Purpose Stereotactic body radiation therapy (SBRT) is widely used for pulmonary oligometastatic disease. Guideline-based regimens target a biologically effective dose <InlineEquation ID="IEq3"><EquationSource Format="TEX">\((\textrm{BED}_{10}) \geq100~\textrm{Gy}\)</EquationSource></InlineEquation>; However, this threshold may not be achievable in patients with limited physiological reserve or ultracentral lesions. We examined outcomes after SBRT with <InlineEquation ID="IEq4"><EquationSource Format="TEX">\(\textrm{BED}_{10} < 100~\textrm{Gy}\)</EquationSource></InlineEquation> versus <InlineEquation ID="IEq5"><EquationSource Format="TEX">\(\textrm{BED}_{10}\geq100~\textrm{Gy}\)</EquationSource></InlineEquation> in a consecutive cohort of patients with recurrent lung-only metastases. Methods and materials Consecutive patients treated with SBRT for recurrent lung-only metastases between January 2019 and December 2022 were retrospectively reviewed. Primary endpoints were overall survival (OS), progression-free survival (PFS), and freedom from local–regional progression (FFLP). Kaplan–Meier estimates were compared using log-rank tests, and univariable Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). A propensity-score inverse probability of treatment weighting (IPTW) analysis adjusted for age, Eastern Cooperative Oncology Group (ECOG) performance status, Charlson Comorbidity Index (CCI), lung primary status, and number of metastases. Results Fifty-three patients were included. Median OS was 47.3 months for <InlineEquation ID="IEq6"><EquationSource Format="TEX">\(\textrm{BED}_{10}\geq100~\textrm{Gy}\)</EquationSource></InlineEquation> versus 34.3 months for <InlineEquation ID="IEq7"><EquationSource Format="TEX">\(\textrm{BED}_{10} < 100~\textrm{Gy}\)</EquationSource></InlineEquation> (HR 1.45; 95% CI 0.66–3.16; <InlineEquation ID="IEq8"><EquationSource Format="TEX">\(p=0.35\)</EquationSource></InlineEquation>). Median PFS was 22.8 months versus 14.7 months (HR 1.59; 95% CI 0.82–3.11; <InlineEquation ID="IEq9"><EquationSource Format="TEX">\(p=0.17\)</EquationSource></InlineEquation>). For FFLP, the HR was 2.67 (95% CI 0.60–11.93; <InlineEquation ID="IEq10"><EquationSource Format="TEX">\(p=0.20\)</EquationSource></InlineEquation>). In IPTW-weighted models, <InlineEquation ID="IEq11"><EquationSource Format="TEX">\(\textrm{BED}_{10}\geq100~\textrm{Gy}\)</EquationSource></InlineEquation> was not significantly associated with OS (HR 0.58; 95% CI 0.25–1.32; <InlineEquation ID="IEq12"><EquationSource Format="TEX">\(p=0.19\)</EquationSource></InlineEquation>) or PFS (HR 0.59; 95% CI 0.24–1.40; <InlineEquation ID="IEq13"><EquationSource Format="TEX">\(p=0.23\)</EquationSource></InlineEquation>). Conclusion In this retrospective cohort, <InlineEquation ID="IEq14"><EquationSource Format="TEX">\(\textrm{BED}_{10} < 100~\textrm{Gy}\)</EquationSource></InlineEquation> was delivered to selected higher-risk patients on the basis of frailty, ultracentral anatomy, or both. Differences in OS, PFS, and FFLP compared with <InlineEquation ID="IEq15"><EquationSource Format="TEX">\(\textrm{BED}_{10}\geq100~\textrm{Gy}\)</EquationSource></InlineEquation> did not reach statistical significance, and IPTW-weighted estimates were directionally consistent. These observations are consistent with the feasibility of sub-ablative SBRT in selected higher-risk patients when ablative dosing is not safely deliverable, and they define the patient population and dose parameters that warrant prospective, risk-stratified evaluation.

Risk-adapted SBRT (\(\textrm{BED}_{10} < 100~\textrm{Gy}\)) for recurrent lung-only metastases in patients with frailty or ultracentral anatomy

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2026年6月16日

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Ismaell Massalha,
Mhammad Abu-Juda,
Reem Zabit,
Nitzan Sagie,
Kim Sheva,
Leonid Bogolmoni,
Olga Belochitski,
Ofir Cohen,
Amichay Meirovitz,
Konstantin Lavrenkov

摘要

Purpose

Stereotactic body radiation therapy (SBRT) is widely used for pulmonary oligometastatic disease. Guideline-based regimens target a biologically effective dose \((\textrm{BED}_{10}) \geq100~\textrm{Gy}\); However, this threshold may not be achievable in patients with limited physiological reserve or ultracentral lesions. We examined outcomes after SBRT with \(\textrm{BED}_{10} < 100~\textrm{Gy}\) versus \(\textrm{BED}_{10}\geq100~\textrm{Gy}\) in a consecutive cohort of patients with recurrent lung-only metastases.

Methods and materials

Consecutive patients treated with SBRT for recurrent lung-only metastases between January 2019 and December 2022 were retrospectively reviewed. Primary endpoints were overall survival (OS), progression-free survival (PFS), and freedom from local–regional progression (FFLP). Kaplan–Meier estimates were compared using log-rank tests, and univariable Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). A propensity-score inverse probability of treatment weighting (IPTW) analysis adjusted for age, Eastern Cooperative Oncology Group (ECOG) performance status, Charlson Comorbidity Index (CCI), lung primary status, and number of metastases.

Results

Fifty-three patients were included. Median OS was 47.3 months for \(\textrm{BED}_{10}\geq100~\textrm{Gy}\) versus 34.3 months for \(\textrm{BED}_{10} < 100~\textrm{Gy}\) (HR 1.45; 95% CI 0.66–3.16; \(p=0.35\)). Median PFS was 22.8 months versus 14.7 months (HR 1.59; 95% CI 0.82–3.11; \(p=0.17\)). For FFLP, the HR was 2.67 (95% CI 0.60–11.93; \(p=0.20\)). In IPTW-weighted models, \(\textrm{BED}_{10}\geq100~\textrm{Gy}\) was not significantly associated with OS (HR 0.58; 95% CI 0.25–1.32; \(p=0.19\)) or PFS (HR 0.59; 95% CI 0.24–1.40; \(p=0.23\)).

Conclusion

In this retrospective cohort, \(\textrm{BED}_{10} < 100~\textrm{Gy}\) was delivered to selected higher-risk patients on the basis of frailty, ultracentral anatomy, or both. Differences in OS, PFS, and FFLP compared with \(\textrm{BED}_{10}\geq100~\textrm{Gy}\) did not reach statistical significance, and IPTW-weighted estimates were directionally consistent. These observations are consistent with the feasibility of sub-ablative SBRT in selected higher-risk patients when ablative dosing is not safely deliverable, and they define the patient population and dose parameters that warrant prospective, risk-stratified evaluation.