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Lee JH, Shi DD, Shin KY, Buckley E, Gunasti L, Hall E, Mann E, Spicer B, Chen YH, Hammoudeh L, Brennan V, Huynh MA, Spektor A, Krishnan MS, Balboni TA, Hertan LM. A Prospective Study Assessing the Efficacy and Toxicity of Stereotactic Body Radiation Therapy for Oligometastatic Bone Metastases. Adv Radiat Oncol 2024; 9:101411. [PMID: 38406391 PMCID: PMC10884444 DOI: 10.1016/j.adro.2023.101411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/17/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) is a promising treatment for oligometastatic disease in bone because of its delivery of high dose to target tissue and minimal dose to surrounding tissue. The purpose of this study is to assess the efficacy and toxicity of this treatment in patients with previously unirradiated oligometastatic bony disease. Methods and Materials In this prospective phase II trial, patients with oligometastatic bone disease, defined as ≤3 active sites of disease, were treated with SBRT at Brigham and Women's Hospital/Dana Farber Cancer Center and Beth Israel Deaconess Medical Center between December 2016 and May 2019. SBRT dose and fractionation regimen were not protocol mandated. Local progression-free survival, progression-free survival, prostatic specific antigen progression, and overall survival were reported. Treatment-related toxicity was also reported. Results A total of 98 patients and 126 lesions arising from various tumor histologies were included in this study. The median age of patients enrolled was 72.8 years (80.6% male, 19.4% female). Median follow-up was 26.7 months. The most common histology was prostate cancer (68.4%, 67/98). The most common dose prescriptions were 27/30 Gy in 3 fractions (27.0%, 34/126), 30 Gy in 5 fractions (16.7%, 21/126), or 30/35 Gy in 5 fractions (16.7%, 21/126). Multiple doses per treatment regimen reflect dose painting employing the lower dose to the clinical target volume and higher dose to the gross tumor volume. Four patients (4.1%, 4/98) experienced local progression at 1 site for each patient (3.2%, 4/126). Among the entire cohort, 2-year local progression-free survival (including death without local progression) was 84.8%, 2-year progression-free survival (including deaths as well as local, distant, and prostatic specific antigen progression) was 47.5%, and 2-year overall survival was 87.3%. Twenty-six patients (26.5%, 26/98) developed treatment-related toxicities. Conclusions Our study supports existing literature in showing that SBRT is effective and tolerable in patients with oligometastatic bone disease. Larger phase III trials are necessary and reasonable to determine long-term efficacy and toxicities.
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Affiliation(s)
- Joyce H. Lee
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Diana D. Shi
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Kee-Young Shin
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth Buckley
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Lauren Gunasti
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Emily Hall
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Eileen Mann
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beverly Spicer
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Yu-Hui Chen
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lubna Hammoudeh
- Knight Cancer Institute Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Victoria Brennan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mai Anh Huynh
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Alexander Spektor
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Monica S. Krishnan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Tracy A. Balboni
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Lauren M. Hertan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Chan K, Chan B, Linden K, Erler D, D'Alimonte L, Kong V, Kraus J, Harnett N. Framework Development: Standardizing Definition of Advanced Practice Radiation Therapy Activities for Clinical Workload Quantification. Tech Innov Patient Support Radiat Oncol 2024; 29:100238. [PMID: 38426124 PMCID: PMC10904180 DOI: 10.1016/j.tipsro.2024.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024] Open
Abstract
Purpose Advanced practice (AP) in radiation therapy (RT) is being implemented around the globe. In an effort to advance the understanding of the similarities and differences in APRT roles in Ontario, Canada, a community of practice (CoP) sought ways to provide quantitative data on the nature of APRT clinical activities and the frequency with which these activities were being executed. Methods In 2017, a consensus building project involving 20 APRTs and 14 radiation therapy (RT) department managers in Ontario was completed to establish a mechanism to quantify APRTs' clinical impact. In Round 1 & 2, expert feedback was gathered to generate an Advanced Practice (AP) Activity List. In Round 3: 20 APRTs completed an online survey to assess the importance and applicability of each AP Activity to their role using Likert scale (0-5). A final AP Activity List & Definitions was generated. Results & discussion Round 1: Forty-seven AP activities were identified. Round 2: 3/14 RT managers provided 145 feedback statements on Round 1 AP Activity List. The working group used RT managers' feedback to clarify AP activities and definitions, specifically merging 33 unique AP activities to create 11 inclusive AP activities and eliminating 8 activities identified from Round 1. The most inclusive AP activity created was #1 New Patient Consultation, this AP Activity is merged from 7 unique AP activities. Incorporating RT managers' feedback with the internal AP clinical workload lists from 2 Ontario cancer centres resulted in a revised AP Activity List with 20 AP inclusive activities. Round 3: 14/20 APRTs provided Likert scores on this revised list. The most applicable AP activities (mean score) were #16 Technical Consultation (4.0), #15 Contouring Target Volume (3.8) and #2 Planning Consultation (3.8); the least applicable was #18 MR Applicator Assessment (0.9). Conclusions This is the first systematic attempt to build consensus on AP clinical activities. Non-clinical APRT activities related to research, education, innovation, and program development were not in the scope of this project. The Final AP Activity List & Definitions serves as a framework that allows standardized and continuous monitoring of AP clinical activities and impact.
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Affiliation(s)
- Kitty Chan
- Princess Margaret Cancer Centre, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Biu Chan
- Princess Margaret Cancer Centre, Canada
| | | | - Darby Erler
- Department of Radiation Oncology, University of Toronto, Canada
- Odette Cancer Centre, Canada
| | - Laura D'Alimonte
- Department of Radiation Oncology, University of Toronto, Canada
- Windsor Regional Hospital, Canada
| | - Vickie Kong
- Princess Margaret Cancer Centre, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | | | - Nicole Harnett
- Princess Margaret Cancer Centre, Canada
- Department of Radiation Oncology, University of Toronto, Canada
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Shi Z, Zhu S, Jin Y, Qi L, Zhou M, Zhou Z, Zhang J, Liu B, Shen J. Lymphocyte-to-C Reactive Protein Ratio is an Independent Predictor of Survival Benefits for Hepatocellular Carcinoma Patients Receiving Radiotherapy. J Hepatocell Carcinoma 2024; 11:305-316. [PMID: 38348098 PMCID: PMC10860807 DOI: 10.2147/jhc.s452424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) has emerged as an alternative approach for patients with hepatocellular carcinoma (HCC), and we aim to find potential prognostic biomarkers for HCC patients who received SBRT. Methods In this study, we retrospectively analyzed HCC patients who underwent SBRT in our institution from January 2018 to December 2022. The inflammatory parameters, along with baseline patients' characteristics were collected to elucidate the potential relationship with survival benefits and liver toxicities. Results Overall, 35 patients were enrolled in our study. For the efficacy population (25 patients who underwent SBRT for primary liver lesions), the objective response rate (ORR) and disease control rate (DCR) were 60% and 100%, respectively. The median progression-free survival (PFS) was 9.9 months [95% confidence interval (CI) 5.6-14.1 months], and the median overall survival (OS) was 18.5 months (95% CI 14.2-22.8 months). We further confirmed that higher baseline lymphocyte-C-reactive protein ratio (LCR) (≥2361.11) was positively related to both longer PFS (12.0 vs 4.3 months, P = 0.002) and OS (21.9 vs 11.4 months, P = 0.022). Moreover, patients with diabetes and higher alpha-fetoprotein (AFP) (≥400 ng/mL) were also found to be associated with worse OS. The most common hepatotoxicity was elevated gamma-glutamyl transferase (GGT) (84.0%). Conclusion In conclusion, for patients with inoperable HCC, SBRT resulted in satisfactory local control, survival benefits, and acceptable liver toxicity. Pre-radiotherapy LCR might be an independent and readily available predictor for survival, which facilitates us to find the most appropriate treatment options.
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Affiliation(s)
- Zhan Shi
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Sihui Zhu
- The Comprehensive Cancer Centre of Nanjing International Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Yuncheng Jin
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Liang Qi
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Mingzhen Zhou
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Ziyan Zhou
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Juan Zhang
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Baorui Liu
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Jie Shen
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
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Naessens C, Chamois J, Supiot S, Faivre JC, Arnaud A, Thureau S. Stereotactic body radiation therapy for bone oligometastases. Cancer Radiother 2024; 28:111-118. [PMID: 37838605 DOI: 10.1016/j.canrad.2023.04.006] [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: 04/15/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 10/16/2023]
Abstract
Stereotactic body radiation therapy is effective for the local management of oligometastases (at most five metastases) with a benefit in survival and local control. Most studies on the management of oligometastases focus on all oligometastatic sites in primary cancer and very few focus on a single oligometastatic site. In particular, there are few data on bone oligometastases, which represent one of the preferred sites for secondary cancer locations. This article focuses on the benefit of stereotactic radiotherapy for bone oligometastases of all cancers by histological types, and reviews the results of major studies in this field.
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Affiliation(s)
- C Naessens
- Département de radiothérapie, hôpital Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - J Chamois
- Institut de cancérologie radiothérapie Brétillien, boulevard de la Routière, 35760 Saint-Grégoire, France
| | - S Supiot
- Département de radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Centre de recherche en cancéro-immunologie Nantes/Angers (CRCINA, UMR 892 Inserm), institut de recherche en santé de l'université de Nantes, Nantes, France
| | - J-C Faivre
- Département de radiothérapie, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - A Arnaud
- Département de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France; Laboratoire QuantIF, EA4108-Litis, FR CNRS 3638, 1, rue d'Amiens, 76000 Rouen, France.
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Singh R, Valluri A, Lehrer EJ, Cao Y, Upadhyay R, Trifiletti DM, Lo SS, Redmond KJ, Sahgal A, Nguyen QN, Palmer JD. Clinical Outcomes After Stereotactic Body Radiation Therapy for Nonspinal Bone Metastases: A Systematic Review and Meta-analysis. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00024-5. [PMID: 38220068 DOI: 10.1016/j.ijrobp.2023.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 12/17/2023] [Accepted: 12/31/2023] [Indexed: 01/16/2024]
Abstract
There are limited data available on clinical outcomes after stereotactic body radiation therapy (SBRT) for nonspinal bone metastases. We performed a systematic review and meta-analysis to characterize local control (LC), overall survival (OS), pain response rates, and toxicity after SBRT. The primary outcomes were 1-year LC, incidence of acute and late grade 3 to 5 toxicities, and overall pain response rate at 3 months. The secondary outcome was 1-year OS. The Newcastle-Ottawa scale was used for assessment of study bias, with a median score of 5 for included studies (range, 4-8). Weighted random-effects meta-analyses were conducted to estimate effect sizes. We identified 528 patients with 597 nonspinal bone lesions in 9 studies (1 prospective study and 8 retrospective observational studies) treated with SBRT. The estimated 1-year LC rate was 94.6% (95% CI, 87.0%-99.0%). The estimated 3-month combined partial and complete pain response rate after SBRT was 87.7% (95% CI, 55.1%-100.0%). The estimated combined acute and late grade 3 to 5 toxicity rate was 0.5% (95% CI, 0%-5.0%), with an estimated pathologic fracture rate of 3.1% (95% CI, 0.2%-9.1%). The estimated 1-year OS rate was 71.0% (95% CI, 51.7%-87.0%). SBRT results in excellent LC and palliation of symptoms with minimal related toxicity. Prospective investigations are warranted to further characterize long-term outcomes of SBRT for patients with nonspinal bone metastases.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology and Neurosurgery, James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anisha Valluri
- Department of Radiation Oncology, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yilin Cao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rituraj Upadhyay
- Department of Radiation Oncology and Neurosurgery, James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joshua D Palmer
- Department of Radiation Oncology and Neurosurgery, James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia.
