Main Outcomes and MeasuresCumulative incidence of local and distant recurrence, chemotherapy-free survival (CFS), and overall survival (OS) probabilities after SABR were calculated using Kaplan-Meier methods. Univariable and multivariable analysis was conducted using Cox regression methods.ResultsA total of 215 patients with 320 lesions meeting criteria were included in the analysis; the median (range) age at primary diagnosis was 59 (23-86) years. The median (range) follow-up from SABR was 18.5 (0.1-124.5) months. The primary site included the endometrium (n = 107), ovary (n = 64), cervix (n = 30), and vulva or vagina (n = 14). Local cumulative incidence of recurrence was 13.7% (95% CI, 9.4-18.9) and 18.5% (95% CI, 13.2-24.5) at 1 and 5 years, respectively. Distant cumulative incidence of recurrence was 48.5% (95% CI, 41.4-55.1) and 73.1% (95% CI, 66.0-79.0) at 1 and 5 years, respectively. OS was 75.7% (95% CI, 69.2-81.1) and 33.1% (95% CI, 25.3-41.1) at 1 and 5 years, respectively. The median CFS was 21.7 months (95% CI, 15.4-29.9). On multivariable analysis, local recurrence was significantly associated with nodal metastasis, lesion size, biologically effective dose, treatment indication, institution, and primary disease type. Distant progression-free survival was associated with nodal targets and lesion size. OS and CFS were significantly associated with lesion size.Conclusions and RelevanceIn this study, SABR appeared to have excellent local control with minimal toxic effects in this large patient group, and certain patients may achieve durable distant control and OS as well. It may be possible to delay time to chemotherapy in select patient subtypes and therefore reduce associated toxic effects. Prospective multicenter trials will be critical to establish which characteristics procure the greatest benefit from SABR use and to define the ideal time to implement SABR with other oncologic treatments.

中文翻译：

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立体定向消融放射治疗妇科少转移性和少进展性肿瘤


重要性尽管近期临床已开始采用立体定向消融放射治疗 (SABR) 对妇科恶性肿瘤的作用，但其作用尚未明确。目的评估 SABR 对寡转移性和寡进展性妇科癌症患者的疗效。设计、设置和参与者在这项回顾性汇总分析中，对来自加拿大和美国的 5 个机构接受 SABR 的寡转移性和寡进展性妇科癌症患者进行了研究。收集2011年1月至2020年12月的数据，并分析2023年1月至2023年12月的数据。暴露立体定向消融放疗。主要结果和措施局部和远处复发的累积发生率、无化疗生存（CFS）和总生存（OS）概率SABR 后使用 Kaplan-Meier 方法计算。采用Cox回归方法进行单变量和多变量分析。结果共纳入215例患者，320个符合标准的病灶纳入分析；初次诊断时的中位年龄（范围）为 59（23-86）岁。 SABR 的中位随访时间（范围）为 18.5 (0.1-124.5) 个月。主要部位包括子宫内膜 (n = 107)、卵巢 (n = 64)、子宫颈 (n = 30) 和外阴或阴道 (n = 14)。 1 年和 5 年局部累积复发率分别为 13.7% (95% CI, 9.4-18.9) 和 18.5% (95% CI, 13.2-24.5)。 1 年和 5 年的远处累积复发率分别为 48.5% (95% CI, 41.4-55.1) 和 73.1% (95% CI, 66.0-79.0)。 1 年和 5 年的 OS 分别为 75.7% (95% CI, 69.2-81.1) 和 33.1% (95% CI, 25.3-41.1)。中位 CFS 为 21.7 个月（95% CI，15.4-29.9）。 多变量分析显示，局部复发与淋巴结转移、病灶大小、生物有效剂量、治疗适应症、机构和原发疾病类型显着相关。远处无进展生存期与淋巴结目标和病变大小相关。 OS 和 CFS 与病灶大小显着相关。结论和相关性在本研究中，SABR 在这一大患者群体中似乎具有出色的局部控制效果，且毒性作用最小，并且某些患者还可能实现持久的远程控制和 OS。在某些亚型的患者中，有可能延迟化疗时间，从而减少相关的毒性作用。前瞻性多中心试验对于确定哪些特征从 SABR 的使用中获得最大益处以及确定 SABR 与其他肿瘤治疗一起实施的理想时间至关重要。