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Ren S, Li J, Dorado J, Sierra A, González-Díaz H, Duardo A, Shen B. From molecular mechanisms of prostate cancer to translational applications: based on multi-omics fusion analysis and intelligent medicine. Health Inf Sci Syst 2024; 12:6. [PMID: 38125666 PMCID: PMC10728428 DOI: 10.1007/s13755-023-00264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Prostate cancer is the most common cancer in men worldwide and has a high mortality rate. The complex and heterogeneous development of prostate cancer has become a core obstacle in the treatment of prostate cancer. Simultaneously, the issues of overtreatment in early-stage diagnosis, oligometastasis and dormant tumor recognition, as well as personalized drug utilization, are also specific concerns that require attention in the clinical management of prostate cancer. Some typical genetic mutations have been proved to be associated with prostate cancer's initiation and progression. However, single-omic studies usually are not able to explain the causal relationship between molecular alterations and clinical phenotypes. Exploration from a systems genetics perspective is also lacking in this field, that is, the impact of gene network, the environmental factors, and even lifestyle behaviors on disease progression. At the meantime, current trend emphasizes the utilization of artificial intelligence (AI) and machine learning techniques to process extensive multidimensional data, including multi-omics. These technologies unveil the potential patterns, correlations, and insights related to diseases, thereby aiding the interpretable clinical decision making and applications, namely intelligent medicine. Therefore, there is a pressing need to integrate multidimensional data for identification of molecular subtypes, prediction of cancer progression and aggressiveness, along with perosonalized treatment performing. In this review, we systematically elaborated the landscape from molecular mechanism discovery of prostate cancer to clinical translational applications. We discussed the molecular profiles and clinical manifestations of prostate cancer heterogeneity, the identification of different states of prostate cancer, as well as corresponding precision medicine practices. Taking multi-omics fusion, systems genetics, and intelligence medicine as the main perspectives, the current research results and knowledge-driven research path of prostate cancer were summarized.
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Affiliation(s)
- Shumin Ren
- Department of Urology and Institutes for Systems Genetics, West China Hospital, Sichuan University, Chengdu, 610041 China
- Department of Computer Science and Information Technology, University of A Coruña, 15071 A Coruña, Spain
| | - Jiakun Li
- Department of Urology and Institutes for Systems Genetics, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Julián Dorado
- Department of Computer Science and Information Technology, University of A Coruña, 15071 A Coruña, Spain
| | - Alejandro Sierra
- Department of Computer Science and Information Technology, University of A Coruña, 15071 A Coruña, Spain
- IKERDATA S.L., ZITEK, University of Basque Country UPVEHU, Rectorate Building, 48940 Leioa, Spain
| | - Humbert González-Díaz
- Department of Computer Science and Information Technology, University of A Coruña, 15071 A Coruña, Spain
- IKERDATA S.L., ZITEK, University of Basque Country UPVEHU, Rectorate Building, 48940 Leioa, Spain
| | - Aliuska Duardo
- Department of Computer Science and Information Technology, University of A Coruña, 15071 A Coruña, Spain
- IKERDATA S.L., ZITEK, University of Basque Country UPVEHU, Rectorate Building, 48940 Leioa, Spain
| | - Bairong Shen
- Department of Urology and Institutes for Systems Genetics, West China Hospital, Sichuan University, Chengdu, 610041 China
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Liu Y, Ma J, Zeng XY, Zuo ZC, Chen RZ, Li XY, Liang ZG, Chen KH, Pan XB, Pei S, Yu BB, Li L, Qu S, Yang YL, Zhu XD. Efficacy of metastatic lesion radiotherapy in patients with metastatic nasopharyngeal carcinoma: A multicenter retrospective study. Radiother Oncol 2024; 196:110311. [PMID: 38670263 DOI: 10.1016/j.radonc.2024.110311] [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: 09/21/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE We investigated the efficacy of metastatic lesion radiotherapy (MLRT) in patients with metastatic nasopharyngeal carcinoma (mNPC). MATERIALS AND METHODS Patients with mNPC from three institutions were included in this study. Propensity score matching (PSM) was employed to ensure comparability between patient groups. Overall survival (OS) rates were assessed using the Kaplan-Meier method and compared using the log-rank test. Prognostic factors were identified using univariate and multivariate Cox hazard analyses. Subgroup analyses were conducted to assess the effects of MLRT on specific patient populations. RESULTS We analyzed data from 1157 patients with mNPC. Patients who received MLRT had significantly better OS than those who did not, both in the original (28 vs. 21 months) and PSM cohorts (26 vs. 23 months). MLRT was identified as an independent favorable predictor of OS in multivariate analyses, with hazard ratios of 0.67. The subgroup analysis results indicated that radiotherapy effectively treated liver, lung, and bone metastatic lesions, particularly in patients with a limited tumor burden. Higher total radiation doses of MLRT (biologically effective dose (BED) ≥ 56 Gy) were associated with improved OS, while neither radiation technique nor dose fractionation independently influenced prognosis. CONCLUSIONS MLRT offers survival advantages to patients diagnosed with mNPC. Patients with limited metastatic burden derive the most benefit from MLRT, and the recommended regimen for MLRT is a minimum BED of 56 Gy for optimal outcomes.