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Lee J, Kim JA, An TJ, Lee H, Han EJ, Sa YJ, Kim HR, Park CK, Kim TJ, Lim JU. Optimal timing for local ablative treatment of bone oligometastases in non-small cell lung cancer. J Bone Oncol 2023; 42:100496. [PMID: 37589036 PMCID: PMC10425942 DOI: 10.1016/j.jbo.2023.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023] Open
Abstract
Oligometastases is a term commonly used to describe a disease state characterized by a limited number of distant metastases, and represents a transient phase between localized and widespread systemic diseases. This subgroup of stage IV cancer has increased in clinical importance due to the possibility of curative rather than palliative treatment. Among advanced lung cancer patients, 30-40% show bone metastases, and can show complications such as pathological fractures. Many prospective studies have shown efficacy of localized treatment in oligometastatic non-small cell lung cancer (NSCLC) in improving progression-free survival and overall survival. Compared to metastases in other organs, bone metastases are unique in terms of tumor microenvironment and clinical outcomes. Radiotherapy is the most frequently used treatment modality for local ablative treatment for both primary and metastatic lesions. Stereotactic body radiation therapy demonstrated more rapid and effective pain control compared to conventional 3D conformal radiotherapy. Radiotherapy improved outcomes in terms of time-to-skeletal related events skeletal-related events (SRE), hospitalization for SRE, pain relief, and overall survival in patients with bone metastases. Decision on timing of local ablative treatment depends on patient's overall clinical status, treatment goals, potential side effects of each approach, and expected initial responses to systemic anti-cancer treatment.
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Affiliation(s)
- Jayoung Lee
- Department of Radiation Oncology, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul 150-713, Republic of Korea
| | - Jung A. Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Republic of Korea
- Outpatient Department of Respiratory Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Republic of Korea
| | - Tai Joon An
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Republic of Korea
| | - Hyochun Lee
- Department of Radiation Oncology, The Catholic University of Korea, St. Vincent's Hospital, Republic of Korea
| | - Eun Ji Han
- Division of Nuclear Medicine, Department of Radiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Republic of Korea
| | - Young Jo Sa
- Department of Thoracic and Cardiovascular Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Republic of Korea
| | - Hyo Rim Kim
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 150-713, Republic of Korea
| | - Chan Kwon Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Republic of Korea
| | - Tae-Jung Kim
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul 150-713, Republic of Korea
| | - Jeong Uk Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Republic of Korea
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Nguyen EK, Korol R, Ali S, Cumal A, Erler D, Louie AV, Nguyen TK, Poon I, Cheung P, Chu W, Soliman H, Vesprini D, Sahgal A, Chen H. Predictors of pathologic fracture and local recurrence following stereotactic body radiation therapy to 505 non-spine bone metastases. Radiother Oncol 2023; 186:109792. [PMID: 37414253 DOI: 10.1016/j.radonc.2023.109792] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Stereotactic Body Radiation Therapy (SBRT) is increasingly applied to treat non-spine bone metastases (NSBM) though data remains limited on this approach. In this retrospective study, we report outcomes and predictors of local failure (LF) and pathological fracture (PF) post-SBRT for NSBM using a mature single-institution database. METHODS Patients with NSBM treated with SBRT between 2011 and 2021 were identified. The primary objective was to assess the rates of radiographic LF. Secondary objectives were to assess the rates of in-field PF, overall survival (OS), and late grade ≥ 3 toxicity. Competing risks analysis was used to assess rates of LF and PF. Univariable regression and multivariable regression (MVR) were performed to investigate predictors of LF and PF. RESULTS A total of 373 patients with 505 NSBM were included in this study. Median follow-up was 26.5 months. The cumulative incidence of LF at 6, 12, and 24 months were 5.7%, 7.9%, and 12.6%, respectively. The cumulative incidence of PF at 6, 12, and 24 months were 3.8%, 6.1%, and 10.9%, respectively. Lytic NSBM (HR = 2.18; p < 0.01), a lower biologically effective dose (HR = 1.11 per 5 Gy10 decrease; p = 0.04), and a PTV ≥ 54 cc (HR = 4.32; p < 0.01) predicted for a higher risk of LF on MVR. Lytic NSBM (HR = 3.43; p < 0.01), mixed (lytic/sclerotic) lesions (HR = 2.70; p = 0.04), and rib metastases (HR = 2.68; p < 0.01) predicted for a higher risk of PF on MVR. CONCLUSION SBRT is an effective modality to treat NSBM with high rates of radiographic local control with an acceptable rate of PF. We identify predictors of both LF and PF that can serve to inform practice and trial design.
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Affiliation(s)
- Eric K Nguyen
- Department of Radiation Oncology, Walker Family Cancer Center, Niagara Health, St. Catharines, Ontario L2S 0A9, Canada
| | - Renee Korol
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Saher Ali
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Aaron Cumal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Darby Erler
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Timothy K Nguyen
- Department of Radiation Oncology, London Health Sciences Center, Western University, London, Ontario N6A 5W9, Canada
| | - Ian Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - William Chu
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Danny Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada.
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Pastorello E, Nicosia L, Cuccia F, Olivari L, Fiorini M, Giaj Levra N, Mazzola R, Ricchetti F, Rigo M, Ravelli P, D'Alessandro S, Salgarello M, Ruggieri R, Alongi F. PSMA-PET/CT-Based Stereotactic Body Radiotherapy (SBRT) in the Treatment of Uncomplicated Non-Spinal Bone Oligometastases from Prostate Cancer. Cancers (Basel) 2023; 15:2800. [PMID: 37345138 DOI: 10.3390/cancers15102800] [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: 03/24/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND AND PURPOSE Stereotactic body radiotherapy (SBRT) has a consolidated role in the treatment of bone oligometastases from prostate cancer (PCa). While the evidence for spinal oligometastases SBRT was robust, its role in non-spinal-bone metastases (NSBM) is not standardized. In fact, there was no clear consensus about dose and target definition in this setting. The aim of our study was to evaluate efficacy, toxicity, and the pattern of relapse in SBRT delivered to NSBM from PCa. MATERIALS AND METHODS From 2016 to 2021, we treated a series of oligo-NSBM from PCa with 68Ga-PSMA PET/CT-guided SBRT. The primary endpoint was local progression-free survival (LPFS). The secondary endpoints were toxicity, the pattern of intraosseous relapse, distant progression-free survival (DPFS), polimetastases-free survival (PMFS), and overall survival (OS). RESULTS a total of 150 NSBM in 95 patients were treated with 30-35 Gy in five fractions. With a median follow-up of 26 months, 1- and 3 years LPFS was 96.3% and 89%, respectively. A biologically effective dose (BED) ≥ 198 Gy was correlated with improved LPFS (p = 0.007). Intraosseous relapse occurred in eight (5.3%) cases. Oligorecurrent disease was associated with a better PMFS compared to de novo oligometastatic disease (p = 0.001) and oligoprogressive patients (p = 0.007). No grade ≥ 3 toxicity occurred. CONCLUSION SBRT is a safe and effective tool for NSBM from PCa in the oligometastatic setting. Intraosseous relapse was a relatively rare event. Predictive factors of the improved outcomes were defined.
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Affiliation(s)
- Edoardo Pastorello
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
| | - Francesco Cuccia
- Francesco Cuccia, Radiotherapy Unit, ARNAS Civico Hospital, 90127 Palermo, Italy
| | - Laura Olivari
- Nuclear Medicine Unit, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy
| | - Matilde Fiorini
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
| | - Niccolò Giaj Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
| | - Paolo Ravelli
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
| | - Salvatore D'Alessandro
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
| | - Matteo Salgarello
- Nuclear Medicine Unit, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Negrar, Italy
- Radiation Oncology School, University of Brescia, 25121 Brescia, Italy
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9
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Vilotte F, Pasquier D, Blanchard P, Supiot S, Khalifa J, Schick U, Lacornerie T, Vieillevigne L, Marre D, Chapet O, Latorzeff I, Magne N, Meyer E, Cao K, Belkacemi Y, Bibault J, Berge-Lefranc M, Faivre J, Gnep K, Guimas V, Hasbini A, Langrand-Escure J, Hennequin C, Graff P. Recommendations for stereotactic body radiation therapy for spine and non-spine bone metastases. A GETUG (French society of urological radiation oncolgists) consensus using a national two-round modified Delphi survey. Clin Transl Radiat Oncol 2022; 37:33-40. [PMID: 36052019 PMCID: PMC9424259 DOI: 10.1016/j.ctro.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background and purpose The relevance of metastasis-directed stereotactic body radiation therapy (SBRT) remains to be demonstrated through phase III trials. Multiple SBRT procedures have been published potentially resulting in a disparity of practices. Therefore, the french society of urological radiation oncolgists (GETUG) recognized the need for joint expert consensus guidelines for metastasis-directed SBRT in order to standardize practice in trials carried out by the group. Materials and methods After a comprehensive literature review, 97 recommendation statements were created regarding planning and delivery of spine bone (SBM) and non-spine bone metastases (NSBM) SBRT. These statements were then submitted to a national online two-round modified Delphi survey among main GETUG investigators. Consensus was achieved if a statement received ≥ 75 % agreements, a trend to consensus being defined as 65-74 % agreements. Any statement without consensus at round one was re-submitted in round two. Results Twenty-one out of 29 (72.4%) surveyed experts responded to both rounds. Seventy-five statements achieved consensus at round one leaving 22 statements needing a revote of which 16 achieved consensus and 5 a trend to consensus. The final rate of consensus was 91/97 (93.8%). Statements with no consensus concerned patient selection (3/19), dose and fractionation (1/11), prescription and dose objectives (1/9) and organs at risk delineation (1/15). The voting resulted in the writing of step-by-step consensus guidelines. Conclusion Consensus guidelines for SBM and NSBM SBRT were agreed upon using a validated modified Delphi approach. These guidelines will be used as per-protocole recommendations in ongoing and further GETUG clinical trials.
