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Patel PH, Dreibe S, Reid A, Parker C, Murray J, Pathmanathan A, Tirona A, Guevara J, Suh YE, Frew J, Palaniappan N, Syndikus I, Attard G, Tunariu N, Tree AC. Stereotactic Body Radiotherapy for Oligoprogression in Castration-Resistant Prostate Cancer: Early Toxicity Analysis of the TRAP Trial. Clin Oncol (R Coll Radiol) 2024; 36:585-592. [PMID: 39004535 DOI: 10.1016/j.clon.2024.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/16/2024]
Abstract
AIMS To assess toxicity and patient quality of life after stereotactic body radiotherapy (SBRT) to oligoprogressive disease (OPD) in patients with metastatic castrate-resistant prostate cancer (CRPC) on androgen receptor targeted agents (ARTA). MATERIAL AND METHODS This phase II trial enrolled patients with metastatic CRPC with ≤ 2 oligoprogressive lesions in bone, lymph node, lung, or prostate. All patients were receiving systemic treatment with abiraterone or enzalutamide at the time of oligoprogression. All patients received SBRT to the OPD site(s) and continued the current ARTA. Patients received 30 Gy in 5 fractions (alternate days) to the OPD site. The primary endpoint of the trial is to assess if SBRT to OPD sites results in progression free survival of >6 months. The primary endpoint for this toxicity analysis is the rate of grade 3 or higher adverse events at any timepoint up to 6 months after SBRT. Secondary endpoints included comparing pre- and post-SBRT patient-related outcomes reported using visual analogue scale scores and EQ-5D health questionnaire. RESULTS Forty enrolled patients had at least 6 months of follow-up at the time of analysis. Grade 3 or higher toxicity from any cause recorded using common terminology criteria for adverse events and radiation therapy oncology group was found in 8/40 (20%) of patients, but only 1/40 (2.5%) was deemed possibly related to SBRT. There was no significant difference in mean EQ5D visual analogue scale score from baseline to each timepoint after SBRT (p = 0.449). CONCLUSION In this prospective phase II clinical trial for OPD whilst on ARTA in the CRPC setting, we report low grade ≥ 3 toxicity after SBRT. There is no discernible change in patient-reported quality of life due to SBRT treatment. The final results of progression-free survival and toxicity of SBRT treatment will be reported once further follow-up is complete.
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Affiliation(s)
- P H Patel
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK.
| | - S Dreibe
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK
| | - A Reid
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK
| | - C Parker
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK; The Institute of Cancer Research, London, SM2 5NG, UK
| | - J Murray
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK; The Institute of Cancer Research, London, SM2 5NG, UK
| | - A Pathmanathan
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK
| | - A Tirona
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK
| | - J Guevara
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK
| | - Y-E Suh
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK
| | - J Frew
- Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle-Upon-Tyne, NE7 7DN, UK
| | | | - I Syndikus
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK
| | - G Attard
- University College London Cancer Institue, London, NW1 2BU, UK; University College London Hospital, London, NW1 2BU, UK
| | - N Tunariu
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK
| | - A C Tree
- The Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK; The Institute of Cancer Research, London, SM2 5NG, UK
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Pezzulla D, Chiloiro G, Lima EM, Macchia G, Romano C, Reina S, Panza G, Cilla S, Morganti AG, Cellini F, Gambacorta MA, Deodato F. Stereotactic radiotherapy for liver oligometastases: a pooled analysis following the estro/eortc consensus recommendations. Clin Exp Metastasis 2024:10.1007/s10585-024-10301-6. [PMID: 39017807 DOI: 10.1007/s10585-024-10301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
A large pooled analysis of liver oligometastases, classified accordingly to the ESTRO/EORTC recommendations, treated by stereotactic radiotherapy (SBRT) and Radiosurgery (SRS) was carried out. The clinical and dosimetric data of patients who underwent SBRT/SRS for liver metastases were analysed in terms of efficacy and toxicity profile. In particular, the Local Control (LC), the Distant Metastases Free Survival (DMFS), the Disease-Free Survival (DFS), the Overall Survival (OS), and the Next Systemic Therapy Free Survival (NEST-FS) rates were analysed. 113 patients (M/F: 49/64), accounting for a total of 150 hepatic lesions (March 2006-February 2023) in two Italian radiotherapy Institutions were evaluated. Median age was 67 years old (36-92) and 48 (42.5%) patients had at least one comorbidity. The majority of the lesions were induced (30.7%) or repeated oligoprogressive (12.7%) metastases. 98 lesions were treated with more than one daily fraction (mainly 50 Gy in 5 fractions), while 52 were radiosurgery treatments (mainly 32 Gy). The treatment response at 3-4 months was evaluable in 147 lesions: complete response was 32.0%, partial response 17.0%, and stable disease 32.0%. Actuarial LC, DMFS, DFS, OS, and NEST-FS at 1 year were 75.8%, 37.7%, 34.9%, 78.7%, and 59.4% respectively; while actuarial LC, DMFS, DFS, OS, and NEST-FS at 2 years were 52.1%, 24.9%, 21.9%, 51.3%, and 36.8%, respectively. The achievement of complete response, synchronous oligometastases, and no treatment interruptions correlated with a more favorable outcomes. As per the toxicity profile, we registered only two acute and one late toxicity cases higher than grade 2. Stereotactic treatment for liver metastases seems to be a safe and promising option in terms of local control. The best results in term of outcomes have been obtained in patients with complete response, synchronous oligometastases, favorable histology, and no treatment interruptions.
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Affiliation(s)
- D Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - G Chiloiro
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - E M Lima
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - G Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy.
| | - C Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - S Reina
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - G Panza
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - S Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - A G Morganti
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, IRCCS Azienda Ospedaliero, Universitaria di Bologna - Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Cellini
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Milano, Italy
| | - M A Gambacorta
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Milano, Italy
| | - F Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Milano, Italy
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3
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Suydam CR, Schlussel AT. Management of Oligometastatic Colorectal Cancer. Surg Clin North Am 2024; 104:619-629. [PMID: 38677825 DOI: 10.1016/j.suc.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
The management of oligometastatic colorectal cancer differs from the treatment of metastatic colorectal cancer, and it is essential that those who treat oligometastatic disease be familiar with the treatment options for these patients. Although definitive treatment is often surgical, there are situations where local therapies such as SBRT or ablative techniques may better serve the patient. Adjuvant therapy should be provided to all patients, and neoadjuvant chemotherapy should be considered as well. The role of immunotherapy is currently limited due to the lack of clinical trials in this area.
