1
|
Sütcüoğlu O, Özdemir N, Yazıcı O. Re: Post-progression outcomes of NSCLC patients with PD-L1 expression ≥50% receiving first-line single-agent pembrolizumab in a large multicentre real-world study. Eur J Cancer 2021; 155:294-295. [PMID: 34364743 DOI: 10.1016/j.ejca.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Osman Sütcüoğlu
- Gazi University, Department of Medical Oncology, Ankara, Turkey.
| | - Nuriye Özdemir
- Gazi University, Department of Medical Oncology, Ankara, Turkey.
| | - Ozan Yazıcı
- Gazi University, Department of Medical Oncology, Ankara, Turkey.
| |
Collapse
|
2
|
Mangaj A, Chopra S, Nout RA. Defining the role of high-dose radiation in oligometastatic & oligorecurrent cervical cancer. Indian J Med Res 2021; 154:303-318. [PMID: 35295014 PMCID: PMC9131772 DOI: 10.4103/ijmr.ijmr_298_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Around 5-8 per cent of women diagnosed with cervical cancer present with metastatic disease at presentation and 16-25 per cent of patients fail at either within irradiated fields or at distant sites post-curative therapy in advanced cervical cancers. Conventionally, chemotherapy with palliative intent constituted the mainstay of treatment with modest survival outcomes and radiation therapy was reserved for symptomatic benefit only. While targeted therapies and immunotherapy have been added in therapeutic armamentarium, the impact on the outcomes is modest. In limited metastatic disease, radiation therapy to metastatic sites from different primary cancers has shown survival benefits; however, the data are scarce in cervical cancer. With a better understanding of the molecular biology of the metastases and recurrence pattern, emphasis is laid upon total eradication of the disease rather than offering relief from symptoms. This article summarizes the role of radiation therapy in limited metastatic disease and recurrent cervical cancer.
Collapse
Affiliation(s)
- Akshay Mangaj
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India,For correspondence: Dr Supriya Chopra, Department of Radiation Oncology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400 012, Maharashtra, India. e-mail:
| | - Remi A. Nout
- Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Conibear J, Chia B, Ngai Y, Bates AT, Counsell N, Patel R, Eaton D, Faivre-Finn C, Fenwick J, Forster M, Hanna GG, Harden S, Mayles P, Moinuddin S, Landau D. Study protocol for the SARON trial: a multicentre, randomised controlled phase III trial comparing the addition of stereotactic ablative radiotherapy and radical radiotherapy with standard chemotherapy alone for oligometastatic non-small cell lung cancer. BMJ Open 2018; 8:e020690. [PMID: 29666135 PMCID: PMC5905762 DOI: 10.1136/bmjopen-2017-020690] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/02/2018] [Accepted: 02/09/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Following growing evidence to support the safety, local control (LC) and potential improvement in overall survival (OS) in patients with oligometastatic non-small cell lung cancer (NSCLC) that have been treated with local ablative therapy such as stereotactic ablative radiotherapy (SABR) and stereotactic radiosurgery (SRS), we initiate the SARON trial to investigate the impact and feasibility of adding SABR/SRS and radical radiotherapy (RRT) following standard chemotherapy on OS. METHODS AND ANALYSIS SARON is a large, randomised controlled, multicentre, phase III trial for patients with oligometastatic EGFR, ALK and ROS1 mutation negative NSCLC (1-3 sites of synchronous metastatic disease, one of which must be extracranial). 340 patients will be recruited over 3 years from approximately 30 UK sites and randomised to receive either standard platinum-doublet chemotherapy only (control arm) or standard chemotherapy followed by RRT/SABR to their primary tumour and then SABR/SRS to all other metastatic sites (investigational arm). The primary endpoint is OS; the study is powered to detect an improvement in median survival from 9.9 months in the control arm to 14.3 months in the investigational arm with 85% power and two-sided 5% significance level. The secondary endpoints are LC, progression-free survival, new distant metastasis-free survival, toxicity and quality of life. An early feasibility review will take place after 50 randomised patients. Patients requiring both conventional thoracic RT to the primary and SABR to a thoracic metastasis will be included in a thoracic SABR safety substudy to assess toxicity and planning issues in this subgroup of patients more thoroughly. ETHICS AND DISSEMINATION All participants are given a SARON patient information sheet and required to give written informed consent. Results will be submitted for presentation at local and international conferences and expected to be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02417662. SPONSOR REFERENCE UCL/13/0594.