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Affiliation(s)
- F. Vilotte
- Department of Radiation Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33076 Bordeaux, France
| | - D. Pasquier
- Department of Radiation Oncology, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - P. Blanchard
- Department of Radiation Oncology, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - S. Supiot
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Boulevard Professeur Jacques Monod, 44800 Saint Herblain, France
| | - J. Khalifa
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopole, 1 AV Irène Joliot Curie, 31059 Toulouse, France
| | - U. Schick
- Department of Radiation Oncology, CHU de Brest, Hôpital Morvan, avenue Foch, 29200 Brest, France
| | - T. Lacornerie
- Division of Radiation Medical Physics, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - L. Vieillevigne
- Division of Radiation Medical Physics, Institut Universitaire du Cancer de Toulouse-Oncopole, 1 AV Irène Joliot Curie, 31059 Toulouse, France
| | - D. Marre
- Division of Radiation Medical Physics, Groupe ONCORAD Garonne, Clinique Pasteur, Bât Atrium, 1 rue de la petite vitesse, 31300 Toulouse, France
| | - O. Chapet
- Department of Radiation Oncology, CH Lyon Sud 165 Chemin Du Grand Revoyet, 69310 Pierre-bénite, France
| | - I. Latorzeff
- Department of Radiation Oncology, Groupe ONCORAD Garonne, Clinique Pasteur, Bât Atrium, 1 rue de la petite vitesse, 31300 Toulouse, France
| | - N. Magne
- Department of Radiation Oncology, Institut de cancérologie Lucien Neuwirth, 108 bis AV Albert Raimond, 42270 Saint Priest en Jarez, France
| | - E. Meyer
- Department of Radiation Oncology, Centre François Baclesse, 3 Av. du Général Harris, 14000 Caen, France
| | - K. Cao
- Department of Radiation Oncology, Institut Curie Paris, 26 rue d’Ulm, 75005 Paris, France
| | - Y. Belkacemi
- Department of Radiation Oncology, Hôpital Henri-Mondor, 1 rue Gustave Eiffel, 94000 Créteil, France
| | - J.E. Bibault
- Department of Radiation Oncology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - M. Berge-Lefranc
- Department of Radiation Oncology, Centre Saint Michel, rue du Docteur Schweitzer, 17000 La Rochelle, France
| | - J.C. Faivre
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, 6 Av. de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - K. Gnep
- Department of Radiation Oncology, Centre Eugène Marquis, AV de la Bataille Flandres Dunkerque, 35000 Rennes, France
| | - V. Guimas
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Boulevard Professeur Jacques Monod, 44800 Saint Herblain, France
| | - A. Hasbini
- Department of Radiation Oncology, Clinique Pasteur, 32 r Auguste Kervern, 29200 Brest, France
| | - J. Langrand-Escure
- Department of Radiation Oncology, Institut de cancérologie Lucien Neuwirth, 108 bis AV Albert Raimond, 42270 Saint Priest en Jarez, France
| | - C. Hennequin
- Department of Radiation Oncology, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - P. Graff
- Department of Radiation Oncology, Institut Curie Saint Cloud, 35 rue Dailly, 92210 Saint Cloud, France
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10
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Ito K, Saito T, Nakamura N, Imano N, Hoskin P. Stereotactic body radiotherapy versus conventional radiotherapy for painful bone metastases: a systematic review and meta-analysis of randomised controlled trials. Radiat Oncol 2022; 17:156. [PMID: 36100905 PMCID: PMC9472415 DOI: 10.1186/s13014-022-02128-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) is a promising approach in treating painful bone metastases. However, the superiority of SBRT over conventional external beam radiotherapy (cEBRT) remains controversial. Therefore, this systematic review and meta-analysis of randomised controlled trials was conducted to compare SBRT and cEBRT for the treatment of bone metastases. METHODS A search was conducted using PubMed on January 22, 2022, with the following inclusion criteria: (i) randomised controlled trials comparing SBRT with cEBRT for bone metastases and (ii) endpoint including pain response. Effect sizes across studies were pooled using random-effects models in a meta-analysis of risk ratios. RESULTS A total of 1246 articles were screened, with 7 articles comprising 964 patients (522 and 442 patients in the SBRT and cEBRT arms, respectively) meeting the inclusion criteria. The overall pain response (OR) rates of bone metastases at 3 months were 45% and 36% in the SBRT and cEBRT arms, respectively. The present analyses showed no significant difference between the two groups. In four studies included for the calculation of OR rates of spinal metastases at three months, the OR rates were 40% and 35% in the SBRT and cEBRT arms, respectively, with no significant difference between the two groups. The incidence of severe adverse effects and health-related quality of life outcomes were comparable between the two arms. CONCLUSIONS The superiority of SBRT over cEBRT for pain palliation in bone metastases was not confirmed in this meta-analysis. Although SBRT is a standard of care for bone metastases, patients receiving SBRT should be selected appropriately.
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Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Tetsuo Saito
- Department of Radiation Oncology, Arao Municipal Hospital, 2600, Arao, Arao-shi, Kumamoto, 864-0041, Japan.
| | - Naoki Nakamura
- Department of Radiation Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae Ward, Kawasaki, Kanagawa, 216-8511, Japan
| | - Nobuki Imano
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima, 734-8551, Japan
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN, UK.,Division of Cancer Sciences, University of Manchester, 604 E College Ave, North Manchester, 46962, UK
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11
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Madani I, Sahgal A, Erler D, Stish BJ, Olivier KR, Park SS, Eppinga WSC, Seravalli E, Redmond KJ, Cao Y, Siva S, Chang D, Nguyen TK, O'Neil M, Guckenberger M. STEREOTACTIC BODY RADIATION THERAPY FOR METASTASES IN LONG BONES. Int J Radiat Oncol Biol Phys 2022; 114:738-746. [PMID: 35850362 DOI: 10.1016/j.ijrobp.2022.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the cumulative incidence of fracture and local failure and associated risk factors after stereotactic body radiotherapy (SBRT) for long bone metastases. MATERIAL AND METHODS Data from 111 patients with 114 metastases in the femur, humerus and tibia treated with SBRT in 7 international centers between October 2011 and February 2021 were retrospectively reviewed and analyzed using a competing risk regression model. RESULTS The median follow-up was 21 months (range 6-91 months). All but one patient had a Karnofsky performance status ≥70. There were 84 femur (73.7%), 26 humerus (22.8%) and 4 tibia (3.5%) metastases from prostate (45 [39.5%]), breast (22 [19.3%]), lung (15 [13.2%]), kidney (13 [11.4%]) and other (19 [16.6%]) malignancies. Oligometastases accounted for 74.8% of metastases and 28.1% were osteolytic. The most common total doses were 30-50 Gy in 5 daily fractions (50.9%). Eight fractures (5 in the femur, 2 in the tibia and 1 in the humerus) were observed with a median time to fracture of 12 months (range 0.8-33 months). In 6/8 patients, fracture was not associated with local failure. The cumulative incidence of fracture was 3.5%, 6.1% and 9.8% at 1, 2 and 3 years, respectively. The cumulative incidence of local failure (9/110 metastases with imaging follow-up) was 5.7%, 7.2% and 13.5% at 1, 2 and 3 years, respectively. On multivariate analysis, extraosseous disease extension was significantly associated with fracture (P=0.001; subhazard ratio [SHR] 10.8; 95% CI 2.8-41.9) and local failure (P=0.02; SHR 7.9; 95% CI 1.4-44.7). CONCLUSION SBRT for metastases in long bones achieved high rates of durable local metastasis control without an increased risk of fracture. Similar to spine SBRT, patients with extraosseous disease extension are at higher risk of local failure and fracture.
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Affiliation(s)
- Indira Madani
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Arjun Sahgal
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Darby Erler
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | | | - W S C Eppinga
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Kristin J Redmond
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Yilin Cao
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David Chang
- Peter MacCallum Cancer Centre, Melbourne, Australia
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12
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Deodato F, Pezzulla D, Cilla S, Ferro M, Romano C, Bonome P, Buwenge M, Zamagni A, Strigari L, Valentini V, Morganti AG, Macchia G. Stereotactic radiosurgery for bone metastases in oligometastatic prostate cancer patients: DESTROY-2 clinical trial subanalysis. Clin Transl Oncol 2022; 24:1177-1183. [PMID: 34984604 DOI: 10.1007/s12094-021-02764-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Aim of this analysis was to report toxicity and clinical outcomes in oligorecurrent prostate cancer (PCa) patients treated with single fraction stereotactic radiosurgery (SRS) for bone metastases. METHODS We separately analyzed clinical data of PCa patients with bone oligometastases enrolled in a prospective phase I trial (DESTROY-2). DESTROY-2 was based on SRS delivered using volumetric modulated arc therapy in patients with primary or metastatic tumors in several extra-cranial body sites. Acute and late toxicity, biochemical tumor response, local control (LC), distant metastases-free (DPFS), progression-free (PFS), time to next-line systemic treatment-free (NEST-FS), and overall survival (OS) were calculated. RESULTS Data on 37 PCa patients, carrying out 50 bone metastases, candidates for curative-intent treatment and treated with SRS at our Institution were collected. SRS dose ranged between 12 and 24 Gy. One grade 1 acute skin toxicity in one patient treated on the hip (24 Gy) and one grade 1 late skin toxicity in a patient with a scapular lesion (24 Gy) were recorded. No cases of bone fracture were registered in the treated population. With a median follow-up of 25 months (range 3-72 months) 2-year actuarial LC, DPFS, PFS, and OS were 96.7%, 58.1%, 58.1%, and 95.8%, respectively. Median and 2-year NEST-FS were 30 months (range 1-69 months) and 51.2%, respectively. CONCLUSIONS Data analysis showed few toxicity events, high local control rate and prolonged NEST-FS after linear accelerator-based radiosurgery of bone oligometastases from PCa. The possibility of postponing systemic treatments in patients with oligometastatic PCa by means of SRS should be taken into account. Further prospective studies on larger series are needed to confirm the reported results.
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Affiliation(s)
- F Deodato
- Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy.,Radiology Institute, Università Cattolica del Sacro Cuore, 00135, Rome, Italy
| | - D Pezzulla
- Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy.
| | - S Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - M Ferro
- Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - C Romano
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - P Bonome
- Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy
| | - M Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - A Zamagni
- Radiotherapy Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Giuseppe Massarenti, Bologna, Italy
| | - L Strigari
- Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - V Valentini
- Radiology Institute, Università Cattolica del Sacro Cuore, 00135, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - A G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - G Macchia
- Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy
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13
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Local Control after Locally Ablative, Image-Guided Radiotherapy of Oligometastases Identified by Gallium-68-PSMA-Positron Emission Tomography in Castration-Sensitive Prostate Cancer Patients (OLI-P). Cancers (Basel) 2022; 14:cancers14092073. [PMID: 35565207 PMCID: PMC9100669 DOI: 10.3390/cancers14092073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary In this clinical trial, 63 patients with a total of 89 prostate cancer metastases identified on PSMA-PET were included, none of them undergoing androgen deprivation therapy. We showed that local ablative radiotherapy controls >90% of the metastases, but progression at other sites is common after two years. Local ablative radiotherapy may be an option to at least temporarily avoid systemic therapy in selected patients. Abstract Progression of prostate-specific antigen (PSA) values after curative treatment of prostate cancer patients is common. Prostate-specific membrane antigen (PSMA-) PET imaging can identify patients with metachronous oligometastatic disease even at low PSA levels. Metastases-directed local ablative radiotherapy (aRT) has been shown to be a safe treatment option. In this prospective clinical trial, we evaluated local control and the pattern of tumor progression. Between 2014 and 2018, 63 patients received aRT of 89 metastases (MET) (68 lymph node (LN-)MET and 21 bony (OSS-)MET) with one of two radiation treatment schedules: 50 Gy in 2 Gy fractions in 34 MET or 30 Gy in 10 Gy fractions in 55 MET. The mean gross tumor volume and planning target volume were 2.2 and 14.9 mL, respectively. The median follow-up time was 40.7 months. Local progression occurred in seven MET, resulting in a local control rate of 93.5% after three years. Neither treatment schedule, target volume, nor type of lesion was associated with local progression. Regional progression in the proximity to the LN-MET was observed in 19 of 47 patients with at least one LN-MET (actuarial 59.3% free of regional progression after 3 years). In 33 patients (52%), a distant progression was reported. The median time to first tumor-related clinical event was 16.6 months, and 22.2% of patients had no tumor-related clinical event after three years. A total of 14 patients (22%) had another aRT. In conclusion, local ablative radiotherapy in patients with PSMA-PET staged oligometastatic prostate cancer may achieve local control, but regional or distant progression is common. Further studies are warranted, e.g., to define the optimal target volume coverage in LN-MET and OSS-MET.