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Affiliation(s)
- Yang Liu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China
| | - Jie Ma
- Medical Imaging Department, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China
| | - Xiao-Yi Zeng
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou, People's Republic of China
| | - Zhi-Chao Zuo
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, People's Republic of China
| | - Rui-Zhong Chen
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou, People's Republic of China
| | - Xiao-Yu Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China
| | - Zhong-Guo Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China
| | - Kai-Hua Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China
| | - Xin-Bin Pan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China
| | - Su Pei
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China
| | - Bin-Bin Yu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China
| | - Ling Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China; Key Laboratory of Early Prevention and Treatment for Regional High-Incidence-Tumor, Guangxi Medical University, Ministry of Education, Nanning, Guangxi, People's Republic of China
| | - Song Qu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China; Key Laboratory of Early Prevention and Treatment for Regional High-Incidence-Tumor, Guangxi Medical University, Ministry of Education, Nanning, Guangxi, People's Republic of China
| | - Yun-Li Yang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China.
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China; Key Laboratory of Early Prevention and Treatment for Regional High-Incidence-Tumor, Guangxi Medical University, Ministry of Education, Nanning, Guangxi, People's Republic of China; Department of Oncology, Affiliated Wu-Ming Hospital of Guangxi Medical University, Nanning, People's Republic of China.
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Huang S, Jiang F, Cao C, Jin Q, Jin T, Hua Y, Chen X. Long-term efficacy analysis of radiotherapy and local management of metastases in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma: A prospective, single-arm, single-center clinical study. Radiother Oncol 2024; 196:110265. [PMID: 38583720 DOI: 10.1016/j.radonc.2024.110265] [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: 11/02/2023] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE We conducted a single-center, single-arm study (NCT03129412) to prospectively analyze the long-term outcomes of newly diagnosed patients with oligometastatic nasopharyngeal carcinoma (NPC) who received radical radiotherapy and local treatment of metastases. PATIENTS AND METHODS Patients who reached disease controll after platinum-based palliative chemotherapy continued to receive radical radiotherapy for the nasopharyngeal region and neck. Appropriate local treatments were selected to treat the metastatic lesions. The primary endpoint of this study was overall survival (OS) and the secondary endpoint was progression-free survival (PFS). RESULTS Fifty-one patients were included in the final analysis. During a median follow-up of 60 months, the median OS and PFS were 53.87 and 24.23 months, respectively. The 1-year, 3-year, and 5-year PFS and OS rates were 76.5 %, 38.1 %, and 31.8 % and 98 %, 75.4 %, 45.6 %, respectively. Both single and multivariate analysis indicated that maintenance therapy after radiotherapy could significantly increase PFS (36.43 vs. 16.1 months, P = 0.005). The OS of patients with single organ metastasis was significantly better than that of patients with double organ metastasis (P = 0.001). In addition, the number of metastatic organs also significantly affected PFS in the multifactor analysis. CONCLUSION Patients with newly diagnosed oligometastatic NPC can achieve long-term survival after receiving radical radiotherapy to the primary site and local treatment for metastases.