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Affiliation(s)
- Camille R Suydam
- Department of General Surgery, 300 East Hospital Road, Fort Eisenhower, GA 30905, USA.
| | - Andrew T Schlussel
- Department of Surgery, Charlie Norwood VA Medical Center, 950 15th Street, Augusta, GA 30901, USA
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4
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Yang G, Kim KH, Lee CG, Hong MH, Kim HR, Cho Y, Yoon HI. Aggressive Local Ablative Radiotherapy Mitigates Progression Risk in Oligometastatic Lung Adenocarcinoma. Cancer Res Treat 2024; 56:115-124. [PMID: 37641819 PMCID: PMC10789958 DOI: 10.4143/crt.2023.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/28/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE This study aimed to determine the role of local ablative radiotherapy (LART) in oligometastatic/oligoprogressive lung adenocarcinoma. MATERIALS AND METHODS Patients (n=176) with oligometastatic lung adenocarcinoma treated with LART were identified, and those treated with LART at the initial diagnosis of synchronous oligometastatic disease (OMD group) or treated with LART when they presented with repeat oligoprogression (OPD group) were included. RESULTS In the OMD group (n=54), the 1- and 3-year progression-free survival (PFS) were 50.9% and 22.5%, respectively, whereas the 1- and 3-year overall survival in the OPD group were 75.9% and 58.1%, respectively. Forty-one patients (75.9%) received LART at all gross disease sites. Tyrosine kinase inhibitor (TKI) use and all-metastatic site LART were significant predictors of higher PFS (p=0.018 and p=0.046, respectively). In patients treated with TKIs at the time of LART (n=23) and those treated with all-metastatic site LART, the 1-year PFS was 86.7%, while that of patients not treated with all-metastatic site LART was 37.5% (p=0.006). In the OPD group (n=122), 67.2% of the patients (n=82) maintained a systemic therapy regimen after LART. The cumulative incidence of changing systemic therapy was 39.6%, 62.9%, and 78.5% at 6 months, 1 year, and 2 years after LART, respectively. CONCLUSION Aggressive LART can be an option to improve survival in patients with oligometastatic disease. Patients with synchronous oligometastatic disease receiving TKI and all-metastatic site LART may have improved PFS. In patients with repeat oligoprogression, LART might potentially extend survival by delaying the need to change the systemic treatment regimen.
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Affiliation(s)
- Gowoon Yang
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Min Hee Hong
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yeona Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
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5
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Mheid S, Allen S, Ng SSW, Hall WA, Sanford NN, Aguilera TA, Elamir AM, Bahij R, Intven MPW, Radhakrishna G, Mohamad I, De Leon J, Tan H, Lewis S, Gani C, Stanecu T, Dell’Acqua V, Hosni A. Local Control Following Stereotactic Body Radiation Therapy for Liver Oligometastases: Lessons from a Quarter Century. Curr Oncol 2023; 30:9230-9243. [PMID: 37887567 PMCID: PMC10605011 DOI: 10.3390/curroncol30100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
The utilization of stereotactic body radiation therapy for the treatment of liver metastasis has been widely studied and has demonstrated favorable local control outcomes. However, several predictive factors play a crucial role in the efficacy of stereotactic body radiation therapy, such as the number and size (volume) of metastatic liver lesions, the primary tumor site (histology), molecular biomarkers (e.g., KRAS and TP53 mutation), the use of systemic therapy prior to SBRT, the radiation dose, and the use of advanced technology and organ motion management during SBRT. These prognostic factors need to be considered when clinical trials are designed to evaluate the efficacy of SBRT for liver metastases.
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Affiliation(s)
- Sara Mheid
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (S.M.); (T.S.)
| | - Stefan Allen
- Department of Radiation Oncology, Dalhousie University, Nova Scotia Health, Halifax, NS B3H 4R2, Canada;
| | - Sylvia S. W. Ng
- Department of Radiation Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
| | - William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Nina N. Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75235, USA; (N.N.S.); (T.A.A.); (A.M.E.)
| | - Todd A. Aguilera
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75235, USA; (N.N.S.); (T.A.A.); (A.M.E.)
| | - Ahmed M. Elamir
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75235, USA; (N.N.S.); (T.A.A.); (A.M.E.)
| | - Rana Bahij
- Department of Oncology, Odense University Hospital, 5000 Odense, Denmark;
| | - Martijn P. W. Intven
- Department of Radiotherapy, Division Imaging and Oncology, University Medical Centre, 3584 CX Utrecht, The Netherlands;
| | - Ganesh Radhakrishna
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan;
| | | | - Hendrick Tan
- Department of Radiation Oncology, Fiona Stanley Hospital, Perth, WA 6150, Australia;
- GenesisCare, Perth, WA 6150, Australia
| | - Shirley Lewis
- Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India;
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Teo Stanecu
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (S.M.); (T.S.)
| | - Veronica Dell’Acqua
- Medical Affairs and Clinical Research, Linac-Based RT, Elekta Milan, 20864 Lombardy, Italy;
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (S.M.); (T.S.)
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6
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Patel PH, Tunariu N, Levine DS, de Bono JS, Eeles RA, Khoo V, Murray J, Parker CC, Pathmanathan A, Reid A, van As N, Tree AC. Oligoprogression in Metastatic, Castrate-Resistant Prostate Cancer-Prevalence and Current Clinical Practice. Front Oncol 2022; 12:862995. [PMID: 35656509 PMCID: PMC9152030 DOI: 10.3389/fonc.2022.862995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Oligoprogression is poorly defined in current literature. Little is known about the natural history and significance of oligoprogression in patients with hormone-resistant prostate cancer on abiraterone or enzalutamide treatment [termed androgen receptor-targeted therapy (ARTT)]. The aim of this study was to determine the prevalence of oligoprogression, describe the characteristics of oligoprogression in a cohort of patients from a single center, and identify the number of patients potentially treatable with stereotactic body radiotherapy (SBRT). Methods Castration-resistant prostate cancer (CRPC) patients who radiologically progressed while on ARTT were included. Patients with oligoprogressive disease (OPD) (≤3 lesions) on any imaging were identified in a retrospective analysis of electronic patient records. Kaplan-Meier method and log-rank test were used to calculate progression-free and overall survival. Results A total of 102 patients with metastatic CRPC on ARTT were included. Thirty (29%) patients presented with oligoprogression (46 lesions in total); 21 (21% of total) patients had lesions suitable for SBRT. The majority of lesions were in the bone (21, 46%) or lymph nodes (15, 33%). Patients with oligoprogression while on ARTT had a significantly better prostate-specific antigen (PSA) response on commencing ARTT as compared to patients who later developed polyprogression. However, PSA doubling time immediately prior to progression did not predict OPD. Median progression-free survival to oligoprogression versus polyprogression was 16.8 vs. 11.7 months. Time to further progression after oligoprogression was 13.6 months in those treated with radiotherapy (RT) for oligoprogression vs. 5.7 months in those treated with the continuation of ARTT alone. Conclusions In this study, nearly a third of patients on ARTT for CRPC were found to have OPD. OPD patients had a better PSA response on ART and a longer duration on ARTT before developing OPD as compared to those developing polyprogressive disease (Poly-PD). The majority of patients (70%) with OPD had lesions suitable for SBRT treatment. Prospective randomized control trials are needed to establish if there is a survival benefit of SBRT in oligoprogressive prostate cancer and to determine predictive indicators.