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14
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Kowalchuk RO, Johnson-Tesch BA, Marion JT, Mullikin TC, Harmsen WS, Rose PS, Siontis BL, Kim DK, Costello BA, Morris JM, Gao RW, Shiraishi S, Lucido JJ, Sio TT, Trifiletti DM, Olivier KR, Owen D, Stish BJ, Waddle MR, Laack NN, Park SS, Brown PD, Merrell KW. Development and Assessment of a Predictive Score for Vertebral Compression Fracture After Stereotactic Body Radiation Therapy for Spinal Metastases. JAMA Oncol 2022; 8:412-419. [PMID: 35084429 PMCID: PMC8796057 DOI: 10.1001/jamaoncol.2021.7008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Vertebral compression fracture (VCF) is a potential adverse effect following treatment with stereotactic body radiation therapy (SBRT) for spinal metastases. OBJECTIVE To develop and assess a risk stratification model for VCF after SBRT. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study conducted at a high-volume referral center included 331 patients who had undergone 464 spine SBRT treatments from December 2007 through October 2019. Data analysis was conducted from November 1, 2020, to August 17, 2021. Exclusions included proton therapy, prior surgical intervention, vertebroplasty, or missing data. EXPOSURES One and 3 fraction spine SBRT treatments were most commonly delivered. Single-fraction treatments generally involved prescribed doses of 16 to 24 Gy (median, 20 Gy; range, 16-30 Gy) to gross disease compared with multifraction treatment that delivered a median of 30 Gy (range, 21-50 Gy). MAIN OUTCOMES AND MEASURES The VCF and radiography components of the spinal instability neoplastic score were determined by a radiologist. Recursive partitioning analysis was conducted using separate training (70%), internal validation (15%), and test (15%) sets. The log-rank test was the criterion for node splitting. RESULTS Of the 331 participants, 88 were women (27%), and the mean (IQR) age was 63 (59-72) years. With a median follow-up of 21 months (IQR, 11-39 months), we identified 84 VCFs (18%), including 65 (77%) de novo and 19 (23%) progressive fractures. There was a median of 9 months (IQR, 3-21 months) to developing a VCF. From 15 candidate variables, 6 were identified using the backward selection method, feature importance testing, and a correlation heatmap. Four were selected via recursive partitioning analysis: epidural tumor extension, lumbar location, gross tumor volume of more than 10 cc, and a spinal instability neoplastic score of more than 6. One point was assigned to each variable, and the resulting multivariable Cox model had a concordance of 0.760. The hazard ratio per 1-point increase for VCF was 1.93 (95% CI, 1.62-2.30; P < .001). The cumulative incidence of VCF at 2 years (with death as a competing risk) was 6.7% (95% CI, 4.2%-10.7%) for low-risk (score, 0-1; 273 [58.3%]), 17.0% (95% CI, 10.8%-26.7%) for intermediate-risk (score, 2; 99 [21.3%]), and 35.4% (95% CI, 26.7%-46.9%) for high-risk cases (score, 3-4; 92 [19.8%]) (P < .001). Similar results were observed for freedom from VCF using stratification. CONCLUSIONS AND RELEVANCE The results of this cohort study identify a subgroup of patients with high risk for VCF following treatment with SBRT who may potentially benefit from undergoing prophylactic spinal stabilization or vertebroplasty.
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Affiliation(s)
| | | | | | - Trey C. Mullikin
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - William S. Harmsen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Dong Kun Kim
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Robert W. Gao
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Satomi Shiraishi
- Division of Medical Physics, Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - John J. Lucido
- Division of Medical Physics, Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Terence T. Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | | | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bradley J. Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Mark R. Waddle
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sean S. Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Paul D. Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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15
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[Stereotactic body radiation therapy for non-spine bone oligometastatic disease]. Cancer Radiother 2021; 25:837-842. [PMID: 34742637 DOI: 10.1016/j.canrad.2021.09.009] [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: 08/12/2021] [Revised: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Stereotaxic radiotherapy is performed regularly for the irradiation of non-spine bone metastases, but its place is not well understood. MATERIALS AND METHODS This article in stereotaxic radiotherapy of non-spine bones oligometastases presents the current scientific data relating to the indications, to virtual simulation, to the delineation of target volumes, to the total dose and fractionation, to the efficacy and tolerance. RESULTS Oligometastatic patients are classified into 4 categories: oligorecurrences, oligometastasis, oligopersistence, oligoprogression. The prognosis will be evaluated according to the following characteristics: primary tumor, quantitative characteristics, kinetics, qualitative characteristics. The delineation of GTV includes extensions to the soft tissue and bone marrow with the aid of MRI and PET. The CTV corresponds to a margin of 2 to 5mm and the PTV to a margin of 2mm. The most widely used irradiation schemes are: 1 single fraction of 18 to 24Gy/1 fr; 24Gy/2 fr; 27 to 30Gy/3 fr; 30 to 35Gy/5 fr. Stereotaxis provides 90% local control at 1 year and good pain control. The side effects are not very marked. CONCLUSION Stereotaxic radiotherapy is feasible, non-invasive, minimally toxic and effective with good local control and good pain relief. The main issue remains selecting the patients most likely to benefit from it.
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16
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Ito K, Nakajima Y, Ogawa H, Taguchi K. Fracture risk following stereotactic body radiotherapy for long bone metastases. Jpn J Clin Oncol 2021; 52:47-52. [PMID: 34648002 DOI: 10.1093/jjco/hyab164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stereotactic body radiotherapy is a new treatment modality for long bone metastasis and has not been discussed in literature. We aimed to clarify stereotactic body radiotherapy outcomes for long bone metastases. METHODS Data of patients receiving stereotactic body radiotherapy for long bone metastases (July 2016-November 2020) were retrospectively reviewed. The prescribed dose was 30 or 35 Gy in five fractions. The endpoints were local failure and adverse effects. Local failure was defined as radiological tumor growth within the irradiation field. Adverse effects were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5. RESULTS Nineteen osseous lesions in 17 patients were assessed. The target lesions included 13 femoral, 4 humeral and 2 radial lesions. The median follow-up duration was 14 (range, 3-62) months. The 12- and 18-month local failure rates were 0 and 11%, respectively. Following 2 and 46 months of stereotactic body radiotherapy, two lesions (11%) resulted in painful femoral fractures (grade 3). Both patients underwent bipolar hip arthroplasty and could walk normally after surgery. In the late phase, one patient developed radiculopathy (almost complete paralysis of grasp) and another developed grade 2 limb edema. Other grade 2 or more severe acute and late toxicities were not observed during the follow-up period. CONCLUSIONS Stereotactic body radiotherapy for long bone metastases achieved excellent local control and caused two femoral fractures. We argue that stereotactic body radiotherapy for curative intent should not be contraindicated in long bone oligometastasis because fractures do not directly contribute to life expectancy.
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Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yujiro Nakajima
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.,Department of Radiological Sciences, Komazawa University, Tokyo, Japan
| | - Hiroaki Ogawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kentaro Taguchi
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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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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18
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Ignat P, Todor N, Ignat RM, Șuteu O. Prognostic Factors Influencing Survival and a Treatment Pattern Analysis of Conventional Palliative Radiotherapy for Patients with Bone Metastases. Curr Oncol 2021; 28:3876-3890. [PMID: 34677249 PMCID: PMC8534390 DOI: 10.3390/curroncol28050331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/24/2021] [Accepted: 09/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Treatment indication for bone metastases is influenced by patient prognosis. Single-fraction radiotherapy (SFRT) was proven equally effective as multiple fractionation regimens (MFRT) but continues to be underused. OBJECTIVE Primary objectives: (a) to identify prognostic factors for overall survival and (b) to analyze treatment patterns of palliative radiotherapy (proportion of SFRT indication and predictive factors of radiotherapy regimen) for bone metastases. METHODS 582 patients with bone metastases who underwent conventional radiotherapy between January 1st 2014-31 December 2017 were analyzed. The Cox proportional hazard model was used to identify predictors of overall survival. For the treatment pattern analysis, 677 radiotherapy courses were evaluated. The logistic regression model was used to identify potential predictors of radiotherapy regimen. RESULTS The 3-year overall survival was 15%. Prognostic factors associated with poor overall survival were multiple bone metastases [hazard ratio (HR = 5.4)], poor performance status (HR = 1.5) and brain metastases (HR = 1.37). SFRT prescription increased from 41% in 2017 to 51% in 2017. Predictors of SFRT prescription were a poor performance status [odds ratio (OR = 0.55)], lung (OR = 0.49) and urologic primaries (OR = 0.33) and the half-body lower site of irradiation (OR = 0.59). Spinal metastases were more likely to receive MFRT (OR = 2.09). CONCLUSIONS Based on the prognostic factors we identified, a selection protocol for patients candidates for palliative radiotherapy to bone metastases could be established, in order to further increase SFRT prescription in our institution.
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Affiliation(s)
- Patricia Ignat
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (P.I.); (O.Ș.)
- Prof. Dr. I. Chiricuță Oncology Institute, 400015 Cluj-Napoca, Romania;
| | - Nicolae Todor
- Prof. Dr. I. Chiricuță Oncology Institute, 400015 Cluj-Napoca, Romania;
| | - Radu-Mihai Ignat
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (P.I.); (O.Ș.)
- Correspondence:
| | - Ofelia Șuteu
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (P.I.); (O.Ș.)
- Prof. Dr. I. Chiricuță Oncology Institute, 400015 Cluj-Napoca, Romania;
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19
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Nguyen TK, Chin L, Sahgal A, Dagan R, Eppinga W, Guckenberger M, Kim JH, Lo SS, Redmond KJ, Siva S, Stish BJ, Chan R, Lawrence L, Lau A, Tseng CL. International Multi-institutional Patterns of Contouring Practice and Clinical Target Volume Recommendations for Stereotactic Body Radiation Therapy for Non-Spine Bone Metastases. Int J Radiat Oncol Biol Phys 2021; 112:351-360. [PMID: 34509549 DOI: 10.1016/j.ijrobp.2021.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/22/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Despite the increasing use of stereotactic body radiation therapy for non-spine bone metastases (NSBM), there is no established standard for target delineation. The objective of this study was to provide consensus recommendations on clinical target volume (CTV) delineation based on international expert contours. METHODS AND MATERIALS Eleven cases of NSBM were contoured by 9 international radiation oncologists. For each case, the gross tumor volume was provided on the simulation computed tomography scans with accompanying magnetic resonance imaging. Participants contoured the CTV and completed a clinical survey. Agreement between CTV contours were analyzed with simultaneous truth and performance level estimation using the kappa coefficient and the Dice similarity coefficient (DSC) and summarized to establish contouring recommendations. A direction-dependent analysis was applied to the consensus contours to quantify margins. RESULTS All CTV contours were completed. Six participants used a single-dose level, whereas 3 used a 2-dose level simultaneous integrated boost (SIB) technique. For the SIB cases, the largest volume receiving a stereotactic body radiation therapy (SBRT) dose was used for contour analysis. There was substantial agreement between contours across cases with a mean kappa of 0.72 (mean sensitivity 0.85, mean specificity 0.97). The mean DSC value was 0.77 (range, 0.67-0.87). Consensus CTV contouring recommendations were (1) an intraosseous CTV margin of 5 to 10 mm should be strongly considered within contiguous bone; (2) an extraosseous margin of 5 to 10 mm should be strongly considered where there is soft tissue disease or cortical bone disruption; (3) CTVs should be manually cropped to respect anatomic barriers to spread (eg, peritoneal cavity, pleura, uninvolved joint space and cortical bone). CONCLUSIONS CTV contouring recommendations for NSBM-SBRT were established based on analysis of international expert consensus contours with a high level of agreement. These principles may provide guidance to treating physicians and inform future study until prospective clinical data can provide further refinement.