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Affiliation(s)
- Shuang Huang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Key Laboratory of Radiation Oncology of Zhejiang Province; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, China
| | - Feng Jiang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Key Laboratory of Radiation Oncology of Zhejiang Province; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, China
| | - Caineng Cao
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Key Laboratory of Radiation Oncology of Zhejiang Province; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, China
| | - Qifeng Jin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Key Laboratory of Radiation Oncology of Zhejiang Province; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, China
| | - Ting Jin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Key Laboratory of Radiation Oncology of Zhejiang Province; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, China
| | - Yonghong Hua
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Key Laboratory of Radiation Oncology of Zhejiang Province; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, China
| | - Xiaozhong Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China; Key Laboratory of Radiation Oncology of Zhejiang Province; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, China.
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Rodríguez MCR, Chen-Zhao X, Hernando O, Flamarique S, Fernández-Letón P, Campo M, López M, Rodríguez M, Zucca D, Martínez D, Sánchez-Saugar E, Mañeru F, Ruiz-Zorrilla JG, de Acilu PG, Valero J, Montero A, Ciérvide R, Alvarez B, García-Aranda M, Alonso R, de la Casa MA, Alonso L, Nuñez M, Martí J, Arias F. SBRT-SG-01: final results of a prospective multicenter study on stereotactic body radiotherapy for liver metastases. Clin Transl Oncol 2024; 26:1790-1797. [PMID: 38431539 DOI: 10.1007/s12094-024-03403-w] [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: 12/22/2023] [Accepted: 02/01/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE This study aimed to assess the efficacy and tolerability of stereotactic body radiation therapy (SBRT) for the treatment of liver metastases. METHODS Patients with up to 5 liver metastases were enrolled in this prospective multicenter study and underwent SBRT. Efficacy outcomes included in-field local control (LC), progression-free survival (PFS), and overall survival (OS). Acute and late toxicities were evaluated using CTCAE v.4.0. RESULTS A total of 52 patients with 105 liver metastases were treated between 2015 and 2018. The most common primary tumor was colorectal cancer (72% of cases). Liver metastases were synchronous with the primary tumor diagnosis in 24 patients (46.2%), and 21 patients (40.4%) presented with other extrahepatic oligometastases. All patients underwent intensity-modulated radiation therapy (IMRT)/volumetric-modulated arc therapy (VMAT) with image-guided radiation therapy (IGRT) and respiratory gating, and a minimum biologically effective dose (BED10Gy) of 100 Gy was delivered to all lesions. With a median follow-up of 23.1 months (range: 13.4-30.9 months) since liver SBRT, the median actuarial local progression-free survival (local-PFS) was not reached. The actuarial in-field LC rates were 84.9% and 78.4% at 24 and 48 months, respectively. The median actuarial liver-PFS and distant-PFS were 11 and 10.8 months, respectively. The actuarial median overall survival (OS) was 27.7 months from SBRT and 52.5 months from metastases diagnosis. Patients with lesion diameter ≤ 5 cm had significantly better median liver-PFS (p = 0.006) and OS (p = 0.018). No acute or late toxicities of grade ≥ 3 were observed. CONCLUSIONS This prospective multicenter study confirms that liver SBRT is an effective alternative for the treatment of liver metastases, demonstrating high rates of local control and survival while maintaining a low toxicity profile.