Collapse
Affiliation(s)
| | | | - Yenting Ngai
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | - Andrew Tom Bates
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Rushil Patel
- National Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, UK
| | - David Eaton
- National Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, UK
| | - Corinne Faivre-Finn
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - John Fenwick
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - Gerard G Hanna
- Centre for Cancer Research and Cell Biology, Queen’s University of Belfast, Belfast, UK
| | | | | | | | - David Landau
- Guys & St Thomas NHS Trust, London, UK
- Department of Oncology, University College London, London, UK
| |
Collapse
|
4
|
Outcomes Following Hypofractionated Stereotactic Radiotherapy in the Management of Brain Metastases. Am J Clin Oncol 2017; 39:379-83. [PMID: 24755663 DOI: 10.1097/coc.0000000000000076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the outcomes of patients treated with hypofractionated stereotactic radiotherapy (HSRT) for radiosensitive and radioresistant brain metastases. METHODS Between August 2006 and July 2013, a total of 56 lesions in 44 patients with brain metastases were treated with HSRT. Twenty-three (41.1%) lesions were radioresistant. Patients were treated to a total dose of 24 to 30 Gy in 3 to 5 fractions. Median planning target volume was 6.18 cm. The primary endpoint for this study was local control with secondary endpoints of overall survival, distant failure, performance status, and treatment toxicity. RESULTS The median follow-up for all patients was 5 months (range, 0.4 to 58.3 mo). Six- and 12-month Kaplan-Meier estimates of local control for all lesions were 85.6% and 79.4%, respectively. Radioresistant tumors had a 6- and 12-month local control rate of 87.0%, whereas radiosensitive tumors had a 6- and 12-month local control rate of 82.5% and 72.2%, respectively (P=0.41). Six- and 12-month distant brain control rates were 56.8% and 46.9%, respectively. Overall survival was significantly associated with recursive partitioning analysis classes I, II, and III (P=0.0003) and graded prognostic assessment classes 2 to 3 and 1 to 1.5 (P=0.041). CONCLUSIONS HSRT is a safe and feasible alternative to single-session stereotactic radiosurgery for brain metastases. No difference was observed in local control rates between radioresistant and radiosensitive tumors.
Collapse
|
5
|
Janvary ZL, Jansen N, Baart V, Devillers M, Dechambre D, Lenaerts E, Seidel L, Barthelemy N, Berkovic P, Gulyban A, Lakosi F, Horvath Z, Coucke PA. Clinical Outcomes of 130 Patients with Primary and Secondary Lung Tumors treated with Cyberknife Robotic Stereotactic Body Radiotherapy. Radiol Oncol 2017; 51:178-186. [PMID: 28740453 PMCID: PMC5514658 DOI: 10.1515/raon-2017-0015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/27/2017] [Indexed: 12/25/2022] Open
Abstract
Background Authors report clinical outcomes of patients treated with robotic stereotactic body radiotherapy (SBRT) for primary, recurrent and metastatic lung lesions. Patients and methods 130 patients with 160 lesions were treated with Cyberknife SBRT, including T1-3 primary lung cancers (54%), recurrent tumors (22%) and pulmonary metastases (24%). The mean biologically equivalent dose (BED10Gy) was 151 Gy (72–180 Gy). Median prescribed dose for peripheral and central lesions was 3×20 Gy and 3×15 Gy, respectively. Local control (LC), overall survival (OS), and cause-specific survival (CSS) rates, early and late toxicities are reported. Statistical analysis was performed to identify factors influencing local tumor control. Results Median follow-up time was 21 months. In univariate analysis, higher dose was associated with better LC and a cut-off value was detected at BED10Gy ≤ 112.5 Gy, resulting in 1-, 2-, and 3-year actuarial LC rates of 93%, vs 73%, 80% vs 61%, and 63% vs 54%, for the high and low dose groups, respectively (p = 0.0061, HR = 0.384). In multivariate analysis, metastatic origin, histological confirmation and larger Planning Target Volume (PTV) were associated with higher risk of local failure. Actuarial OS and CSS rates at 1, 2, and 3 years were 85%, 74% and 62%, and 93%, 89% and 80%, respectively. Acute and late toxicities ≥ Gr 3 were observed in 3 (2%) and 6 patients (5%), respectively. Conclusions Our favorable LC and survival rates after robotic SBRT, with low rates of severe toxicities, are coherent with the literature data in this mixed, non-selected study population.