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Affiliation(s)
- Timothy K Nguyen
- Department of Radiation Oncology, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Lee Chin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida Health Proton Therapy Institute, Jacksonville, Florida
| | - Wietse Eppinga
- Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, Maryland
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Rachel Chan
- Department of Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Liam Lawrence
- Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Angus Lau
- Department of Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
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20
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Cao Y, Chen H, Sahgal A, Erler D, Badellino S, Biswas T, Dagan R, Foote MC, Louie AV, Poon I, Ricardi U, Redmond KJ. An international pooled analysis of SBRT outcomes to oligometastatic spine and non-spine bone metastases. Radiother Oncol 2021; 164:98-103. [PMID: 34454974 DOI: 10.1016/j.radonc.2021.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE There is a paucity of data on SBRT to non-spine bone (NSB) lesions compared to spine metastases. We report local recurrence (LR), widespread progression (WSP), and overall survival (OS) for oligometastatic patients treated to bone lesions with SBRT and investigate the hypothesis that outcomes are different between patients with spine and non-spine bone oligometastatic disease. METHODS Patients with oligometastatic disease (≤5 cumulative extracranial metastases) treated with bone SBRT at 6 international institutions from 2007 to 2016 were reviewed. Fine and Gray competing risks and Cox regressions were used to analyze univariable and multivariable relationships between disease/treatment factors and outcomes. RESULTS In total, 288 spine and 233 NSB lesions are reported in 356 patients. Cumulative incidence of LR across all bone lesions was 6.3%, 12.6% and 19.3% at 6 mo, 1 yr and 2 yrs. While univariable analysis suggested inferior LC and OS in spine patients, this did not hold true in multivariable analysis. The final regression model for LR in NSB lesions included PTV ≥ median of 31.8 cc (HR 5.02, p = 0.014) and primary histology, with RCC and NSCLC conferring a 10.8- and 6.5-fold increased risk of LR compared to prostate histology, respectively. The spine LR model included radioresistant histology (HR 2.11, p = 0.0051), PTV Dmin (BED10) ≥ median of 19.1 Gy (HR 0.46, p = 0.0085), and epidural disease (HR 1.99, p = 0.016). CONCLUSION This large multi-institutional series reports comparably excellent response to SBRT for a balanced distribution of oligometastatic NSB and spine lesions. Dose escalation for large and/or radioresistant NSB lesions should be explored, given the typical lack of an immediately adjacent dose-limiting critical structure.
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Affiliation(s)
- Yilin Cao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Darby Erler
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, United States
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, United States
| | - Matthew C Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, United States.
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21
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Gouveia AG, Chan DCW, Hoskin PJ, Marta GN, Trippa F, Maranzano E, Chow E, Silva MF. Advances in radiotherapy in bone metastases in the context of new target therapies and ablative alternatives: A critical review. Radiother Oncol 2021; 163:55-67. [PMID: 34333087 DOI: 10.1016/j.radonc.2021.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
In patients with bone metastases (BM), radiotherapy (RT) is used to alleviate symptoms, reduce the risk of fracture, and improve quality of life (QoL). However, with the emergence of concepts like oligometastases, minimal invasive surgery, ablative therapies such as stereotactic ablative RT (SABR), radiosurgery (SRS), thermal ablation, and new systemic anticancer therapies, there have been a paradigm shift in the multidisciplinary approach to BM with the aim of preserving mobility and function survival. Despite guidelines on using single-dose RT in uncomplicated BM, its use remains relatively low. In uncomplicated BM, single-fraction RT produces similar overall and complete response rates to RT with multiple fractions, although it is associated with a higher retreatment rate of 20% versus 8%. Complicated BM can be characterised as the presence of impending or existing pathologic fracture, a major soft tissue component, existing spinal cord or cauda equina compression and neuropathic pain. The rate of complicated BM is around 35%. Unfortunately, there is a lack of prospective trials on RT in complicated BM and the best dose/fractionation regimen is not yet established. There are contradictory outcomes in studies reporting BM pain control rates and time to pain reduction when comparing SABR with Conventional RT. While some studies showed that SABR produces a faster reduction in pain and higher pain control rates than conventional RT, other studies did not show differences. Moreover, the local control rate for BM treated with SABR is higher than 80% in most studies, and the rate of grade 3 or 4 toxicity is very low. The use of SABR may be preferred in three circumstances: reirradiation, oligometastatic disease, and radioresistant tumours. Local ablative therapies like SABR can delay change or use of systemic therapy, preserve patients' Qol, and improve disease-free survival, progression-free survival and overall survival. Moreover, despite the potential benefit of SABR in oligometastatic disease, there is a need to establish the optial indication, RT dose fractionation, prognostic factors and optimal timing in combination with systemic therapies for SABR. This review evaluates the role of RT in BM considering these recent treatment advances. We consider the definition of complicated BM, use of single and multiple fractions RT for both complicated and uncomplicated BM, reirradiation, new treatment paradigms including local ablative treatments, oligometastatic disease, systemic therapy, physical activity and rehabilitation.
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Affiliation(s)
- André G Gouveia
- Radiation Oncology Department, Américas Centro de Oncologia Integrado, Rio de Janeiro, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Dominic C W Chan
- Department of Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, London, United Kingdom; Radiation Oncology Department, University of Manchester, United Kingdom
| | - Gustavo N Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Department, Hospital Sírio Libanês, São Paulo, Brazil
| | - Fabio Trippa
- Radiation Oncology Center, Santa Maria Hospital, Terni, Italy
| | | | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Mauricio F Silva
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Unit, Santa Maria Federal University, Santa Maria, Brazil; Clínica de Radioterapia de Santa Maria, Brazil.
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22
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Kubota H, Nakamura N, Shikama N, Tonari A, Wada H, Harada H, Nagakura H, Heianna J, Ito K, Nozaki M, Tago M, Fushiki M, Uchida N, Araki N, Sekii S, Kosugi T, Takahashi T, Kawamoto T, Saito T, Yamada K. Practice patterns for postoperative radiation therapy in patients with metastases to the long bones: a survey of the Japanese Radiation Oncology Study Group. JOURNAL OF RADIATION RESEARCH 2021; 62:356-363. [PMID: 33454759 PMCID: PMC7948830 DOI: 10.1093/jrr/rraa133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/19/2020] [Indexed: 06/12/2023]
Abstract
Evidence regarding postoperative radiation therapy (PORT) for metastases to the long bones is lacking. Characterizing the current practice patterns and identifying factors that influence dose-fractionation schedules are essential for future clinical trials. An internet-based survey of the palliative RT subgroup of the Japanese Radiation Oncology Study Group was performed in 2017 to collect data regarding PORT prescription practices and dose-fractionation schedules. Responders were also asked to recommend dose-fractionation schedules for four hypothetical cases that involved a patient with impending pathological fractures and one of four clinical features (poor prognosis, solitary metastasis, radio-resistant primary tumor or expected long-term survival). Responders were asked to indicate their preferred irradiation fields and the reasons for the dose fractionation schedule they chose. Responses were obtained from 89 radiation oncologists (67 institutions and 151 RT plans) who used 22 dose-fractionation schedules, with the most commonly used and recommended schedule being 30 Gy in 10 fractions. Local control was the most common reason for preferring longer-course RT. High-dose fractionated schedules were preferred for oligometastasis, and low-dose regimens were preferred for patients with a poor prognosis; however, single-fraction RT was not preferred. Most respondents recommended targeting the entire orthopedic prosthesis. These results indicated that PORT using 30 Gy in 10 fractions to the entire orthopedic prosthesis is preferred in current Japanese practice and that single-fraction RT was not preferred. Oligometastasis and poor prognosis influenced the selection of high- or low-dose regimens.
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Affiliation(s)
- Hikaru Kubota
- Corresponding author. Department of Radiation Oncology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. Fax: +81-78-382-5265;
| | - Naoki Nakamura
- Department of Radiation Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao Kawasaki City, Kanagawa prefecture 216-8511, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Ayako Tonari
- Department of Radiation Oncology, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, 172-7, Yatsuyamada,Koriyama,Fukushima 963-8563, Japan
| | - Hideyuki Harada
- Division of Radiation Therapy, Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture 411-8777, Japan
| | - Hisayasu Nagakura
- Department of Radiology, KKR Sapporo Medical Center, 6-3-40 Hiragishi-1, Toyohira-ku, Sapporo 062-0931, Japan
| | - Joichi Heianna
- Department of Radiation Oncology, Ryukyu University Hospital
| | - Kei Ito
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Miwako Nozaki
- Department of Radiation Oncology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Masao Tago
- Department of Radiology, Teikyo University Mizonokuchi Hospital, 3-8-3, Mizokuchi, Takatsu-ku, Kawasaki city, Kanagawa pref., Japan
| | - Masato Fushiki
- Department of Radiation Oncology, Nagahama City Hospital, 313 Oinuicho, Nagahama, Shiga 526-8580, Japan
| | - Nobue Uchida
- Department of Radiation Oncology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan
| | - Norio Araki
- Department of Radiation Oncology, Kyoto Medical Center, 1-1 Fukakusamukaihatacho, Fushimi-ku, Kyoto-shi, Kyoto 612-8555, Japan
| | - Shuhei Sekii
- Department of Radiation Oncology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo Prefecture 650-0017, Japan
| | - Takashi Kosugi
- Department of Radiation Oncology, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda City, Shizuoka Prefecture 426-8677, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical University Saitama Medical Center, 1981 kamoda,kawagoeshi, saitama 350-8550, Japan
| | - Terufumi Kawamoto
- Department of Radiation Oncology, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Tetsuo Saito
- Department of Radiation Oncology, Arao Municipal Hospital, 2600 Arao, Arao City, Kumamoto 864-0041, Japan
| | - Kazunari Yamada
- Department of Radiation Oncology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka 433-8558, Japan
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23
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Cao Y, Stachelek GC, Fu W, Song DY, Hales RK, Voong KR, Meyer JJ, Quon H, Hu C, Redmond KJ. Bone density and fracture risk following SBRT for non-spine bone metastases. JOURNAL OF RADIOSURGERY AND SBRT 2021; 7:199-206. [PMID: 33898083 PMCID: PMC8055232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE/METHODS This retrospective study evaluated local recurrence (LR) and fracture risk in non-spine bone metastases treated with SBRT. RESULTS 181 lesions in 116 patients are reported. The median dose was 27 Gy (range 15-40) in 3 fractions (range 1-6). The cumulative incidence of LR was 2.8%, 7.2% and 12.5% at 6 mo, 1 yr and 2 yrs. Fractures occurred in 11 lesions (6%). Radioresistant histology and increasing PTV predicted for LR on univariate analysis, while rib location was associated with control. Increasing PTV remained a significant predictor for LR on multivariate analysis. Univariate predictors of fracture risk included female gender, lytic lesions and poorer KPS. Average CT-approximated L1 trabecular attenuation in patients with fracture was significantly lower than in patients without fracture (112.2 vs. 142.6 Hounsfield units). CONCLUSION In the largest series to date, we report excellent local control for SBRT to non-spine bone metastases and a novel relationship between CT-based bone quality assessment and fracture risk.