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Affiliation(s)
- Priyanka H. Patel
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- Radiology and Imaging, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Daniel S. Levine
- Radiology and Imaging, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Johann S. de Bono
- Drug Development Unit, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Rosalind A. Eeles
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Vincent Khoo
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Julia Murray
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Christopher C. Parker
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Angela Pathmanathan
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Alison Reid
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Nicholas van As
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Alison C. Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
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7
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Torres-Jiménez J, Esteban-Villarrubia J, Ferreiro-Monteagudo R, Carrato A. Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist. Cancers (Basel) 2021; 13:5938. [PMID: 34885047 PMCID: PMC8656541 DOI: 10.3390/cancers13235938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/12/2022] Open
Abstract
For patients with isolated liver metastases from colorectal cancer who are not candidates for potentially curative resections, non-surgical local treatments may be useful. Non-surgical local treatments are classified according to how the treatment is administered. Local treatments are applied directly on hepatic parenchyma, such as radiofrequency, microwave hyperthermia and cryotherapy. Locoregional therapies are delivered through the hepatic artery, such as chemoinfusion, chemoembolization or selective internal radiation with Yttrium 90 radioembolization. The purpose of this review is to describe the different interventional therapies that are available for these patients in routine clinical practice, the most important clinical trials that have tried to demonstrate the effectiveness of each therapy and recommendations from principal medical oncologic societies.
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Affiliation(s)
- Javier Torres-Jiménez
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.E.-V.); (R.F.-M.)
| | - Jorge Esteban-Villarrubia
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.E.-V.); (R.F.-M.)
| | - Reyes Ferreiro-Monteagudo
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.E.-V.); (R.F.-M.)
| | - Alfredo Carrato
- Medical Oncology Department, Ramón y Cajal Health Research Institute (IRYCIS), CIBERONC, Alcalá University, University Hospital Ramon y Cajal, 28034 Madrid, Spain;
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8
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Lopez-Campos F, Cacicedo J, Couñago F, García R, Leaman-Alcibar O, Navarro-Martin A, Pérez-Montero H, Conde-Moreno A. SEOR SBRT-SG stereotactic body radiation therapy consensus guidelines for non-spine bone metastasis. Clin Transl Oncol 2021; 24:215-226. [PMID: 34633602 DOI: 10.1007/s12094-021-02695-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/11/2021] [Indexed: 12/31/2022]
Abstract
The use of stereotactic body radiation therapy (SBRT) to treat non-spine bone metastases (NSBM) is becoming increasingly common in clinical practice. The clinical advantages of SBRT include good pain control and high local control rates, although only limited data are available. The Spanish Society of Radiation Oncology (SEOR) SBRT group recently convened a task force of experts in the field to address key questions related to SBRT for NSBM, including treatment indications, planning, techniques, and dose fractionation. The task force reviewed the available literature to develop evidence-based recommendations for the safe application of NSBM SBRT and to standardize and optimize SBRT processes. The present document provides a comprehensive analysis of the available data, including ongoing clinical trials and controversies, providing clinically applicable recommendations.
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Affiliation(s)
- F Lopez-Campos
- Radiation Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - J Cacicedo
- Radiation Oncology Department, Osakidetza/Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Spain.,Department of Surgery, Radiology and Physical Medicine of the University of the Basque Country (UPV/EHU), Vizcaya, Spain
| | - F Couñago
- Radiation Oncology Department, Hospital Universitario Quirón Salud, Hospital La Luz, Madrid, Universidad Europea de Madrid (UEM), Madrid, Spain
| | - R García
- Radiation Oncology Department, Hospital Ruber Internacional Madrid, Madrid, Spain
| | - O Leaman-Alcibar
- Radiation Oncology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - A Navarro-Martin
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - H Pérez-Montero
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - A Conde-Moreno
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, CEU Cardenal Herrera University, Castellón, Spain
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9
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Molla M, Fernandez-Plana J, Albiol S, Fondevila C, Vollmer I, Cases C, Garcia-Criado A, Capdevila J, Conill C, Fundora Y, Fernandez-Martos C, Pineda E. Limited Liver or Lung Colorectal Cancer Metastases. Systemic Treatment, Surgery, Ablation or SBRT. J Clin Med 2021; 10:jcm10102131. [PMID: 34069240 PMCID: PMC8157146 DOI: 10.3390/jcm10102131] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022] Open
Abstract
The prognosis for oligometastatic colorectal cancer has improved in recent years, mostly because of recent advances in new techniques and approaches to the treatment of oligometastases, including new surgical procedures, better systemic treatments, percutaneous ablation, and stereotactic body radiation therapy (SBRT). There are several factors to consider when deciding on the better approach for each patient: tumor factors (metachronous or synchronous metastases, RAS mutation, BRAF mutation, disease-free interval, size and number of metastases), patient factors (age, frailty, comorbidities, patient preferences), and physicians' factors (local expertise). These advances have presented major challenges and opportunities for oncologic multidisciplinary teams to treat patients with limited liver and lung metastases from colorectal cancer with a curative intention. In this review, we describe the different treatment options in patients with limited liver and lung metastases from colorectal cancer, and the possible combination of three approaches: systemic treatment, surgery, and local ablative treatments.
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Affiliation(s)
- Meritxell Molla
- Department of Radiation Oncology, Hospital Clinic Barcelona, Barcelona 08036, Spain; (M.M.); (C.C.); (C.C.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona 08036, Spain
| | | | - Santiago Albiol
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona 08036, Spain;
| | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clinic de Barcelona, Barcelona 08036, Spain; (C.F.); (Y.F.)
| | - Ivan Vollmer
- Department of Radiology, Hospital Clinic Barcelona, Barcelona 08036, Spain; (I.V.); (A.G.-C.)
| | - Carla Cases
- Department of Radiation Oncology, Hospital Clinic Barcelona, Barcelona 08036, Spain; (M.M.); (C.C.); (C.C.)
| | - Angeles Garcia-Criado
- Department of Radiology, Hospital Clinic Barcelona, Barcelona 08036, Spain; (I.V.); (A.G.-C.)
| | - Jaume Capdevila
- Department of Medical Oncology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona 08035, Spain;
| | - Carles Conill
- Department of Radiation Oncology, Hospital Clinic Barcelona, Barcelona 08036, Spain; (M.M.); (C.C.); (C.C.)