Collapse
Affiliation(s)
- Zsolt Levente Janvary
- Division of Radiotherapy, Department of Clinical Oncology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nicolas Jansen
- Department of Radiation Oncology, Liege University Hospital, Liege, Belgium
| | - Veronique Baart
- Department of Radiation Oncology, Liege University Hospital, Liege, Belgium
| | - Magali Devillers
- Department of Radiation Oncology, Liege University Hospital, Liege, Belgium
| | - David Dechambre
- Department of Radiation Oncology, Liege University Hospital, Liege, Belgium
| | - Eric Lenaerts
- Department of Radiation Oncology, Liege University Hospital, Liege, Belgium
| | - Laurence Seidel
- Department of Biostatistics, Liege University Hospital, Liege, Belgium
| | - Nicole Barthelemy
- Department of Radiation Oncology, Liege University Hospital, Liege, Belgium
| | - Patrick Berkovic
- Department of Radiation Oncology, Liege University Hospital, Liege, Belgium
| | - Akos Gulyban
- Department of Radiation Oncology, Liege University Hospital, Liege, Belgium
| | - Ferenc Lakosi
- Department of Radiation Oncology, Liege University Hospital, Liege, Belgium
| | - Zsolt Horvath
- Division of Radiotherapy, Department of Clinical Oncology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Philippe A Coucke
- Department of Radiation Oncology, Liege University Hospital, Liege, Belgium
| |
Collapse
|
6
|
Abstract
Indication, doses, and technique of radiotherapy, for intrathoracic metastases are presented. The recommendations for delineation of the target volumes and organs at risk are detailed.
Collapse
Affiliation(s)
- P Giraud
- Service d'oncologie radiothérapie, hôpital européen-Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, Paris-Cité Sorbonne, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - T Lacornerie
- Service de physique médicale, centre Oscar-Lambret, 3, avenue Frédéric-Combemale, 59000 Lille, France
| | - F Mornex
- EMR 3738, université Claude-Bernard Lyon 1, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Département de radiothérapie-oncologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| |
Collapse
|
7
|
Takeda A, Oku Y, Sanuki N, Eriguchi T, Aoki Y, Enomoto T, Kaneko T, Nishimura S, Kunieda E. Feasibility study of stereotactic body radiotherapy for peripheral lung tumors with a maximum dose of 100 Gy in five fractions and a heterogeneous dose distribution in the planning target volume. JOURNAL OF RADIATION RESEARCH 2014; 55:988-95. [PMID: 24833770 PMCID: PMC4202295 DOI: 10.1093/jrr/rru037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 05/24/2023]
Abstract
We evaluated toxicity and outcomes for patients with peripheral lung tumors treated with stereotactic body radiation therapy (SBRT) in a dose-escalation and dose-convergence study. A total of 15 patients were enrolled. SBRT was performed with 60 Gy in 5 fractions (fr.) prescribed to the 60% isodose line of maximum dose, which was 100 Gy in 5 fr., covering the planning target volume (PTV) surface (60 Gy/5 fr. - (60%-isodose)) using dynamic conformal multiple arc therapy (DCMAT). The primary endpoint was radiation pneumonitis (RP) ≥ Grade 2 within 6 months. Toxicities were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. Using dose-volumetric analysis, the trial regimen of 60 Gy/5 fr. - (60%-isodose) was compared with our institutional conventional regimen of 50 Gy/5 fr. - (80%-isodose). The enrolled consecutive patients had either a solitary peripheral tumor or two ipsilateral tumors. The median follow-up duration was 22.0 (12.0-27.0) months. After 6 months post-SBRT, the respective number of RP Grade 0, 1 and 2 cases was 5, 9 and 1. In the Grade 2 RP patient, the image showed an organizing pneumonia pattern at 6.0 months post-SBRT. No other toxicity was found. At last follow-up, there was no evidence of recurrence of the treated tumors. The target volumes of 60 Gy/ 5 fr. - (60%-isodose) were irradiated with a significantly higher dose than those of 50 Gy/5 fr. - (80%-isodose), while the former dosimetric parameters of normal lung were almost equivalent to the latter. SBRT with 60 Gy/5 fr. - (60%-isodose) using DCMAT allowed the delivery of very high and convergent doses to peripheral lung tumors with feasibility in the acute and subacute phases. Further follow-up is required to assess for late toxicity.