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Affiliation(s)
- Yilin Cao
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA
| | - Gregory C. Stachelek
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA
| | - Wei Fu
- Johns Hopkins University School of Medicine, Department of Statistics and Bioinformatics, Baltimore, MD, USA
| | - Daniel Y. Song
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA
| | - Russell K. Hales
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA
| | - K. Ranh Voong
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA
| | - Jeffrey J. Meyer
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA
| | - Harry Quon
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA
| | - Chen Hu
- Johns Hopkins University School of Medicine, Department of Statistics and Bioinformatics, Baltimore, MD, USA
| | - Kristin J. Redmond
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA
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24
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Mercier C, Claessens M, Buys MSc A, Gryshkevych S, Billiet C, Joye I, Van Laere S, Vermeulen P, Meijnders P, Löfman F, Poortmans P, Dirix L, Verellen D, Dirix P. Stereotactic Ablative Radiation Therapy to All Lesions in Patients With Oligometastatic Cancers: A Phase 1 Dose-Escalation Trial. Int J Radiat Oncol Biol Phys 2020; 109:1195-1205. [PMID: 33307151 DOI: 10.1016/j.ijrobp.2020.11.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Increasing evidence suggests that patients with a limited number of metastases benefit from SABR to all lesions. However, the optimal dose and fractionation remain unknown. This is particularly true for bone and lymph node metastases. Therefore, a prospective, single-center, dose-escalation trial was initiated. METHODS Dose-Escalation trial of STereotactic ablative body RadiOtherapY for non-spine bone and lymph node metastases (DESTROY) was an open-label phase 1 trial evaluating SABR to nonspine bone and lymph node lesions in patients with up to 3 metastases. Patients with European Cooperative Oncology Group performance status ≤1, an estimated life expectancy of at least 6 months, and histologically confirmed nonhematological malignancy were eligible. Three SABR fractionation regimens, ie, 5 fractions of 7.0 Gy versus 3 fractions of 10.0 Gy versus a single fraction of 20.0 Gy, were applied in 3 consecutive patient cohorts. The rate of ≥grade 3 toxicity, scored according to the Common Toxicity Criteria for Adverse Events v. 4.03, up to 6 months after SABR, was the primary endpoint. The trial was registered on clinicaltrials.gov (NCT03486431). RESULTS Between July 2017 and December 2018, 90 patients were enrolled. In total 101 metastases were treated. No ≥grade 3 toxicity was observed in any of the enrolled patients (95% CI 0.0%-12.3% for the first cohort with 28 analyzable patients; 95% CI 0.0%-11.6% for the second and third cohort with 30 analyzable patients each). Treatment-related grade 2 toxicities occurred in 4 out of 30 versus 2 out of 30 versus 2 out of 30 patients for the 5, 3 and 1 fraction schedule, respectively. Actuarial local control rate at 12 months was 94.5%. CONCLUSION All 3 treatment schedules were feasible and effective with remarkably low toxicity rates and high local control rates. From a patient and resource point of view, the single-fraction schedule is undoubtedly most convenient.
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Affiliation(s)
- Carole Mercier
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium; Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium.
| | - Michaël Claessens
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium; Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium
| | - Andy Buys MSc
- Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium
| | - Sergii Gryshkevych
- Department of Machine Learning, RaySearch Laboratories AB, Stockholm, Sweden
| | - Charlotte Billiet
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium; Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium
| | - Ines Joye
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium; Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium
| | - Steven Van Laere
- Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium
| | - Peter Vermeulen
- Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium
| | - Paul Meijnders
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium; Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium
| | - Fredrik Löfman
- Department of Machine Learning, RaySearch Laboratories AB, Stockholm, Sweden
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium
| | - Luc Dirix
- Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium; Department of Medical Oncology, GZA Sint-Augustinus, Wilrijk (Antwerp), Belgium
| | - Dirk Verellen
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium; Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium; Translational Cancer Research Unit (TCRU), Center for Oncological Research (CORE), University of Antwerp, Edegem (Antwerp), Belgium
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De la Pinta C. SBRT in non-spine bone metastases: a literature review. Med Oncol 2020; 37:119. [PMID: 33221952 DOI: 10.1007/s12032-020-01442-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
Stereotactic Body Radiotherapy (SBRT) is a technique for delivering high doses of radiation to tumors while preserving the normal tissues located around this area. Bone metastases are frequent in cancer patients. They can be distressingly painful or may cause pathological fractures. Radiation therapy is a fundamental aspect of treatment for bone metastases. The objective of this study is to analyze the literature on non-spine bone metastasis treated with SBRT, including immobilization, volume delineation, dose and fractionation, local control, side effects, and assessment of response after treatment. Full-text articles written in English language and published in the last 10 years were included in this review and were accessible on PubMed and MEDLINE. We examined 78 articles. A total of 40 studies were included in this review. Most were retrospective studies. The articles included were evaluated for content and validation. The immobilization systems and imaging tests used for tumor delimitation were variable between studies. The use of CTV (Clinical Target Volume) has not been defined. Doses and fractions were variable from 15 to 24 Gy/1 fraction to 24-50 Gy in 3-5 fractions, with local control being around 90% with a low rate of side effects. We review state of the art in SBRT non-spine metastases. SBRT can result in better local control and pain management in non-spine bone metastases patients. We need more research in volume delineation determining whether or not to use CTV and the role of MRI in volume contouring, optimal doses, and fractionation according to histology and a reliable response assessment tool. Studies that compare SBRT to conventional radiotherapy in local control and pain control are needed.
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Nguyen TK, Sahgal A, Dagan R, Eppinga W, Guckenberger M, Kim JH, Lo SS, Redmond KJ, Siva S, Stish BJ, Tseng CL. Stereotactic Body Radiation Therapy for Nonspine Bone Metastases: International Practice Patterns to Guide Treatment Planning. Pract Radiat Oncol 2020; 10:e452-e460. [DOI: 10.1016/j.prro.2020.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 11/16/2022]
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Ito K, Nakajima Y, Onoe T, Ogawa H, Harada H, Saito M, Karasawa K. Phase 2 Clinical Trial of Stereotactic Body Radiation Therapy for Painful Nonspine Bone Metastases. Pract Radiat Oncol 2020; 11:e139-e145. [PMID: 33068791 DOI: 10.1016/j.prro.2020.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE The present multicenter, single-arm, phase 2 study aimed to prospectively evaluate the palliative efficacy of stereotactic body radiation therapy (SBRT) in patients with painful nonspine bone metastases. METHODS AND MATERIALS Patients with painful (≥2 points on a 0-to-10 scale) nonspine bone metastases from a solid tumor were enrolled. The prescribed dose was 35 Gy in 5 fractions. The primary endpoint was overall pain response rate (complete response [CR] and partial response [PR]) as measured per the International Consensus on Palliative Radiotherapy Endpoints guideline 6 months after SBRT. RESULTS Forty-one osseous lesions in 38 patients were registered between June 2018 and June 2019. All lesions satisfied the inclusion criteria, and the patients completed the protocol treatment. Patients most commonly had lung cancer (22%), followed by prostate cancer, uterus cancer, and renal cell carcinoma (15%, 15%, and 12%, respectively). Bone metastases were most commonly located in coxal bones (56%). The median duration of follow-up after registration was 8 months (range, 1-19 months). Among evaluable lesions at 3 and 6 months after SBRT, the 3- and 6-month pain response rates were 78% and 75%, respectively. The local control rate at 6 months was 92%. Seven patients (17%) experienced bone fracture after irradiation, and 3 patients (7%) experienced grade 2 limb edema. One patient had regrowth of coxal bone metastases, and the tumor penetrated the sigmoid colon. Soft tissue abscess around the tumor and osteonecrosis of coxal bones were confirmed. The patient died of infection 4 months after SBRT and was determined to be a possible treatment-related death. CONCLUSIONS This prospective clinical trial showed that SBRT for nonspine bone metastases was effective in terms of pain palliation. These findings warrant a larger randomized controlled trial to compare SBRT with conventional radiation therapy. Additionally, operation history should be considered as a risk factor for edema.
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Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
| | - Yujiro Nakajima
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tsuyoshi Onoe
- Division of Radiation Therapy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hiroaki Ogawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hideyuki Harada
- Division of Radiation Therapy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Makoto Saito
- Division of Clinical Research Support, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Katsuyuki Karasawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Garnon J, Jennings JW, Meylheuc L, Auloge P, Weiss J, Koch G, Caudrelier J, Cazzato RL, Bayle B, Gangi A. Biomechanics of the Osseous Pelvis and Its Implication for Consolidative Treatments in Interventional Oncology. Cardiovasc Intervent Radiol 2020; 43:1589-1599. [DOI: 10.1007/s00270-020-02624-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/05/2020] [Indexed: 12/11/2022]
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Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document. Radiother Oncol 2020; 148:157-166. [DOI: 10.1016/j.radonc.2020.04.003] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
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Nguyen QN, Chun SG, Chow E, Komaki R, Liao Z, Zacharia R, Szeto BK, Welsh JW, Hahn SM, Fuller CD, Moon BS, Bird JE, Satcher R, Lin PP, Jeter M, O'Reilly MS, Lewis VO. Single-Fraction Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone Metastases: A Randomized Phase 2 Trial. JAMA Oncol 2020; 5:872-878. [PMID: 31021390 DOI: 10.1001/jamaoncol.2019.0192] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Importance Consensus is lacking as to the optimal radiotherapy dose and fractionation schedule for treating bone metastases. Objective To assess the relative efficacy of high-dose, single-fraction stereotactic body radiotherapy (SBRT) vs standard multifraction radiotherapy (MFRT) for alleviation of pain in patients with mostly nonspine bone metastases. Design, Setting, and Participants This prospective, randomized, single-institution phase 2 noninferiority trial conducted at a tertiary cancer care center enrolled 160 patients with radiologically confirmed painful bone metastases from September 19, 2014, through June 19, 2018. Patients were randomly assigned in a 1:1 ratio to receive either single-fraction SBRT (12 Gy for ≥4-cm lesions or 16 Gy for <4-cm lesions) or MFRT to 30 Gy in 10 fractions. Main Outcomes and Measures The primary end point was pain response, defined by international consensus criteria as a combination of pain score and analgesic use (daily morphine-equivalent dose). Pain failure (ie, lack of response) was defined as worsening pain score (≥2 points on a 0-to-10 scale), an increase in morphine-equivalent opioid dose of 50% or more, reirradiation, or pathologic fracture. We hypothesized that SBRT was noninferior to MFRT. Results In this phase 2 noninferiority trial of 96 men and 64 women (mean [SD] age, 62.4 [10.4] years), 81 patients received SBRT and 79 received MFRT. Among evaluable patients who received treatment per protocol, the single-fraction group had more pain responders than the MFRT group (complete response + partial response) at 2 weeks (34 of 55 [62%] vs 19 of 52 [36%]) (P = .01), 3 months (31 of 43 [72%] vs 17 of 35 [49%]) (P = .03), and 9 months (17 of 22 [77%] vs 12 of 26 [46%]) (P = .03). No differences were found in treatment-related toxic effects or quality-of-life scores after SBRT vs MFRT; local control rates at 1 and 2 years were higher in patients receiving single-fraction SBRT. Conclusions and Relevance Delivering high-dose, single-fraction SBRT seems to be an effective treatment option for patients with painful bone metastases. Among evaluable patients, SBRT had higher rates of pain response (complete response + partial response) than did MFRT and thus should be considered for patients expected to have relatively long survival. Trial Registration ClinicalTrials.gov identifier: NCT02163226.