| | - Yliam Fundora
- Department of General and Digestive Surgery, Hospital Clinic de Barcelona, Barcelona 08036, Spain; (C.F.); (Y.F.)
| | | | - Estela Pineda
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona 08036, Spain
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona 08036, Spain;
- Correspondence:
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10
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Systematic review of stereotactic body radiotherapy for nodal metastases. Clin Exp Metastasis 2021; 38:11-29. [PMID: 33452954 DOI: 10.1007/s10585-020-10071-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
The aim of this analysis was to assess the efficacy of stereotactic body radiotherapy (SBRT) in terms of local control (LC) and progression-free survival (PFS) in patients with lymph node metastases (NMs) from solid tumors. A systematic literature search from the earliest date to July 25th, 2019 was performed following PRISMA guidelines. Papers reporting LC and/or PFS of NMs using SBRT (< 10 fractions) were selected. The clinical outcomes rates were pooled by means of a random or fixed-effect model. Twenty-nine studies were eligible (969 patients: 938 (LC) and 698 (PFS)). LC and PFS results were reported in 28 and 18 papers, respectively. Heterogeneity was observed in terms of patient and treatment characteristics. Pooled 2-year LC reported in 11 studies was 79.3% (95%CI, 72.8%-85.7%) with substantial heterogeneity between studies (Q2 test: p = 0.0083; I2 = 57.9%), while pooled 2-year PFS reported in 8 studies was 35.9% (95%CI, 22.1%-49.7%) with very high heterogeneity between studies (Q2 test: p < 0.0001; I2 = 86.1%). Grade ≥ 3 and Grade 5 toxicity rates were 2.0% and 0.2%, respectively. SBRT of NMs seems to be safe and effective in terms of LC. However, due to the marked heterogeneity of the included series, prospective studies are required.
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11
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Chandy E, Taylor H, Gaito S, Wells E, Jones C, Meehan C, Burland H, Stone J, Snowball C, Mashru J, Riddell C, Hon Y, Welsh L, Saran F, Mandeville H. Hypofractionated Stereotactic Ablative Radiotherapy for Recurrent or Oligometastatic Tumours in Children and Young Adults. Clin Oncol (R Coll Radiol) 2020; 32:316-326. [DOI: 10.1016/j.clon.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/09/2019] [Accepted: 10/20/2019] [Indexed: 12/13/2022]
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12
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Ihnát P, Skácelíková E, Vávra P, Jonszta T, Ihnát Rudinská L, Tomášková H. Novel strategy in the treatment of liver metastases - Hepatic resection combined with stereotactic body radiotherapy. Asian J Surg 2020; 43:902-906. [PMID: 31911035 DOI: 10.1016/j.asjsur.2019.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To evaluate the safety, feasibility and outcomes of patients treated for colorectal liver metastases (CLM) with an innovative combined approach - hepatic resection and Stereotactic body radiotherapy (SBRT) using CyberKnife® system. METHODS This was a retrospective cohort study conducted in a single institution. Patients with CLM and no evidence of extrahepatic disease were included during a 6-year study period. RESULTS In total, 19 patients with 63 liver lesions underwent liver resection combined with SBRT of unresectable lesions. Major hepatectomy was performed in 42.1% patients; postoperative complications were noted in 31.6% patients. 27 unresectable lesions were treated by SBRT with a total dose of 50-60 Gy in five fractions. The median follow-up of study patients was 29.7 ± 20.58 months. Local control of CLM at 1 and 2 years was achieved in 89.5% of patients. Out-of-field hepatic recurrence was diagnosed in 63.1% patients. The 1-year disease-free survival (DFS) was 52.6%; 2-year DFS was 31.6%. The overall actuarial survival rates at 1 and 2 years were 88.2% and 50.4%. CONCLUSION Liver resection combined with SBRT presents a promising therapeutic option for patients with CLM which traditionally are unresectable. The additional use of SBRT allows for the effective clearance of the disease for thoroughly selected patients.
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Affiliation(s)
- Peter Ihnát
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic.
| | - Eva Skácelíková
- Department of Oncology, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Petr Vávra
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
| | - Tomáš Jonszta
- Department of Radiology, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Lucia Ihnát Rudinská
- Department of Forensic Medicine, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Hana Tomášková
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
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13
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Tree AC. Stereotactic Body Radiotherapy in Metastatic Disease: The Known Unknowns and the Unknown Unknowns. Clin Oncol (R Coll Radiol) 2019; 31:813-814. [PMID: 31326144 DOI: 10.1016/j.clon.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/24/2022]
Affiliation(s)
- A C Tree
- The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, UK.
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14
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Patel PH, Palma D, McDonald F, Tree AC. The Dandelion Dilemma Revisited for Oligoprogression: Treat the Whole Lawn or Weed Selectively? Clin Oncol (R Coll Radiol) 2019; 31:824-833. [PMID: 31182289 PMCID: PMC6880295 DOI: 10.1016/j.clon.2019.05.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 12/19/2022]
Abstract
Oligoprogressive disease is a relatively new clinical concept describing progression at only a few sites of metastasis in patients with otherwise controlled widespread disease. In the era of well-tolerated targeted treatments, resistance inevitably occurs and overcoming this is a challenge. Local ablative therapy for oligoprogressive disease may allow the continuation of systemic treatments by overcoming the few sub-clones that have developed resistance. Stereotactic body radiotherapy is now frequently used in treating oligometastatic disease using ablative doses with minimally invasive techniques and acceptable toxicity. We discuss the current retrospective clinical evidence base supporting the use of local ablative therapy for oligoprogression in metastatic patients on targeted treatments within multiple tumour sites. As there is currently a lack of published prospective data available, the best management for these patients remains unclear. We discuss current trials in recruitment and the potential advancements in treating this group of patients with stereotactic radiotherapy.
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Affiliation(s)
- P H Patel
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, Sutton, Surrey, UK.
| | - D Palma
- Department of Radiation Oncology, London Health Sciences Center, London, Ontario, Canada
| | - F McDonald
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, Sutton, Surrey, UK
| | - A C Tree
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, Sutton, Surrey, UK
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15
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Beaton L, Bandula S, Gaze MN, Sharma RA. How rapid advances in imaging are defining the future of precision radiation oncology. Br J Cancer 2019; 120:779-790. [PMID: 30911090 PMCID: PMC6474267 DOI: 10.1038/s41416-019-0412-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 01/23/2019] [Accepted: 02/05/2019] [Indexed: 12/13/2022] Open
Abstract
Imaging has an essential role in the planning and delivery of radiotherapy. Recent advances in imaging have led to the development of advanced radiotherapy techniques—including image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic body radiotherapy and proton beam therapy. The optimal use of imaging might enable higher doses of radiation to be delivered to the tumour, while sparing normal surrounding tissues. In this article, we review how the integration of existing and novel forms of computed tomography, magnetic resonance imaging and positron emission tomography have transformed tumour delineation in the radiotherapy planning process, and how these advances have the potential to allow a more individualised approach to the cancer therapy. Recent data suggest that imaging biomarkers that assess underlying tumour heterogeneity can identify areas within a tumour that are at higher risk of radio-resistance, and therefore potentially allow for biologically focussed dose escalation. The rapidly evolving concept of adaptive radiotherapy, including artificial intelligence, requires imaging during treatment to be used to modify radiotherapy on a daily basis. These advances have the potential to improve clinical outcomes and reduce radiation-related long-term toxicities. We outline how recent technological advances in both imaging and radiotherapy delivery can be combined to shape the future of precision radiation oncology.