Collapse
Affiliation(s)
- Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan
| | - Yohei Oku
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan
| | - Naoko Sanuki
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan
| | - Takahisa Eriguchi
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan
| | - Yousuke Aoki
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan
| | - Tatsuji Enomoto
- Department of Respiratory Medicine, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan
| | - Takeshi Kaneko
- Department of Respiratory Medicine, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shuichi Nishimura
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan
| | - Etsuo Kunieda
- Department of Radiology, Tokai University School of Medicine, Sagamihara, Kanagawa, Japan
| |
Collapse
|
8
|
Lo SS, Fakiris AJ, Teh BS, Cardenes HR, Henderson MA, Forquer JA, Papiez L, McGarry RC, Wang JZ, Li K, Mayr NA, Timmerman RD. Stereotactic body radiation therapy for oligometastases. Expert Rev Anticancer Ther 2014; 9:621-35. [DOI: 10.1586/era.09.15] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
9
|
Reyngold M, Wu AJ, McLane A, Zhang Z, Hsu M, Stein NF, Zhou Y, Ho AY, Rosenzweig KE, Yorke ED, Rimner A. Toxicity and outcomes of thoracic re-irradiation using stereotactic body radiation therapy (SBRT). Radiat Oncol 2013; 8:99. [PMID: 23617949 PMCID: PMC3651392 DOI: 10.1186/1748-717x-8-99] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 04/17/2013] [Indexed: 12/25/2022] Open
Abstract
Background Patients treated for a thoracic malignancy carry a significant risk of developing other lung lesions. Locoregional control of intrathoracic recurrences is challenging due to the impact of prior therapies on normal tissues. We examined the safety and efficacy of thoracic re-irradiation using high-precision image-guided stereotactic body radiation therapy (SBRT). Methods Records of 39 patients with prior intra-thoracic conventionally fractionated radiation therapy (RT) who underwent SBRT for a subsequent primary, recurrent or metastatic lung tumor from 11/2004 to 7/2011 were retrospectively reviewed. Results Median dose of prior RT was 61 Gy (range 30–80 Gy). Median biologically effective prescription dose (α/β = 10) (BED10) of SBRT was 70.4 Gy (range 42.6-180 Gy). With a median followup of 12.6 months among survivors, 1- and 2-year actuarial local progression-free survival (LPFS) were 77% and 64%, respectively. Median recurrence-free (RFS) and overall survival (OS) were 13.8 and 22.0 months, respectively. Patients without overlap of high-dose regions of the primary and re-irradiation plans were more likely to receive a BED10 ≥100 Gy, which was associated with higher LPFS (hazard ratio, [HR] = 0.18, p = 0.04), RFS ([HR] = 0.31, p = 0.038) and OS ([HR] = 0.25, p = 0.014). Grade 2 and 3 pulmonary toxicity was observed in 18% and 5% of patients, respectively. Other grade 2–4 toxicities included chest wall pain in 18%, fatigue in 15% and skin toxicity in 5%. No grade 5 events occurred. Conclusions SBRT can be safely and successfully administered to patients with prior thoracic RT. Dose reduction for cases with direct overlap of successive radiation fields results in acceptable re-treatment toxicity profile.
Collapse
Affiliation(s)
- Marsha Reyngold
- Department of Radiation Oncology, Memorial Sloan-Kettering, 1275 York Ave, New York, NY 10065, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Inoue T, Oh RJ, Shiomi H, Masai N, Miura H. Stereotactic body radiotherapy for pulmonary metastases. Prognostic factors and adverse respiratory events. Strahlenther Onkol 2013; 189:285-92. [PMID: 23420546 DOI: 10.1007/s00066-012-0290-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/26/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the feasibility, safety, and effectiveness of stereotactic body radiotherapy (SBRT) for pulmonary metastases. PATIENTS AND METHODS Between April 2007 and March 2011, 87 patients underwent SBRT for pulmonary metastases using the in-house Air-Bag System(TM) to obtain the four-dimensional image for treatment planning and to reduce intrafractional intrathoracic organ motion with abdominal compression to reduce the risk of radiation pneumonitis. Survival and respiratory adverse events were analyzed. RESULTS The 2- and 3-year overall survival (OS) rates were 47 and 32 %, and the corresponding cause-specific survivals were 52 and 36 %. The 2- and 3-year OS rates were 57 and 49 % for patients in group 1, respectively, while the corresponding OS rates were 48 and 21 %, and 40 and 32 % for patients in groups 2 and 3, respectively. The 2- and 3-year local control (LC) rates were 80 and 80 %, respectively. The corresponding intrathoracic progression-free survival rates were 40 and 32 %, respectively. Concerning adverse respiratory events after SBRT for pulmonary metastases, 14 % were grade 0 (G0), 66 % G1, 13 % G2, 6 % G3, and 1 % G4. Concerning the adverse respiratory events (NCI-CTC) by grade scale, 1- and 2-year cumulative probabilities of radiation pneumonitis were 12 and 20 % for G2 and 4 and 10 % for G3/4, respectively. The mean values for cumulative V20 were 11.6 ± 8.5 %, 29.8 ± 18.6 %, and 25.7 ± 12.8 % in G0/1, G2, and G3/4, respectively. The number of pulmonary metastases that could be safely treated with SBRT was 6 PTVs (or seven gross tumor volumes) within a cumulative V20 of 30 % under the restricted intrafractional respiratory tumor motion using the Air-Bag System(TM). CONCLUSION We propose that the number of pulmonary metastases that can be safely treated with SBRT is 6 PTVs with a cumulative V20 of 30 % under the restricted respiratory tumor motion using the Air-Bag System(TM). SBRT for pulmonary metastases offers locally effective treatment for recurrent or residual lesions after first line chemotherapy.
