Stereotactic Body Radiotherapy Without Systemic Therapy for Oligometastatic Cancer
Notice bibliographique
Résumé
Importance: Metastasis-directed stereotactic body radiotherapy (SBRT) may be a viable strategy to defer systemic therapy in patients with oligometastatic cancer due to comorbidities, patient preferences, or concerns about adverse effects. To date, the evidence supporting this approach has not been comprehensively assessed. Objective: To evaluate systemic therapy-free survival (STFS) for different types of oligometastatic cancer after SBRT alone and to quantify adverse events, quality of life, and oncological outcomes. Data Sources: A systematic search of PubMed and EMBASE was conducted on July 10, 2024, to identify potentially eligible studies published after 2009. Forward and backward citation tracking was performed to identify additional relevant studies. Study Selection: Studies eligible for inclusion in the systematic review were retrospective or prospective with at least 10 patients who received metastasis-directed SBRT and no up-front systemic therapy for oligometastatic cancer (≤5 metastases) irrespective of primary tumor histology. Required outcomes being reported were STFS, progression-free survival, or overall survival. The subgroup of studies reporting STFS at 1 or 2 years were included in a meta-analysis of these pooled outcomes. Data Extraction and Synthesis: Two reviewers independently extracted data using predefined forms and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used for meta-analysis. Main Outcomes and Measures: The primary outcome of the meta-analysis was the pooled STFS rate at 1 or 2 years. Results: Of 29 unique studies (2074 unique patients) included in the systematic review, 13 (984 patients) contributed data to the meta-analysis. The pooled 1- or 2-year STFS rate was 69.7% (95% CI, 57.4%-80.9%) across cancer types. Renal cell cancer demonstrated the highest STFS rate (87.0%; 95% CI, 76.2%-95.2%), followed by prostate cancer (78.1%; 95% CI, 67.4%-87.3%), with lower rates in other cancer types. Among 20 studies reporting adverse events, rates of adverse effects of grade 3 or higher were absent in 15 of 19 studies (79%) and ranged from 2 of 103 (1.9%) to 3 of 34 patients (8.8%) among those that observed severe adverse events. Conclusions and Relevance: In this systematic review and meta-analysis, metastasis-directed SBRT alone was associated with meaningful STFS, particularly in patients with oligometastatic prostate or renal cell cancer, with low risks of treatment-related adverse events. These findings suggest that SBRT alone might be an acceptable option instead of immediate systemic therapy in selected patients with oligometastatic cancer.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».