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Affiliation(s)
| | - Xin Chen-Zhao
- Radiation Oncology, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Ovidio Hernando
- Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Sonia Flamarique
- Radiation Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Pedro Fernández-Letón
- Medical Physics, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Maider Campo
- Radiation Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Mercedes López
- Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Maitane Rodríguez
- Radiation Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Daniel Zucca
- Medical Physics, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Daniel Martínez
- Medical Physics, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Emilio Sánchez-Saugar
- Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Fernando Mañeru
- Medical Physics, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Paz García de Acilu
- Medical Physics, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Jeannette Valero
- Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Angel Montero
- Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Raquel Ciérvide
- Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Beatriz Alvarez
- Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Mariola García-Aranda
- Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Rosa Alonso
- Radiation Oncology, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | | | - Leyre Alonso
- Medical Physics, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Mónica Nuñez
- Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Jaime Martí
- Medical Physics, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Fernando Arias
- Radiation Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
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Choi SH, Lee BM, Kim J, Kim DY, Seong J. Efficacy of stereotactic ablative radiotherapy in patients with oligometastatic hepatocellular carcinoma: A phase II study. J Hepatol 2024; 81:84-92. [PMID: 38467379 DOI: 10.1016/j.jhep.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND & AIMS Stereotactic ablative radiotherapy (SABR) can extend survival and offers the potential for cure in some patients with oligometastatic disease (OMD). However, limited evidence exists regarding its use in oligometastatic hepatocellular carcinoma (HCC). We aimed to prospectively investigate the efficacy and safety of SABR in patients with oligometastatic HCC. METHODS We enrolled patients with controlled primary HCC and one to five metastatic lesions amenable to SABR. The primary endpoint was treatment efficacy defined as overall survival (OS) and progression-free survival (PFS). The secondary endpoints included time to local progression, objective response rate, disease control rate, toxicities, and quality of life (QOL), assessed using the EORTC QLQ-C30 before, and 0, 1, and 3 months after SABR. RESULTS Overall, 40 consecutive patients received SABR on 62 lesions between 2021 and 2022. The most common locations for OMD were the lungs (48.4%), lymph nodes (22.6%), and bone (17.7%). After a median follow-up of 15.5 months, the 2-year OS was 80%. Median PFS was 5.3 months, with 1- and 2-year PFS rates of 21.2% and 0%, respectively. A shorter time to OMD from the controlled primary independently correlated with PFS (p = 0.039, hazard ratio 2.127) alongside age, Child-Pugh class, and alpha-fetoprotein (p = 0.002, 0.004, 0.019, respectively). The 2-year time to local progression, objective response rate, and disease control rate were 91.1%, 75.8%, and 98.4%, respectively. Overall, 10% of patients experienced acute toxicity, and 7.5% experienced late toxicity, with no grade 3+ toxicity. All QOL scores remained stable, whereas the patients without systemic treatments had improved insomnia and social functioning scores. CONCLUSIONS SABR is an effective and feasible option for oligometastatic HCC that leads to excellent local tumor control and improves survival without adversely affecting QOL. IMPACT AND IMPLICATIONS Stereotactic ablative radiotherapy (SABR) is a non-invasive treatment approach capable of efficiently ablating the target lesion; however, neither the oligometastatic disease concept nor the potential benefits of SABR have been well-defined in hepatocellular carcinoma (HCC). According to this study, SABR is an effective and safe treatment option for oligometastatic HCC, yielding excellent local tumor control and survival improvement without worsening patients' quality of life, regardless of tumor sites. We also demonstrated that patients with a later presentation of OMD from the controlled primary and lower alpha-fetoprotein levels achieved better survival outcomes. This is the first prospective study of SABR in oligometastatic HCC, providing insights for the development of novel strategies to improve oncologic outcomes. CLINICAL TRIAL NUMBER NCT05173610.
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Affiliation(s)
- Seo Hee Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Min Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jina Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Joo B, Kim JH, Ahn SG, Park M, Suh SH, Ahn SJ. De novo versus recurrent metastatic breast cancer affects the extent of brain metastases. J Neurooncol 2024:10.1007/s11060-024-04735-x. [PMID: 38865012 DOI: 10.1007/s11060-024-04735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/01/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE We aimed to identify factors associated with the extent of brain metastases in patients with breast cancer to help distinguish brain oligometastases (1-4 brain metastases) from extensive metastases (5 or more brain metastases). METHODS This retrospective observational study included 100 female patients diagnosed with brain metastases from breast cancer at a single institution between January 2011 and April 2022. Patient demographics and tumor characteristics were compared between the brain oligometastases group and the extensive metastases group. Multivariable logistic regression analysis was performed to determine the independent factors, including age at initial diagnosis, initial stage, breast cancer subtype, detection time of brain metastases, and de novo or recurrent status of the metastatic disease. In a subgroup analysis of patients with brain oligometastases, demographic and tumor characteristics were compared between patients with single and two-four brain metastases. RESULTS Of the 100 patients, 56 had brain oligometastases, while 44 had extensive brain metastases. The multivariable logistic regression analysis revealed that only the de novo/recurrent status of metastatic breast cancer was significantly associated with the extent of brain metastasis (p = 0.023). In the subgroup analysis of 56 patients with brain oligometastases, those diagnosed at an earlier stage were more likely to have a single brain metastasis (p = 0.008). CONCLUSION Patients with de novo metastatic breast cancer are more likely to develop extensive brain metastases than those with recurrent metastatic breast cancer. This insight could influence the development of tailored approaches for monitoring and treating brain metastases, supporting the potential advantages of routine brain screening for patients newly diagnosed with stage IV breast cancer.