Collapse
Affiliation(s)
- T Inoue
- Miyakojima IGRT Clinic, Osaka University, 1-16-22 Miyakojima-Hondori, Miyakojima-Ku, Osaka, Japan.
| | | | | | | | | |
Collapse
|
11
|
Stereotactic body radiotherapy for metachronous multisite oligo-recurrence: a long-surviving case with sequential oligo-recurrence in four different organs treated using locally radical radiotherapy and a review of the literature. Pulm Med 2012; 2012:713073. [PMID: 23150822 PMCID: PMC3486341 DOI: 10.1155/2012/713073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/13/2012] [Indexed: 12/12/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) for oligometastases represents a recent trend in radiation oncology. While abundant data are available regarding the use of SBRT for the treatment of lung or liver oligometastases from various retrospective series and prospective trials, relatively little information has been accumulated for the treatment of oligometastases at sites other than the lungs and liver, particularly for sequential oligometastases in multiple organs. Oligometastases with primary lesions controlled is called “oligo-recurrence.” We describe herein the case of a lung cancer patient who developed repeated oligo-recurrence at multiple sites that were each controlled by radical radiotherapy and achieved long-term survival and discuss the merits of locally aggressive radiotherapy for this type of disease condition with reviewing the literature. Although further investigation should be undertaken to clarify the benefits, objectives, and methods of SBRT for the treatment of oligometastases, we believe utilization of SBRT may be worthwhile for patients with remote metastases who hope for treatment to acquire better local control and possible longer survival.
Collapse
|
12
|
Hatime M, Elmorabit B, Elkhoti Y, Touch S, Tanguy R, Mornex F. [Oligometastatic disease, a new concept: stereotactic irradiation for lung metastases. Literature review]. Cancer Radiother 2012; 16:351-7. [PMID: 22921980 DOI: 10.1016/j.canrad.2012.07.184] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 07/19/2012] [Accepted: 07/25/2012] [Indexed: 12/25/2022]
Abstract
Metastatic lung disease has long been the preserve of systemic treatments, local treatments being considered in a purely palliative intention. Several studies have objectified benefit to the local treatment of metastases, especially oligometastases. Surgery then took an important place in this setting, but the development of techniques for stereotactic radiotherapy on the one hand and the refusal or contraindication for surgery on the other hand led authors to conduct studies in this direction. This literature review describes the realization of stereotactic radiotherapy in treating pulmonary oligometastases and evaluates criteria for the selection of patients who would benefit. A comparison between the results of different studies on this technique allowed to show its effectiveness for local control, overall survival and tolerance. Stereotactic radiotherapy has emerged as a viable alternative, effective and well tolerated with local control rates comparable to that obtained by surgery (74 to 100%). Quality of life after stereotactic radiotherapy should be in a near future an important parameter to support this therapeutic choice, and needs to be precisely assessed.