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Affiliation(s)
- Laura Beaton
- Cancer Institute, University College London, London, UK
| | - Steve Bandula
- Cancer Institute, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK
| | - Mark N Gaze
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK
| | - Ricky A Sharma
- Cancer Institute, University College London, London, UK. .,NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK.
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16
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Bodo S, Campagne C, Thin TH, Higginson DS, Vargas HA, Hua G, Fuller JD, Ackerstaff E, Russell J, Zhang Z, Klingler S, Cho H, Kaag MG, Mazaheri Y, Rimner A, Manova-Todorova K, Epel B, Zatcky J, Cleary CR, Rao SS, Yamada Y, Zelefsky MJ, Halpern HJ, Koutcher JA, Cordon-Cardo C, Greco C, Haimovitz-Friedman A, Sala E, Powell SN, Kolesnick R, Fuks Z. Single-dose radiotherapy disables tumor cell homologous recombination via ischemia/reperfusion injury. J Clin Invest 2019; 129:786-801. [PMID: 30480549 DOI: 10.1172/jci97631] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/20/2018] [Indexed: 12/20/2022] Open
Abstract
Tumor cure with conventional fractionated radiotherapy is 65%, dependent on tumor cell-autonomous gradual buildup of DNA double-strand break (DSB) misrepair. Here we report that single-dose radiotherapy (SDRT), a disruptive technique that ablates more than 90% of human cancers, operates a distinct dual-target mechanism, linking acid sphingomyelinase-mediated (ASMase-mediated) microvascular perfusion defects to DNA unrepair in tumor cells to confer tumor cell lethality. ASMase-mediated microcirculatory vasoconstriction after SDRT conferred an ischemic stress response within parenchymal tumor cells, with ROS triggering the evolutionarily conserved SUMO stress response, specifically depleting chromatin-associated free SUMO3. Whereas SUMO3, but not SUMO2, was indispensable for homology-directed repair (HDR) of DSBs, HDR loss of function after SDRT yielded DSB unrepair, chromosomal aberrations, and tumor clonogen demise. Vasoconstriction blockade with the endothelin-1 inhibitor BQ-123, or ROS scavenging after SDRT using peroxiredoxin-6 overexpression or the SOD mimetic tempol, prevented chromatin SUMO3 depletion, HDR loss of function, and SDRT tumor ablation. We also provide evidence of mouse-to-human translation of this biology in a randomized clinical trial, showing that 24 Gy SDRT, but not 3×9 Gy fractionation, coupled early tumor ischemia/reperfusion to human cancer ablation. The SDRT biology provides opportunities for mechanism-based selective tumor radiosensitization via accessing of SDRT/ASMase signaling, as current studies indicate that this pathway is tractable to pharmacologic intervention.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Katia Manova-Todorova
- Laboratory of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Boris Epel
- Department of Radiation and Cellular Oncology, Center for EPR Imaging In Vivo Physiology, The University of Chicago, Chicago, Illinois, USA
| | | | | | | | | | | | - Howard J Halpern
- Department of Radiation and Cellular Oncology, Center for EPR Imaging In Vivo Physiology, The University of Chicago, Chicago, Illinois, USA
| | | | - Carlos Cordon-Cardo
- Department of Pathology, Mount Sinai School of Medicine, New York, New York, USA
| | | | | | | | | | | | - Zvi Fuks
- Department of Radiation Oncology.,Champalimaud Centre, Lisbon, Portugal
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17
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Ihnát P, Skácelíková E, Tesař M, Penka I. Stereotactic body radiotherapy using the CyberKnife ® system in the treatment of patients with liver metastases: state of the art. Onco Targets Ther 2018; 11:4685-4691. [PMID: 30127616 PMCID: PMC6091471 DOI: 10.2147/ott.s165878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The management of patients with liver metastases presents a challenging problem in clinical oncology. Patients with limited involvement of the liver may be suitable for surgical resection or local ablative techniques. Stereotactic body radiotherapy (SBRT) presents an emerging new technology that has shown high efficacy in ablating tumors at various disease sites. Methods A comprehensive literature search was performed to identify articles in regard to the SBRT in the treatment of patients with liver metastases. Results SBRT allows for the delivery of high-dose radiation in few fractions to the tumor with extreme accuracy, while minimizing the damage to normal surrounding tissue. The CyberKnife® system is an image-guided robotic system that delivers SBRT, tracks tumors during respiration, and automatically adjusts treatment for any patient movement. The most frequently used indications for CyberKnife® therapy are ≤5 liver metastases with maximum tumor sizes of 6 cm, no extrahepatic disease, good performance status, and adequate hepatic functions. Local control rates range from 70%-100% at 1 year and from 60%-90% at 2 years. Severe toxicity related to SBRT is uncommon - grade three side effects occur in less than 5% of cases. Despite excellent local control rates, out-of-field metastatic progression (out-of-field hepatic metastases and extrahepatic metastases) develops in a substantial proportion of patients after SBRT. Therefore, it seems essential to improve the selection of patients with liver metastases for SBRT. Conclusion The CyberKnife® system presents an effective minimally invasive treatment modality for patients with hepatic oligometastases who are not suitable candidates for radical liver resection. The available data suggest that liver metastases can be treated by CyberKnife therapy with very low toxicity and excellent local control rates.