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Affiliation(s)
- Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Jee Hung Kim
- Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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Wu Y, Yi M, Niu M, Zhou B, Mei Q, Wu K. Beyond success: unveiling the hidden potential of radiotherapy and immunotherapy in solid tumors. Cancer Commun (Lond) 2024. [PMID: 38837878 DOI: 10.1002/cac2.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/06/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024] Open
Abstract
Immunotherapy, particularly with immune checkpoint inhibitors, has significantly transformed cancer treatment. Despite its success, many patients struggle to respond adequately or sustain long-lasting clinical improvement. A growing consensus has emerged that radiotherapy (RT) enhances the response rate and overall efficacy of immunotherapy. Although combining RT and immunotherapy has been extensively investigated in preclinical models and has shown promising results, establishing itself as a dynamic and thriving area of research, clinical evidence for this combination strategy over the past five years has shown both positive and disappointing results, suggesting the need for a more nuanced understanding. This review provides a balanced and updated analysis of the combination of immunotherapy and RT. We summarized the preclinical mechanisms through which RT boosts antitumor immune responses and mainly focused on the outcomes of recently updated clinical trials, including those that may not have met expectations. We investigated the optimization of the therapeutic potential of this combined strategy, including key challenges, such as fractionation and scheduling, lymph node irradiation, and toxicity. Finally, we offered insights into the prospects and challenges associated with the clinical translation of this combination therapy, providing a realistic perspective on the current state of research and potential future directions.
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Affiliation(s)
- Yuze Wu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Ming Yi
- Department of Breast Surgery, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, P. R. China
| | - Mengke Niu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Binghan Zhou
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Qi Mei
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Kongming Wu
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, P. R. China
- Cancer Center, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
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Zarba M, Fujiwara R, Yuasa T, Koga F, Heng DYC, Takemura K. Multidisciplinary systemic and local therapies for metastatic renal cell carcinoma: a narrative review. Expert Rev Anticancer Ther 2024:1-11. [PMID: 38813778 DOI: 10.1080/14737140.2024.2362192] [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: 03/31/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Systemic and local therapies for patients with metastatic renal cell carcinoma (mRCC) are often challenging despite the evolution of multimodal cancer therapies in the last decade. In this review, we will focus on recent multidisciplinary approaches for patients with mRCC. AREAS COVERED Systemic therapies for patients with mRCC have been garnering attention particularly after the approval of immuno-oncology (IO) agents, including anti-programmed death 1/programmed death-ligand 1. IO combinations have significantly prolonged overall survival in patients with mRCC in the first-line setting. Regarding local therapies, cytoreductive nephrectomy (CN) has become less common in the post-Cancer du Rein Metastatique Nephrectomie et Antiangiogéniques (CARMENA) trial era, even though CN may still benefit selected patients with mRCC. In addition, metastasis-directed local therapies, namely metastasectomy or stereotactic radiotherapy, particularly for oligo-metastatic lesions or brain metastases, may have a prognostic impact. Several ablative techniques are also evolving while maintaining high local control rates with acceptable safety. EXPERT OPINION Multimodal cancer therapies are essential for conquering complex cases of mRCC. Modern systemic therapies including IO-based combination therapy as well as local therapies including CN, metastasectomy, stereotactic radiotherapy, and ablative techniques appear to improve oncologic outcomes of patients with mRCC, although appropriate patient selection is indispensable.