Collapse
Affiliation(s)
- M Hatime
- Département de radiothérapie oncologie, centre hospitalier Lyon-Sud, Pierre-Bénite, France
| | | | | | | | | | | |
Collapse
|
13
|
Song A, Shiue K, Machtay M, Yao M, Ellis RJ, Huang Z, Mayr NA, Teh BS, Lo SS. Stereotactic body radiation therapy for metastasis in the lung: an undervalued treatment option with future prospects. Lung Cancer Manag 2012. [DOI: 10.2217/lmt.12.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
SUMMARY The lung is a common site of metastatic disease from solid tumors. Most cancers can develop lung metastases, and sarcoma and epithelial (especially colorectal) malignancies are prone to metastasize to the lung. In particular, the International Registry of Lung Metastases describes 5206 cases of lung metastasectomy, of which 43% were epithelial and 42% were sarcomatoid. Common presenting symptoms include cough, hemoptysis, shortness of breath, chest pain and back pain. Data in the literature suggest the existence of an oligometastatic state, where metastases are limited in number and location. For selected patients with lung oligometastases, local therapy such as surgery, stereotactic body radiotherapy (SBRT) and radiofrequency ablation may potentially yield prolonged survival. Data from retrospective series and prospective trials on the use of SBRT for lung metastases are emerging, showing promising results. Most studies show high local control rates rivaling those found in studies of surgical management (the usual treatment of choice) for lung metastases, while SBRT also has the benefit of low rates of significant toxicities. This review will provide an overview of the utilization of SBRT in the management of lung oligometastases.
Collapse
Affiliation(s)
- Andrew Song
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Kevin Shiue
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Mitchell Machtay
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lerner Tower B181, Cleveland, OH 44106, USA
| | - Min Yao
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lerner Tower B181, Cleveland, OH 44106, USA
| | - Rodney J Ellis
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lerner Tower B181, Cleveland, OH 44106, USA
| | - Zhibin Huang
- Department of Radiation Oncology, Leo W Jenkins Cancer Center, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC 27834, USA
| | - Nina A Mayr
- Department of Radiation Oncology, Arthur G James Cancer Hospital, Ohio State University Medical Center, 300 West 10th Avenue, Columbus, OH 43210, USA
| | - Bin S Teh
- Department of Radiation Oncology, The Methodist Cancer Center, 6565 Fannin, Ste DB1-077, Houston, TX 77030, USA
| | - Simon S Lo
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lerner Tower B181, Cleveland, OH 44106, USA
| |
Collapse
|
14
|
Comparison of anisotropic aperture based intensity modulated radiotherapy with 3D-conformal radiotherapy for the treatment of large lung tumors. Radiother Oncol 2012; 102:268-73. [DOI: 10.1016/j.radonc.2011.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 09/19/2011] [Accepted: 10/07/2011] [Indexed: 12/25/2022]
|
15
|
Lo SS, Moffatt-Bruce SD, Dawson LA, Schwarz RE, Teh BS, Mayr NA, Lu JJ, Grecula JC, Olencki TE, Timmerman RD. The role of local therapy in the management of lung and liver oligometastases. Nat Rev Clin Oncol 2011; 8:405-16. [DOI: 10.1038/nrclinonc.2011.75] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
16
|
Computed Tomography-Guided Interstitial High-Dose-Rate Brachytherapy in the Local Treatment of Primary and Secondary Intrathoracic Malignancies. J Thorac Oncol 2011; 6:545-52. [DOI: 10.1097/jto.0b013e318208c7a3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
17
|
Higginson DS, Morris DE, Jones EL, Clarke-Pearson D, Varia MA. Stereotactic body radiotherapy (SBRT): Technological innovation and application in gynecologic oncology. Gynecol Oncol 2010; 120:404-12. [PMID: 21194733 DOI: 10.1016/j.ygyno.2010.11.042] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/28/2010] [Accepted: 11/30/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Stereotactic body radiotherapy (SBRT) is a novel form of noninvasive, highly conformal radiation treatment that delivers a high dose to tumor. The advantage of the technique resides in its ability to provide a high dose to tumor but spare normal tissues to an extent not previously possible. In this paper we will provide an introduction and review of this technology with regard to its use in gynecologic malignancies. Preliminary results from our experience are presented for the purpose of illustrating the range of SBRT applications in gynecologic oncology. METHODS A comprehensive literature review was conducted and our experience from the past three years was reviewed. RESULTS Six case series are published that report results of SBRT for gynecologic malignancies. Sixteen gynecologic patients have been treated with SBRT at our institution. Treatment sites include pelvic and periaortic nodes (9 patients), oligometastatic disease (2), and cervical or endometrial primary tumors when other conventional external radiation or brachytherapy techniques were unsuitable (5). Preliminary follow-up at a median of 11 months (range, 0.3-33 months) demonstrates 79% locoregional control, 43% distant failure, and 50% overall survival. CONCLUSIONS SBRT boosts to macroscopic periaortic node recurrences and other sites seem to provide local control and a possibility of long-term disease-free survival in carefully selected patients. Previously this had been difficult to achieve with conventional radiotherapy because of the proximity of periaortic nodes to small bowel. SBRT also offers a novel approach for minimally invasive treatment in the management of gynecological cancer where current surgical and radiotherapy techniques are unsuitable.