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Affiliation(s)
- Peter Ihnát
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic, .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic,
| | - Eva Skácelíková
- Department of Oncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Milan Tesař
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic, .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic,
| | - Igor Penka
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic, .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic,
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18
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Vilela RA, Navarro NF, Faria ET, Ferreira EB, Ruzza RZ, Gadia R, Guerra ENS, Reis PEDD. Use of stereotactic body radiation therapy for oligometastatic recurrent prostate cancer: A systematic review. J Med Imaging Radiat Oncol 2018; 62:692-706. [DOI: 10.1111/1754-9485.12747] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/14/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Ricardo Alencar Vilela
- Grupo CONFIAR; Goiânia Brazil
- Departamento de Rádio-oncologia; Instituto Nacional de Câncer; Rio de Janeiro Brazil
- Departamento de Rádio-oncologia; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | | | | | | | - Rachel Zomer Ruzza
- Departamento de Rádio-oncologia; Instituto Nacional de Câncer; Rio de Janeiro Brazil
| | - Rafael Gadia
- Departamento de Rádio-oncologia; Hospital Sírio Libanês; Brasilia Brazil
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19
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Erler D, Brotherston D, Sahgal A, Cheung P, Loblaw A, Chu W, Soliman H, Chung H, Kiss A, Chow E, Poon I. Local control and fracture risk following stereotactic body radiation therapy for non-spine bone metastases. Radiother Oncol 2018; 127:304-309. [PMID: 29706460 DOI: 10.1016/j.radonc.2018.03.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/13/2018] [Accepted: 03/29/2018] [Indexed: 02/06/2023]
Abstract
AIMS To report local control and toxicity rates for patients treated with stereotactic body radiotherapy (SBRT) for non-spine bone metastases. METHODS AND MATERIALS Eighty-one patients with 106 non-spine bone metastases were treated between 2011 and 2014 and retrospectively reviewed. Indications included: oligometastases (63%), oligoprogression (17.3%), retreatment (2.4%) or other (17.3%). Cumulative incidence function was used to assess local recurrence and fracture probability. Bivariate relationships were investigated based on selected patient, tumour and dose-volume factors. RESULTS Mean follow-up was 13 months (range, 0.25-45.6) and the median patient age was 66.4 years (range, 36-86). Most patients were male (60.5%) and the predominant histology prostate cancer (32%). Bone metastases were most commonly located in the pelvis (41.5%) and almost half sclerotic. The most common prescriptions were 30 Gy/5 (30.2%) and 35 Gy/5 (42.5%). The cumulative incidence of local recurrence at 6,18 and 24 months respectively was 4.7%, 8.3% and 13.3% with a mean time to local recurrence of 11.8 months (range, 3.9-23.4). A significant association was found between local recurrence and volume of the PTV (p = 0.02), with larger PTVs having a greater risk of local failure. Fracture was observed radiographically in the treatment volume in 9/106 (8.5%) of treated lesions and the mean time to fracture was 8.4 months (range, 0.7-32.5 months). With respect to predictors, a trend was observed for lytic lesions (p = 0.11) and female gender (p = 0.09). CONCLUSIONS The results of this study confirm that SBRT yields high rates of long-term local control for non-spine bone metastases with a low fracture risk.
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Affiliation(s)
- Darby Erler
- Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Canada
| | | | - Arjun Sahgal
- Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Canada
| | - Patrick Cheung
- Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Canada
| | - Andrew Loblaw
- Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Canada
| | - William Chu
- Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Canada
| | - Hany Soliman
- Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Canada
| | - Hans Chung
- Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Canada
| | - Alex Kiss
- Institute of Health Policy, Management & Evaluation, University of Toronto, Canada; Department of Research Design and Biostatistics, Sunnybrook Research Institute, Canada
| | - Edward Chow
- Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Canada
| | - Ian Poon
- Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Canada.
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20
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Hanna GG, Murray L, Patel R, Jain S, Aitken KL, Franks KN, van As N, Tree A, Hatfield P, Harrow S, McDonald F, Ahmed M, Saran FH, Webster GJ, Khoo V, Landau D, Eaton DJ, Hawkins MA. UK Consensus on Normal Tissue Dose Constraints for Stereotactic Radiotherapy. Clin Oncol (R Coll Radiol) 2018; 30:5-14. [PMID: 29033164 DOI: 10.1016/j.clon.2017.09.007] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 09/07/2017] [Accepted: 09/18/2017] [Indexed: 01/19/2023]
Abstract
Six UK studies investigating stereotactic ablative radiotherapy (SABR) are currently open. Many of these involve the treatment of oligometastatic disease at different locations in the body. Members of all the trial management groups collaborated to generate a consensus document on appropriate organ at risk dose constraints. Values from existing but older reviews were updated using data from current studies. It is hoped that this unified approach will facilitate standardised implementation of SABR across the UK and will allow meaningful toxicity comparisons between SABR studies and internationally.
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Affiliation(s)
- G G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK.
| | - L Murray
- Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds, UK
| | - R Patel
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, UK
| | - S Jain
- Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK
| | - K L Aitken
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - K N Franks
- Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds, UK
| | - N van As
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - A Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - P Hatfield
- Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds, UK
| | - S Harrow
- Department of Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - F McDonald
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - M Ahmed
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - F H Saran
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - G J Webster
- Department of Radiotherapy, Worcester Oncology Centre, Worcester, UK
| | - V Khoo
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - D Landau
- Department of Oncology, Guy's and St Thomas' Hospital, London, UK
| | - D J Eaton
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, UK
| | - M A Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
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21
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Single Fraction Stereotactic Ablative Body Radiotherapy for Oligometastasis: Outcomes from 132 Consecutive Patients. Clin Oncol (R Coll Radiol) 2017; 30:178-184. [PMID: 29224900 DOI: 10.1016/j.clon.2017.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/20/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
Abstract
AIMS Stereotactic ablative body radiotherapy (SABR) is currently used to treat oligometastases, but the optimum dose/fractionation schedule is unknown. In this study, we evaluated outcomes after single fraction SABR in patients with oligometastatic disease. MATERIALS AND METHODS Single institutional retrospective review of patients treated with single fraction SABR for one to three oligometastases between 2010 and 2015. The primary outcome was freedom from widespread disease defined as distant recurrence not amenable to surgery or SABR; or recurrence with four or more metastases. RESULTS In total, 186 treatments were delivered in 132 patients. The two most common target sites were lung (51%) and bone (40%). The most frequent single fraction prescription dose was 26 Gy (47%). The most common primary malignancy was genitourinary (n = 46 patients). Freedom from widespread disease was 75% at 1 year (95% confidence interval 67-83%) and 52% at 2 years (95% confidence interval 42-63%). Freedom from local progression at 1 year was 90% (95% confidence interval 85-95%) and at 2 years was 84% (95% confidence interval 77-91%). A compression fracture of the lumbar vertebra was the only grade 3+ treatment-related toxicity. CONCLUSIONS Single fraction SABR is associated with a high rate of freedom from widespread disease, favourable local control and low toxicity comparable with historic multi-fraction SABR reports.