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Affiliation(s)
- Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Stephen G Chun
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Rensi Zacharia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Bill K Szeto
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Stephen M Hahn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Bryan S Moon
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Justin E Bird
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Robert Satcher
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Patrick P Lin
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Melenda Jeter
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael S O'Reilly
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Valerae O Lewis
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston
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Kowalchuk RO, Waters MR, Richardson KM, Spencer K, Larner JM, Sheehan JP, McAllister WH, Kersh CR. A comparison of stereotactic body radiation therapy for metastases to the sacral spine and treatment of the thoracolumbar spine. JOURNAL OF RADIOSURGERY AND SBRT 2020; 7:95-103. [PMID: 33282463 PMCID: PMC7717089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/27/2020] [Indexed: 06/12/2023]
Abstract
Background: This study compares the outcomes of stereotactic body radiation therapy (SBRT) for sacral and thoracolumbar spine metastases. Methods: This analysis considered each sacral spine SBRT treatment at a single institution and a cohort of consecutive thoracolumbar treatments. Results: 28 patients with 35 sacral treatments and 41 patients with 49 thoracolumbar treatments were included. Local control was 63% and 90%, respectively. The sacral cohort contained more lesions with ≥2 vertebrae and epidural and paraspinal involvement. Sacral patients had larger treatment volumes, increased rates of subsequent SBRT, decreased propensity for pain improvement, and decreased local control (p=0.02 on Kaplan-Meier analysis). Multivariate analysis demonstrated that PTV > 50 cc and epidural involvement were correlated with decreased local control. No cases had grade ≥3 toxicity. Conclusion: SBRT for sacral spine metastases is a distinct disease process than metastases to the thoracolumbar spine, resulting in lower rates of local control and pain improvement.
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Affiliation(s)
- Roman O. Kowalchuk
- University of Virginia/Riverside, Radiosurgery Center, 500 J Clyde Morris Blvd, Newport News, VA 23601, USA
| | - Michael R. Waters
- University of Virginia/Riverside, Radiosurgery Center, 500 J Clyde Morris Blvd, Newport News, VA 23601, USA
| | - K. Martin Richardson
- University of Virginia/Riverside, Radiosurgery Center, 500 J Clyde Morris Blvd, Newport News, VA 23601, USA
| | - Kelly Spencer
- University of Virginia/Riverside, Radiosurgery Center, 500 J Clyde Morris Blvd, Newport News, VA 23601, USA
| | - James M. Larner
- University of Virginia, Department of Radiation Oncology, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Jason P. Sheehan
- University of Virginia, Department of Neurosurgery, 1215 Lee St, Charlottesville, VA 22903, USA
| | - William H. McAllister
- Riverside Regional Medical Center, Department of Neurosurgery, 500 J Clyde Morris Blvd, Newport News, VA 23601, USA
| | - Charles R. Kersh
- University of Virginia/Riverside, Radiosurgery Center, 500 J Clyde Morris Blvd, Newport News, VA 23601, USA
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Loi M, Nuyttens JJ, Desideri I, Greto D, Livi L. Single-Fraction Radiotherapy (SFRT) For Bone Metastases: Patient Selection And Perspectives. Cancer Manag Res 2019; 11:9397-9408. [PMID: 31807069 PMCID: PMC6842277 DOI: 10.2147/cmar.s186630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/22/2019] [Indexed: 01/02/2023] Open
Abstract
Bone metastases are a frequent and important source of morbidity in cancer patients. Stereotactic body radiation therapy (SBRT) is an established treatment option for local control and pain relief of bone metastases, and it is increasingly used as upfront treatment, postoperative consolidation or salvage treatment after prior RT. However, heterogeneity of dose schedules described in literature represents a severe limitation in the definition of the role of SBRT as a standard of care. No consensus is available on the use of single versus multiple fraction SBRT for bone metastases. Advantages of single-fraction SBRT include shorter overall duration of treatment, absence of inter-fraction uncertainty, improved compliance, theoretical increased efficacy, and lower costs. However, caution has been advised due to reports of severe late toxicities, in particular, vertebral collapse fracture (VCF). The aim of this paper is to review dose fractionation and indications for the management of bone metastases using SBRT.
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Affiliation(s)
- Mauro Loi
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Joost J Nuyttens
- Radiotherapy Department, Erasmus MC Cancer Center, Rotterdam, The Netherlands
| | - Isacco Desideri
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Daniela Greto
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy
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A phase III randomized-controlled, single-blind trial to improve quality of life with stereotactic body radiotherapy for patients with painful bone metastases (ROBOMET). BMC Cancer 2019; 19:876. [PMID: 31484505 PMCID: PMC6727408 DOI: 10.1186/s12885-019-6097-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Bone metastases represent an important source of morbidity in cancer patients, mostly due to severe pain. Radiotherapy is an established symptomatic treatment for painful bone metastases, however, when conventional techniques are used, the effectiveness is moderate. Stereotactic body radiotherapy (SBRT), delivering very high doses in a limited number of fractions in a highly conformal manner, could potentially be more effective and less toxic. METHODS This is a phase III, randomized-controlled, single-blind, multicenter study evaluating the response rate of antalgic radiotherapy for painful bone metastases and the acute toxicity associated with this treatment. A total of 126 patients will be randomly assigned to receive either the standard schedule of a single fraction of 8.0 Gy delivered through three-dimensional conformal radiotherapy or a single fraction of 20.0 Gy delivered through SBRT. Primary endpoint is pain response at the treated site at 1 month after radiotherapy. Secondary endpoints are pain flare at 24-48-72 h after radiotherapy, duration of pain response, re-irradiation need, acute toxicity, late toxicity, quality of life and subsequent serious skeletal events. In a supplementary analysis, patient-compliance for a paper-and-pencil questionnaire will be compared with an electronic mode. DISCUSSION If a dose-escalated approach within the context of single fraction stereotactic body radiotherapy could improve the pain response to radiotherapy and minimize acute toxicity, this would have an immediate impact on the quality of life for a large number of patients with advanced cancer. Potential disadvantages of this technique include increased pain flare or a higher incidence of radiation-induced fractures. TRIAL REGISTRATION The Ethics committee of the GZA Hospitals (B099201732915) approved this study on September 4th 2018. Trial registered on Clinicaltrials.gov ( NCT03831243 ) on February 5th 2019.
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Pacelli R, Caroprese M, Palma G, Oliviero C, Clemente S, Cella L, Conson M. Technological evolution of radiation treatment: Implications for clinical applications. Semin Oncol 2019; 46:193-201. [PMID: 31395286 DOI: 10.1053/j.seminoncol.2019.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
The contemporary approach to the management of a cancer patient requires an "ab initio" involvement of different medical domains in order to correctly design an individual patient's pathway toward cure. With new therapeutic tools in every medical field developing faster than ever before the patient care outcomes can be achieved if all surgical, drug, and radiation options are considered in the design of the appropriate therapeutic strategy for a given patient. Radiation therapy (RT) is a clinical discipline in which experts from different fields continuously interact in order to manage the multistep process of the radiation treatment. RT is found to be an appropriate intervention for diverse indications in about 50% of cancer patients during the course of their disease. Technologies are essential in dealing with the complexity of RT treatments and for driving the increasingly sophisticated RT approaches becoming available for the treatment of Cancer. High conformal techniques, namely intensity modulated or volumetric modulated arc techniques, ablative techniques (Stereotactic Radiotherapy and Stereotactic Radiosurgery), particle therapy (proton or carbon ion therapy) allow for success in treating irregularly shaped or critically located targets and for the sharpness of the dose fall-off outside the target. The advanced on-board imaging, including real-time position management systems, makes possible image-guided radiation treatment that results in substantial margin reduction and, in select cases, implementation of an adaptive approach. The therapeutic gains of modern RT are also due in part to the enhanced anticancer activity obtained by coadministering RT with chemotherapy, targeted molecules, and currently immune checkpoints inhibitors. These main clinically relevant steps forward in Radiation Oncology represent a change of gear in the field that may have a profound impact on the management of cancer patients.
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Affiliation(s)
- Roberto Pacelli
- Department of Advanced Biomedical Sciences, University "Federico II", Napoli, Italy.
| | - Mara Caroprese
- Department of Advanced Biomedical Sciences, University "Federico II", Napoli, Italy
| | - Giuseppe Palma
- Institute of Biostructures and Bioimages, National Research Council, Napoli, Italy
| | | | | | - Laura Cella
- Institute of Biostructures and Bioimages, National Research Council, Napoli, Italy
| | - Manuel Conson
- Department of Advanced Biomedical Sciences, University "Federico II", Napoli, Italy
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Hemmatazad H, Schmidhalter D, Elicin O, Aebersold DM, Herrmann E. Skin surface markers for stereotactic body radiation therapy of sternal metastasis. Rep Pract Oncol Radiother 2019; 24:322-324. [DOI: 10.1016/j.rpor.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/29/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022] Open
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Jacobs CD, Palta M, Williamson H, Price JG, Czito BG, Salama JK, Moravan MJ. Hypofractionated Image-Guided Radiation Therapy With Simultaneous-Integrated Boost Technique for Limited Metastases: A Multi-Institutional Analysis. Front Oncol 2019; 9:469. [PMID: 31214509 PMCID: PMC6558188 DOI: 10.3389/fonc.2019.00469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/16/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose: To perform a multi-institutional analysis following treatment of limited osseous and/or nodal metastases in patients using a novel hypofractionated image-guided radiotherapy with simultaneous-integrated boost (HIGRT-SIB) technique. Methods: Consecutive patients treated with HIGRT-SIB for ≤5 active metastases at Duke University Medical Center or Durham Veterans' Affairs Medical Center between 2013 and 2018 were analyzed to determine toxicities and recurrence patterns following treatment. Most patients received 50 Gy to the PTVboost and 30 Gy to the PTVelect simultaneously in 10 fractions. High-dose treatment volume recurrence (HDTVR) and low-dose treatment volume recurrence (LDTVR) were defined as recurrences within PTVboost and PTVelect, respectively. Marginal recurrence (MR) was defined as recurrence outside PTVelect, but within the adjacent bone or nodal chain. Distant recurrence (DR) was defined as recurrences not meeting HDTVR, LDTVR, or MR criteria. Freedom from pain recurrence (FFPR) was calculated in patients with painful osseous metastases prior to HIGRT-SIB. Outcome rates were estimated at 12 months using the Kaplan-Meier method. Results: Forty-two patients met inclusion criteria with 59 sites treated with HIGRT-SIB (53% nodal and 47% osseous). Median time from diagnosis to first metastasis was 31 months and the median age at HIGRT-SIB was 69 years. The most common primary tumors were prostate (36%), gastrointestinal (24%), and lung (24%). Median follow-up was 11 months. One acute grade ≥3 toxicity (febrile neutropenia) occurred after docetaxel administration immediately following HIGRT-SIB. Four patients developed late grade ≥3 toxicities: two ipsilateral vocal cord paralyzes and two vertebral compression fractures. The overall pain response rate was 94% and the estimated FFPR at 12 months was 72%. The estimated 12 month rate of HDTVR, LDTVR, MR, and DR was 3.6, 6.2, 7.6, and 55.8%, respectively. DR preceded MR, HDTVR, or LDTVR in each instance. The estimated 12 month probability of in-field and marginal control was 90.0%. Conclusion: Targeting areas at high-risk for occult disease with a lower radiation dose, while simultaneously boosting gross disease with HIGRT in patients with limited osseous and/or nodal metastases, has a high rate of treated metastasis control, a low rate of MR, acceptable toxicity, and high rate of pain palliation. Further investigation with prospective trials is warranted.