Collapse
Affiliation(s)
- Daniel S Higginson
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA.
| | | | | | | | | |
Collapse
|
18
|
|
19
|
Oshiro Y, Aruga T, Tsuboi K, Marino K, Hara R, Sanayama Y, Itami J. Stereotactic Body Radiotherapy for Lung Tumors at the Pulmonary Hilum. Strahlenther Onkol 2010; 186:274-9. [DOI: 10.1007/s00066-010-2072-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 03/05/2010] [Indexed: 12/25/2022]
|
20
|
Pijls-Johannesma M, van Mastrigt G, Hahn SM, De Ruysscher D, Baumert BG, Lammering G, Buijsen J, Bentzen SM, Lievens Y, Kramar A, Lambin P. A systematic methodology review of phase I radiation dose escalation trials. Radiother Oncol 2010; 95:135-41. [PMID: 20338652 DOI: 10.1016/j.radonc.2010.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this review is to evaluate the methodology used in published phase I radiotherapy (RT) dose escalation trials. A specific emphasis was placed on the frequency of reporting late complications as endpoint. MATERIALS AND METHODS We performed a systematic literature review using a predefined search strategy to identify all phase I trials reporting on external radiotherapy dose escalation in cancer patients. RESULTS Fifty-three trials (phase I: n = 36, phase I-II: n = 17) fulfilled the inclusion criteria. Of these, 20 used a modified Fibonacci design for the RT dose escalation, but 32 did not specify a design. Late toxicity was variously defined as > 3 months (n = 43) or > 6 months (n = 3) after RT, or not defined (n = 7). In only nine studies the maximum tolerated dose (MTD) was related to late toxicity, while only half the studies reported the minimum follow-up period for dose escalation (n = 26). CONCLUSION In phase I RT trials, late complications are often not taken into account and there is currently no consensus on the methodology used for radiation dose escalation studies. We therefore propose a decision-tree algorithm which depends on the endpoint selected and whether a validated early surrogate endpoint is available, in order to choose the most appropriate study design.
Collapse
Affiliation(s)
- Madelon Pijls-Johannesma
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Lo SS, Fakiris AJ, Chang EL, Mayr NA, Wang JZ, Papiez L, Teh BS, McGarry RC, Cardenes HR, Timmerman RD. Stereotactic body radiation therapy: a novel treatment modality. Nat Rev Clin Oncol 2009; 7:44-54. [PMID: 19997074 DOI: 10.1038/nrclinonc.2009.188] [Citation(s) in RCA: 253] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiation therapy (SBRT) involves the delivery of a small number of ultra-high doses of radiation to a target volume using very advanced technology and has emerged as a novel treatment modality for cancer. The role of SBRT is most important at two cancer stages-in early primary cancer and in oligometastatic disease. This modality has been used in the treatment of early-stage non-small-cell lung cancer, prostate cancer, renal-cell carcinoma, and liver cancer, and in the treatment of oligometastases in the lung, liver, and spine. A large body of evidence on the use of SBRT for the treatment of primary and metastatic tumors in various sites has accumulated over the past 10-15 years, and efficacy and safety have been demonstrated. Several prospective clinical trials of SBRT for various sites have been conducted, and several other trials are currently being planned. The results of these clinical trials will better define the role of SBRT in cancer management. This article will review the radiobiologic, technical, and clinical aspects of SBRT.