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22
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Lancia A, Ingrosso G, Carosi A, Di Murro L, Giudice E, Cicchetti S, Morelli P, di Cristino D, Bruni C, Murgia A, Cancelli A, Turturici I, Iadevaia A, Ponti E, Santoni R. Oligometastatic cancer: stereotactic ablative radiotherapy for patients affected by isolated body metastasis. Acta Oncol 2017; 56:1621-1625. [PMID: 28820285 DOI: 10.1080/0284186x.2017.1346383] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND To evaluate the outcome of patients affected by a single isolated body metastasis treated with stereotactic body radiotherapy (SBRT). MATERIAL AND METHODS Seven-eight patients were treated with SBRT for isolated body metastasis. The most frequent primary tumor was prostate cancer (28.2%), followed by colorectal cancer (23.1%) and lung cancer (20.5%). Median age at diagnosis of oligometastatic disease was 70 years (range 47-88). Median Karnofsky Performance Status (KPS) was 90 (range 70-100). The most common SBRT fractionation scheme was 5 × 7 Gy (total dose 35 Gy). Response to radiotherapy was determined according to RECIST criteria v1.1. Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. The survival analysis was performed with the Kaplan-Meier method. The correlation between time actuarial incidence and clinical parameters was studied, and the Kaplan-Meier method of log-rank test was applied. RESULTS With a median follow-up of 22.68 months, local control was achieved in 89.7% of the cases. The two-year overall survival (OS) and progression-free survival (PFS) were 68% and 42%, respectively. On univariate analysis, KPS ≥80 is predictive for improved OS (p = .001) and PFS (p = .001). Acute toxicity of grade ≥2 occurred in eight (10.2%) patients and late grade ≥2 toxicity in five (6.4%) patients. CONCLUSIONS Ablative radiotherapy in 'early oligometastatic state' is a safe, effective and minimally invasive treatment modality. A good performance status (KPS ≥80) seems to influence the clinical outcome.
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Affiliation(s)
- Andrea Lancia
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Gianluca Ingrosso
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Alessandra Carosi
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Luana Di Murro
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Emilia Giudice
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Sara Cicchetti
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Pasquale Morelli
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Daniela di Cristino
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Claudia Bruni
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Alessandra Murgia
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Alessandro Cancelli
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Irene Turturici
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Anjali Iadevaia
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Elisabetta Ponti
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
| | - Riccardo Santoni
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy
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Tree AC, Harding V, Bhangu A, Krishnasamy V, Morton D, Stebbing J, Wood BJ, Sharma RA. The need for multidisciplinarity in specialist training to optimize future patient care. Nat Rev Clin Oncol 2017; 14:508-517. [PMID: 27898067 PMCID: PMC7641875 DOI: 10.1038/nrclinonc.2016.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Harmonious interactions between radiation, medical, interventional and surgical oncologists, as well as other members of multidisciplinary teams, are essential for the optimization of patient care in oncology. This multidisciplinary approach is particularly important in the current landscape, in which standard-of-care approaches to cancer treatment are evolving towards highly targeted treatments, precise image guidance and personalized cancer therapy. Herein, we highlight the importance of multidisciplinarity and interdisciplinarity at all levels of clinical oncology training. Potential deficits in the current career development pathways and suggested strategies to broaden clinical training and research are presented, with specific emphasis on the merits of trainee involvement in functional multidisciplinary teams. Finally, the importance of training in multidisciplinary research is discussed, with the expectation that this awareness will yield the most fertile ground for future discoveries. Our key message is for cancer professionals to fulfil their duty in ensuring that trainees appreciate the importance of multidisciplinary research and practice.
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Affiliation(s)
- Alison C Tree
- Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Victoria Harding
- Division of Cancer, ICTEM Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Aneel Bhangu
- Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK
| | - Venkatesh Krishnasamy
- Center for Interventional Oncology, National Cancer Institute and NIH Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20814, USA
| | - Dion Morton
- Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK
| | - Justin Stebbing
- Imperial College/Imperial Healthcare NHS Trust, Charing Cross Hospital, 1st Floor, E Wing, Fulham Palace Road, London, W6 8RF, UK; and at the Division of Cancer, ICTEM Hammersmith Campus, Du Cane Road London W12 0NN, UK
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute and NIH Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20814, USA
| | - Ricky A Sharma
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London WC1E 6DD, UK
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Redmond KJ, Lo SS, Dagan R, Poon I, Foote MC, Erler D, Lee Y, Lohr F, Biswas T, Ricardi U, Sahgal A. A multinational report of technical factors on stereotactic body radiotherapy for oligometastases. Future Oncol 2017; 13:1081-1089. [PMID: 28152619 DOI: 10.2217/fon-2016-0479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIM Oligometastatic cancer is being increasingly managed with aggressive local therapy using stereotactic body radiation therapy (SBRT). However, few guidelines exist. We summarize the results of an international survey reviewing technical factors for extracranial SBRT for oligometastatic disease to guide safe management. MATERIALS & METHODS Seven high-volume centers contributed. Levels of agreement were categorized as strong (6-7 common responses), moderate (4-5), low (2-3) or no agreement. RESULTS & CONCLUSION We present the results of a multi-national and multi-institutional survey of technical factors of SBRT for extracranial oligometastases. Key methods including target delineation, prescription doses, normal tissue constraints, imaging and set-up for safe implementation and practice of SBRT for oligometastasis have been identified. This manuscript will serve as a foundation for future clinical evaluations.
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Affiliation(s)
| | - Simon S Lo
- University of Washington School of Medicine, Seattle, WA, USA
| | - Roi Dagan
- University of Florida, Jacksonville, FL, USA
| | - Ian Poon
- Odette Cancer Centre-Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | - Matthew C Foote
- University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Darby Erler
- Odette Cancer Centre-Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | - Young Lee
- Odette Cancer Centre-Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | - Frank Lohr
- Azienda Az. Ospedaliero-Universitaria di Modena, Dipartimento di Oncologia, Unita Operativa di Radioterapia, Modena, Italy
| | - Tithi Biswas
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | | | - Arjun Sahgal
- Odette Cancer Centre-Sunnybrook Health Sciences, Toronto, Ontario, Canada
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25
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Stereotactic body radiation therapy of liver tumors: post-treatment appearances and evaluation of treatment response: a pictorial review. Abdom Radiol (NY) 2016; 41:2061-77. [PMID: 27167232 DOI: 10.1007/s00261-016-0768-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stereotactic body radiation therapy (SBRT) is a noninvasive treatment technique for selected patients with primary liver tumors and liver-confined oligometastatic disease. Recently, SBRT has emerged as an alternative treatment option in non-surgical candidates and in whom percutaneous treatment methods are not possible or contraindicated. The experience with SBRT continues to grow. There are currently no imaging guidelines for assessment of tumor response and follow-up schedule following SBRT. SBRT produces characteristic radiation-induced changes in the treated tumor and surrounding liver parenchyma. Knowledge of these changes is essential in the interpretation of follow-up imaging and assessment of treatment response. In this review, we will describe the CT, MRI, and PET imaging findings following SBRT of both the targeted liver tumor and surrounding hepatic parenchyma.