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Affiliation(s)
- Martin Zarba
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Ryo Fujiwara
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Yuasa
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Daniel Y C Heng
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Kosuke Takemura
- Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Tankel J, Sakalla R, Boukhili N, Dehghani M, Spicer J, Najmeh S, Cools-Lartigue J, Asselah J, Soldera S, Alcindor T, Alfieri J, David M, Mueller C, Ferri L. Survival in esophageal cancer with nonregional lymphadenopathy: a propensity score-matched analysis. J Gastrointest Surg 2024; 28:916-922. [PMID: 38574965 DOI: 10.1016/j.gassur.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/23/2024] [Accepted: 03/30/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Survival among patients with esophageal cancer with stage IV nonregional lymphadenopathy treated with neoadjuvant therapy and surgical resection is not well described. This study aimed to compare the survival outcomes of patients with nonregional lymphadenopathy with a propensity-matched cohort of patients with locoregional disease. METHODS This was a retrospective cohort analysis of a prospectively maintained database from a regional upper gastrointestinal cancer network in Quebec, Canada. From January 2010 to December 2022, patients with radiologically suspicious nonregional retroperitoneal or supraclavicular lymphadenopathy were identified. Using 1:1 propensity score matching, a control group without nonregional disease was created. RESULTS Of the 1235 patients identified, 39 met the inclusion criteria and were allocated to the study group of whom 35 of 39 (89%) had adenocarcinoma. Retroperitoneal and supraclavicular lymphadenopathy occurred in 26 of 39 patients (67%) and 13 of 39 patients (33%). Of the 39 patients, 34 (87%) received neoadjuvant chemotherapy, and 5 (13%) received chemoradiotherapy. After resection, ypN0 of nonregional lymph node stations occurred in 21 of 39 patients (54%). When comparing the study group with a matched non-stage IV control group, the median overall survival was similar in patients with retroperitoneal lymphadenopathy (21.0 months [95% CI, 8.0-21.0] vs 27.0 months [95% CI, 13.0-41.0]; P = .262) but not with supraclavicular disease (13.0 months; 95% CI, 8.0-18.0; P = .039). The median follow-up intervals were 40.1 months (95% CI, 1.0-83.0) for the study group and 70.0 (95% CI, 33.0-106.0) for the control groups. CONCLUSION Compared with a matched cohort of patients with similar disease burden but not stage IV disease, retroperitoneal lymphadenopathy did not negatively affect survival outcomes. Multimodal curative intent therapy may be appropriate in select cases.
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Affiliation(s)
- James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rawan Sakalla
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Neyla Boukhili
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mehrnoush Dehghani
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Najmeh
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jamil Asselah
- Division of Medical Oncology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Soldera
- Division of Medical Oncology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thierry Alcindor
- Division of Medical Oncology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joanne Alfieri
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc David
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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10
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Hompland I, Boye K, Wiedswang AM, Papakonstantinou A, Røsok B, Joensuu H, Bruland Ø. Discontinuation of imatinib in patients with oligometastatic gastrointestinal stromal tumour who are in complete radiological remission: a prospective multicentre phase II study. Acta Oncol 2024; 63:288-293. [PMID: 38712513 DOI: 10.2340/1651-226x.2024.39851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/16/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Metastatic gastrointestinal stromal tumour (GIST) is considered incurable, and life-long treatment with tyrosine kinase inhibitors is recommended. We investigated whether selected patients with metastatic GIST may remain in durable remission despite imatinib discontinuation. PATIENTS In this 1-group, prospective, multicentre phase II trial selected patients with oligometastatic (≤3 metastases) GIST discontinued imatinib treatment. Eligible patients had been treated with imatinib >5 years without progression and had no radiologically detectable metastases after metastasectomy, radiofrequency ablation (RFA) or complete response to imatinib. The primary endpoint was progression-free survival (PFS) 3-years after stopping imatinib. Overall survival (OS) and quality of life (QoL) were secondary endpoints. RESULTS The trial closed prematurely due to slow accrual. Between January 5, 2017, and June 5, 2019, 13 patients were enrolled, of whom 12 discontinued imatinib. The median follow-up time was 55 months (range, 36 to 69) after study entry. Five (42%) of the 12 eligible patients remained progression free, and seven (58%) progressed with a median time to progression 10 months. Median PFS was 23 months and the estimated 3-year PFS 41%. Six of the seven patients who progressed restarted imatinib, and all six responded. Three-year OS was 100%, and all patients were alive at the time of the study analysis. QoL measured 5 and 11 months after discontinuation of imatinib demonstrated improvement compared to the baseline. INTERPRETATION A substantial proportion of selected patients with oligometastatic GIST treated with imatinib and metastasis surgery/RFA may remain disease-free for ≥3 years with improved QoL after stopping of imatinib.