Collapse
Affiliation(s)
- Simon S Lo
- Department of Radiation Oncology, Arthur G. James Cancer Hospital, Ohio State University College of Medicine, 300 West 10th Avenue, Columbus, OH 43210, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Comparisons of dose-volume histograms for proton-beam versus 3-D conformal x-ray therapy in patients with stage I non-small cell lung cancer. Strahlenther Onkol 2009; 185:231-4. [PMID: 19370425 DOI: 10.1007/s00066-009-1923-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 12/10/2008] [Indexed: 12/25/2022]
Abstract
PURPOSE Dose-volume histograms (DVHs) were reviewed to determine if there is an advantage of the two modalities when treating patients with non-small cell lung cancer (NSCLC). PATIENTS AND METHODS 24 stage I NSCLC patients who underwent proton-beam therapy (PBT) from June 2003 to May 2007 were included in this study. Based on the same clinical target volumes (CTVs), treatment planning was made to cover CTV within 90% isodose lines. Each patient was evaluated by two sets of DVHs, one for PBT and the other for three-dimensional conformal X-ray therapy (3D-CRT). RESULTS For all patients, the 95% isodose line covered 86.4% of the CTV for PBT, and 43.2% for 3D-CRT. PBT was associated with significantly lower mean doses to the ipsilateral lung, total lung, heart, esophagus, and spinal cord than 3D-CRT. PBT offered reduced radiation doses to the lung when evaluated in terms of percentage lung volumes receiving > or = 5 Gy (V(5)), > or = 10 Gy (V(10)), and > or = 20 Gy (V(20)) when compared to 3D-CRT. CONCLUSION PBT is advantageous over 3D-CRT in reducing doses to the lung, heart, esophagus, and spinal cord in treating stage I NSCLC.
Collapse
|
23
|
Abteilungs- und Patientenmanagement in der Strahlenheilkunde. Strahlenther Onkol 2009; 185:143-54. [DOI: 10.1007/s00066-009-1895-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 10/31/2008] [Indexed: 11/29/2022]
|
24
|
Jacob V, Kneschaurek P. A Method for Improved Verification of Entire IMRT Plans by Film Dosimetry. Strahlenther Onkol 2009; 185:34-40. [DOI: 10.1007/s00066-009-1879-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 09/09/2008] [Indexed: 12/26/2022]
|
25
|
Georg D, Hillbrand M, Stock M, Dieckmann K, Pötter R. Can protons improve SBRT for lung lesions? Dosimetric considerations. Radiother Oncol 2008; 88:368-75. [PMID: 18405986 DOI: 10.1016/j.radonc.2008.03.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 03/05/2008] [Accepted: 03/06/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the present study was to investigate potential dosimetric benefits of proton therapy for hypofractionated stereotactic body radiotherapy (SBRT). MATERIALS AND METHOD Twelve patients undergoing hypofractionated SBRT at the Medical University Vienna were selected. Passively scattered protons (PT) and intensity modulated proton therapy (IMPT) were evaluated against a conformal photon technique (3D-CRT), assuming a fractionation of 3x15Gy, prescribed to the 65% isodose. For all treatment techniques shallow breathing with abdominal compression (SB+AC) was compared with a deep inspiration breath hold technique (DIBH). Treatment planning was done with XiO (CMS, USA). Target conformity, dose-volume histograms (DVH) and various associated dosimetric parameters were considered for the planning target volume (PTV), lung, heart and esophagus. RESULTS For both breathing conditions conformity indices were very similar. They were between 0.75 and 0.78 for IMPT and 3D-CRT and around 0.55 for PT using 2-3 beams. Irrespective of treatment modality, DVHs for the ipsilateral lung were improved with the DIBH technique. For the PT technique, the 2Gy isodose (V2Gy) covered on average 7-9% less lung volume compared to 3D-CRT, for IMPT this reduction was more than 10%. Volumes covered the 4 and 6Gy isodoses were 2-4% smaller for IMPT, but very similar for PT and 3D-CRT. Both proton techniques achieved full sparing of the contralateral lung and superior sparing of the heart. Maximum doses to the heart and esophagus were on average around 3Gy for 3D-CRT and almost 0Gy for both proton techniques. For 3D-CRT average V2Gy values for the heart could be reduced from 64% in shallow breathing to 34% in DIBH. V2Gy for protons was negligible. CONCLUSIONS Only small dosimetric differences were found between photons and protons for SBRT of lung lesions. Whether these small dosimetric benefits translate in reduced side effects or have the potential to improve local control rates remains to be demonstrated in clinical studies.
Collapse
Affiliation(s)
- Dietmar Georg
- Department of Radiotherapy, Medical University Vienna/AKH Vienna, Vienna, Austria.
| | | | | | | | | |
Collapse
|
26
|
Stereotactic Radiosurgery for Thoracic Malignancies. Ann Thorac Surg 2008; 85:S785-91. [DOI: 10.1016/j.athoracsur.2007.10.101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 10/22/2007] [Accepted: 10/23/2007] [Indexed: 12/25/2022]
|