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Ost P, Jereczek-Fossa B, Van As N, Zilli T, Tree A, Henderson D, Orecchia R, Casamassima F, Surgo A, Miralbell R, De Meerleer G. Pattern of Progression after Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Nodal Recurrences. Clin Oncol (R Coll Radiol) 2016; 28:e115-20. [DOI: 10.1016/j.clon.2016.04.040] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 10/21/2022]
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Hargreaves S, Comins C. Stereotactic Ablative Radiotherapy for Oligometastatic Disease: a Treatment in Search of Evidence – a Response. Clin Oncol (R Coll Radiol) 2016; 28:503-4. [DOI: 10.1016/j.clon.2016.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
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28
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Dagan R, Lo SS, Redmond KJ, Poon I, Foote MC, Lohr F, Ricardi U, Sahgal A. A multi-national report on stereotactic body radiotherapy for oligometastases: Patient selection and follow-up. Acta Oncol 2016; 55:633-7. [PMID: 27046290 DOI: 10.3109/0284186x.2015.1118659] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aims Stereotactic body radiotherapy (SBRT) for oligometastases is increasingly used with few evidenced-based guidelines. We conducted a survey to determine patient selection and follow-up practice patterns. Materials and methods Seven institutions from US, Canada, Europe, and Australia that recommend SBRT for oligometastases participated in a 72-item survey. Levels of agreement were categorized as strong (6-7 common responses), moderate (4-5), low (2-3), or no agreement. Results There was strong agreement for recommending SBRT for eradication of all detectable oligometastases with most members limiting the number of metastases to five (range 2-5) and three within a single organ (range 2-5). There was moderate agreement for recommending SBRT as consolidative therapy after systemic therapy. There was strong agreement for requiring adequate performance status and no concurrent chemotherapy. Additional areas of strong agreement included staging evaluations, primary diagnosis, target sites, and follow-up recommendations. Several differences emerged, including the use of SBRT for sarcoma oligometastases, treatment response evaluation, and which imaging should be performed during follow-up. Conclusion Significant commonalities and variations exist for patient selection and follow-up recommendations for SBRT for oligometastases. Information from this survey may serve to help clarify the current landscape.
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Affiliation(s)
- Roi Dagan
- University of Florida, Jacksonville, Florida, USA
| | - Simon s. Lo
- University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | | | - Ian Poon
- Odette Cancer Centre-Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | - Matthew C. Foote
- University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Frank Lohr
- University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Arjun Sahgal
- Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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Guerrero E, Ahmed M. The role of stereotactic ablative radiotherapy (SBRT) in the management of oligometastatic non small cell lung cancer. Lung Cancer 2015; 92:22-8. [PMID: 26775592 DOI: 10.1016/j.lungcan.2015.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 11/22/2015] [Indexed: 12/29/2022]
Abstract
Our understanding of metastatic disease has evolved significantly in the last 20 years. Considered strictly a systemic issue, local treatment would only have significant impact in terms of palliation. However, Hellman and Weichselbaum stated that there might be an intermediate state, in which controlling limited metastatic sites could improve oncologic outcomes. This is called an oligometastatic state, a point between locally confined cancer and widespread disease [1,2]. As treatment with chemotherapy alone for non small cell lung cancer (NSCLC) yields median survivals of 8-11 months [3] and minimal chances of long term survival, new strategies are needed to offer better odds for metastatic patients. Outcomes tend to be better in patients with low volume metastatic disease. [4,5], leading us to question whether the oligometastatic group of patients will gain from a more radical treatment paradigm. In this setting, ablative treatments like surgery or SBRT may provide longer survival and better local control times. There is a rationale for the use of ablative local treatments, as most failures after chemotherapy occur at sites initially affected by disease, and these sites could be a source of further dissemination. Also, chemotherapy resistance can adversely impact resolution of metastatic disease [6]. In rare cases, the abscopal effect (an immune effect arising after radiotherapy in non irradiated metastatic sites) has been described [7,8]. In this review article, we address the impact of SBRT in oligometastatic NSCLC, the most relevant prognostic factors, indications and a site specific review. This review will focus on SBRT for extracranial disease as the role for intracranial SBRT is established.
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Affiliation(s)
- Eduardo Guerrero
- Radiation Oncology Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Merina Ahmed
- Academic Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK.
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Ost P, Jereczek-Fossa BA, As NV, Zilli T, Muacevic A, Olivier K, Henderson D, Casamassima F, Orecchia R, Surgo A, Brown L, Tree A, Miralbell R, De Meerleer G. Progression-free Survival Following Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Treatment-naive Recurrence: A Multi-institutional Analysis. Eur Urol 2015; 69:9-12. [PMID: 26189689 DOI: 10.1016/j.eururo.2015.07.004] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 07/02/2015] [Indexed: 01/07/2023]
Abstract
UNLABELLED The literature on metastasis-directed therapy for oligometastatic prostate cancer (PCa) recurrence consists of small heterogeneous studies. This study aimed to reduce the heterogeneity by pooling individual patient data from different institutions treating oligometastatic PCa recurrence with stereotactic body radiotherapy (SBRT). We focussed on patients who were treatment naive, with the aim of determining if SBRT could delay disease progression. We included patients with three or fewer metastases. The Kaplan-Meier method was used to estimate distant progression-free survival (DPFS) and local progression-free survival (LPFS). Toxicity was scored using the Common Terminology Criteria for Adverse Events. In total, 163 metastases were treated in 119 patients. The median DPFS was 21 mo (95% confidence interval, 15-26 mo). A lower radiotherapy dose predicted a higher local recurrence rate with a 3-yr LPFS of 79% for patients treated with a biologically effective dose ≤100Gy versus 99% for patients treated with >100Gy (p=0.01). Seventeen patients (14%) developed toxicity classified as grade 1, and three patients (3%) developed grade 2 toxicity. No grade ≥3 toxicity occurred. These results should serve as a benchmark for future prospective trials. PATIENT SUMMARY This multi-institutional study pools all of the available data on the use of stereotactic body radiotherapy for limited prostate cancer metastases. We concluded that this approach is safe and associated with a prolonged treatment progression-free survival.
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Affiliation(s)
- Piet Ost
- Department of Radiotherapy, Ghent University Hospital, Belgium.
| | | | - Nicholas Van As
- Department of Radiotherapy Royal Marsden NHS Foundation Trust, London, UK
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Kenneth Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Daniel Henderson
- Department of Radiotherapy Royal Marsden NHS Foundation Trust, London, UK
| | | | - Roberto Orecchia
- University of Milan and European Institute of Oncology, Milan Italy
| | - Alessia Surgo
- University of Milan and European Institute of Oncology, Milan Italy
| | - Lindsay Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Alison Tree
- Department of Radiotherapy Royal Marsden NHS Foundation Trust, London, UK
| | - Raymond Miralbell
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
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