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Affiliation(s)
- Corbin D Jacobs
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Manisha Palta
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States.,Radiation Oncology Clinical Service, Durham VA Medical Center, Durham, NC, United States
| | - Hannah Williamson
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States
| | - Jeremy G Price
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Brian G Czito
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States.,Radiation Oncology Clinical Service, Durham VA Medical Center, Durham, NC, United States
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States.,Radiation Oncology Clinical Service, Durham VA Medical Center, Durham, NC, United States
| | - Michael J Moravan
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States.,Radiation Oncology Clinical Service, Durham VA Medical Center, Durham, NC, United States
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Yu T, Choi CW, Kim KS. Treatment outcomes of stereotactic ablative radiation therapy for non-spinal bone metastases: focus on response assessment and treatment indication. Br J Radiol 2019; 92:20181048. [PMID: 31075040 DOI: 10.1259/bjr.20181048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To report treatment outcomes of stereotactic ablative radiation therapy (SABR) for non-spinal bone metastases in a single institution, and to compare assessments of Response Evaluation Criteria in Solid Tumors (RECIST) v. 1.1 and the University of Texas MD Anderson Cancer Center (MDA) criteria. METHODS From July 2011 to January 2017, 33 patients with 38 non-spinal bone metastatic lesions were treated using SABR. Treatment intent was categorized as follows: single metastasis or oligo-metastases; oligo-progression; and dominant areas of progression. Tumor responses were evaluated according to the RECIST and MDA criteria. Local control (LC) was defined as lesions that were not classified as progressive disease on both criteria. RESULTS The median follow-up period was 10.4 months (range, 2.5-47.4). Both 1- and 2 year LC rates were 94.2 %. The median overall survival (OS) was 20.2 months, and the median progression-free survival (PFS) was 6.9 months. Treatment intent was a significant factor for OS in multivariate analysis. The 1 year OS rates for single metastasis or oligo-metastasis, for oligo-progression, and for dominant areas of progression were 84.2%, 66.7%, and 0.0%, respectively ( p < 0.001). Overall response rate was 86.8 % according to MDA criteria, and 75.7 % according to RECIST criteria. When using MDA criteria, there appeared to be significant associations both between response and PFS (median 7.6 months for responders vs 2.5 months for non-responders; p = 0.036) and between response and OS. In contrast, when using RECIST criteria, the associations were significant neither between response and PFS (median 5.8 months for responders vs 9.3 months for non-responders; p = 0.522) nor between response and OS (25.7 months for responders vs 18.5 months for non-responders; p = 0.811). CONCLUSION SABR for non-spinal bone metastases demonstrated high LC rates with acceptable toxicity. The MDA criteria demonstrated advantages in predicting survival outcomes. ADVANCES IN KNOWLEDGE SABR for non-spinal bone metastases is a promising treatment option to achieve good local control. The MDA criteria, which is a newly proposed response evaluation criteria for bone metastases, has advantages in predicting survival outcomes compared to other established criteria.
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Affiliation(s)
- Tosol Yu
- 1 Department of Radiation Oncology, Dongnam Institute of Radiological & Medical Sciences , Busan , Republic of Korea
| | - Chul-Won Choi
- 1 Department of Radiation Oncology, Dongnam Institute of Radiological & Medical Sciences , Busan , Republic of Korea
| | - Kyung Su Kim
- 1 Department of Radiation Oncology, Dongnam Institute of Radiological & Medical Sciences , Busan , Republic of Korea.,2 Department of Radiation Oncology, Ewha Womans University College of Medicine , Seoul , Republic of Korea
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Palacios-Eito A, Béjar-Luque A, Rodríguez-Liñán M, García-Cabezas S. Oligometastases in prostate cancer: Ablative treatment. World J Clin Oncol 2019; 10:38-51. [PMID: 30815370 PMCID: PMC6390116 DOI: 10.5306/wjco.v10.i2.38] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/30/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
Technological advances in radiotherapy have led to the introduction of techniques such as stereotactic body radiation therapy (SBRT), allowing the administration of ablative doses. The hypothesis that oligometastatic disease may be cured through local eradication therapies has led to the increasing use of SBRT in patients with this type of disease. At the same time, scientific advances are being made to allow the confirmation of clinically suspected oligometastatic status at molecular level. There is growing interest in identifying patients with oligometastatic prostate cancer (PCa) who may benefit from curative intent metastasis-directed therapy, including SBRT. The aim is to complement, replace or delay the introduction of hormone therapy or other systemic therapies. The present review aims to compile the evidence from the main ongoing studies and results on SBRT in relation to oligometastatic PCa; examine aspects where gaps in knowledge or a lack of consensus persist (e.g., optimum schemes, response assessment, identification and diagnosis of oligometastatic patients); and document the lack of first-level evidence supporting the use of such techniques.
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Affiliation(s)
- Amalia Palacios-Eito
- Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Amelia Béjar-Luque
- Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba 14004, Spain
| | | | - Sonia García-Cabezas
- Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba 14004, Spain
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Finkelstein S, Raman S, Van Der Velden J, Zhang L, Tan C, Dhillon A, Tonolete F, Chiu N, Probyn L, McDonald R, Sahgal A, Chow E, Chin L. Changes in Volume and Density Parameters Measured on Computed Tomography Images Following Stereotactic Body Radiation Therapy of Nonspine Bone Metastases. Technol Cancer Res Treat 2019; 18:1533033819853532. [PMID: 31319776 PMCID: PMC6640058 DOI: 10.1177/1533033819853532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Volumetric and density parameters measured from computed tomography scans were investigated for evaluating treatment response of nonspine bone lesions following stereotactic body radiation therapy. Methods: Twenty-three patients treated with stereotactic body radiation therapy to nonspine bone metastases with pre- and post-treatment radiological follow-up with computed tomography imaging were identified in a retrospective review. An expert radiologist classified 26 lesions by type (lytic, sclerotic) and by response. Two independent radiation oncologists created separate contours of the bone and soft tissue lesion volumes. Density and volume were assessed relative to baseline values. Results: For bone-only lesions, all lesions designated as local control decreased in volume or remained within 20% of baseline volumes. Lytic lesions classified as progressive disease exhibited much larger volume increases. Lytic bone lesions showed indications of remineralization with some exhibiting immediate increases in density (1-6 months) and others decreasing initially then increasing back toward baseline between 7 and 12 months. The majority of sclerotic lesions, all classified as local control, decreased slightly in both volume and density. Lesions with both soft tissue and boney involvement resulted in contradictory results when employing both radiological and size parameters for assessing treatment response. Classification was dominated by changes in soft tissue volume, despite associated volume or density changes in the corresponding boney lesion. In contrast, when soft tissue volume changes were minimal (<20% increase), classification appeared to be related primarily to density changes and not bone volume. Conclusions: Volume and density changes show promise as quantitative parameters for classifying treatment responses of nonspine osseous lesions. Further work is required for clarifying how these metrics can be applied to lesions with both boney and soft tissue components.
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Affiliation(s)
- Samuel Finkelstein
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Srinivas Raman
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Van Der Velden
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Liying Zhang
- 3 Department of Medical Physics, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Tan
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amanpreet Dhillon
- 4 Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Frances Tonolete
- 4 Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Chiu
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Linda Probyn
- 4 Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rachel McDonald
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lee Chin
- 3 Department of Medical Physics, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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40
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Mercier C, Dirix P, Meijnders P, Vermeulen P, Van Laere S, Debois H, Huget P, Verellen D. A phase I dose-escalation trial of stereotactic ablative body radiotherapy for non-spine bone and lymph node metastases (DESTROY-trial). Radiat Oncol 2018; 13:152. [PMID: 30126440 PMCID: PMC6102883 DOI: 10.1186/s13014-018-1096-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/10/2018] [Indexed: 12/31/2022] Open
Abstract
Background In an oligometastatic setting, metastasis-directed treatment could render patients disease free, possibly for a protracted interval. Stereotactic ablative radiotherapy (SABR) is one of the treatment modalities that can be offered to these patients. In addition, the radiobiological qualities of SABR are promising for the use in perceived radioresistant tumours. There is also emerging evidence that SABR can stimulate the immune response, and a specific therapeutic window may exist for the optimal use of radiotherapy as an immune adjuvant. However, when SABR is considered for non-spine bone or lymph node metastases, the optimal fractionation schedule is not yet known. Methods The DESTROY-trial is a non-randomized prospective phase I trial determining a regimen of choice for patients with non-spine bone and lymph node metastases. A total of 90 patients will be included in three different treatment regimens. They will be offered stereotactic ablative radiotherapy in 5, 3 or 1 fractions. Dose-limiting toxicity will be recorded as primary endpoint. Acute and late toxicity, local response and local recurrence, and progression-free survival are secondary endpoints. Liquid biopsies will be collected throughout the course of this study from the second fractionation schedule on. Discussion Despite its almost universal use in (oligo-)metastatic patients, the level of evidence supporting radical local treatment in general, and stereotactic radiotherapy in particular, is low. This prospective phase I trial will evaluate different SABR regimens for metastases and the differences in immune-stimulatory effects. Trial registration The Ethics committee of the GZA Hospitals (B099201732915) approved this study on 05/07/2017. Amendment for translational research was approved on 06/02/2018. Trial registered on Clinicaltrials.gov (NCT03486431) on 03/04/2018 – Retrospectively registered.
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Affiliation(s)
- Carole Mercier
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium. .,University of Antwerp, Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO), Edegem, Antwerp, Belgium.
| | - Paul Meijnders
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium.,University of Antwerp, Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO), Edegem, Antwerp, Belgium
| | - Peter Vermeulen
- Translational Cancer Research Unit, Oncologisch Centrum GZA, Wilrijk, Antwerp, Belgium.,University of Antwerp, Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO), Edegem, Antwerp, Belgium
| | - Steven Van Laere
- Translational Cancer Research Unit, Oncologisch Centrum GZA, Wilrijk, Antwerp, Belgium.,University of Antwerp, Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO), Edegem, Antwerp, Belgium
| | - Hilde Debois
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium
| | - Philippe Huget
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium
| | - Dirk Verellen
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium.,Departement of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Jette, Belgium
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