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Affiliation(s)
- Ivar Hompland
- Department of Oncology, Oslo University Hospital, Oslo, Norway.
| | - Kjetil Boye
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Andri Papakonstantinou
- Department of Breast Cancer, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Bård Røsok
- Department of Hepato-Pancreatic-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Heikki Joensuu
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Øyvind Bruland
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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11
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Wang M, Jing X, Chen F, Lu S, Sun Y. Immune checkpoint inhibitor (ICI)-based treatment beyond progression with prior immunotherapy in patients with driver-gene negative advanced non-small cell lung cancer. BMC Cancer 2024; 24:569. [PMID: 38714983 PMCID: PMC11075238 DOI: 10.1186/s12885-024-12315-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND No definite conclusion has yet to be reached for immunotherapy beyond progression(IBP) of first-line immunotherapy as the second-line treatment for advanced NSCLC patients with negative driver genes. Therefore a retrospective study was conducted to evaluate the efficacy of IBP in this population and investigated whether the cycles best response and progressive mode of first-line immunotherapy could affect the results. PATIENTS AND METHODS The clinical data of patients with advanced NSCLC whose response was evaluated as progressive disease (PD) after receiving a PD-1/PD-L1 inhibitors as first-line therapy were retrospectively collected and the patients were assigned to the IBP and non-IBP groups. The overall survival (OS), progression-free survival (PFS) were evaluated between the two groups. The survival effects of cycles best response and progressive mode of first-line immunotherapy were also evaluated. RESULTS Between January 2019 and January 2022, a total of 121 patients was evaluated as PD after first-line immunotherapy in our institution; 53 (43.8%) patients were included in the IBP group and 68 (56.2%) patients were included in the non-IBP group. The OS and PFS were no significantly different between the two groups in whole population. Further analysis revealed the OS was prolonged with the prolongation of first-line medication cycle. The median OS was 15.4m (15.4 vs 10.8 p=0.047) 16.1m (16.1 vs 10.8 p=0.039), 16.3m (16.3 vs 10.9 p=0.029) for patients with ≥4, ≥6, ≥8 cycles in first-line immunotherapy, respectively. The advantages of OS and PFS were also seen in the subgroup of PR (best response) and oligo progression of first-line immunotherapy. CONCLUSIONS The clinical outcomes of IBP were similar to those of non-IBP in patients with PD after first-line immnuotherapy in advanced NSCLC. But more cycles, PR as best response and oligo progression in first-line was benefit.
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Affiliation(s)
- Min Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Xuquan Jing
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Feihu Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Shuangqing Lu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Yulan Sun
- Department of Medical Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
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12
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Zhang S, Xiong X, Xie N, Zheng W, Li Y, Lin T, Wei Q, Tan P. The efficacy and safety of stereotactic body radiotherapy combined with systematic therapy for metastatic renal cell carcinoma: a systematic review and meta-analysis. MedComm (Beijing) 2024; 5:e544. [PMID: 38660686 PMCID: PMC11042534 DOI: 10.1002/mco2.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
There is considerable interest in the potential of stereotactic body radiation therapy (SBRT) combined with systemic therapy such as tyrosine kinase inhibitors (TKIs) or immune checkpoint inhibitors (ICIs). However, its efficacy and safety remain unclear. The purpose of this study was to evaluate the efficacy and safety of conducting SBRT during ICI or TKI treatment in different disease settings for patients with metastatic renal cell carcinoma (mRCC). A total of 16 studies were ultimately included. Under the random effects model, the pooled 1-year local control rate (1-yr LCR) and objective response rate (ORR) were 90% (95% confidence interval [CI]: 80%-95%, I 2 = 67%) and 52% (95% CI: 37%-67%, I 2 = 90%), respectively. SBRT concomitant with different systemic therapy yield significant different 1-yr LCR (p < 0.01) and ORR (p = 0.02). Regarding survival benefits, the pooled 1-year progression-free survival (1-yr PFS) and 1-year overall survival (1-yr OS) rates were 45% (95% CI: 29%-62%, I 2 = 91%) and 85% (95% CI: 76%-91%, I 2 = 66%), respectively. 1-yr PFS and 1-yr OS in different disease settings demonstrated significant difference (p < 0.01). As for toxicity, the pooled incidence of grade 3-4 adverse events was 14% (95% CI: 5%-26%, I 2 = 90%). This study highlights the feasibility of utilizing these strategies in mRCC patients, especially those with a low metastatic tumor burden.
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Affiliation(s)
- Shiyu Zhang
- Department of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Xingyu Xiong
- Department of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Nan Xie
- Emergency Department of West China Hospital, West China School of Nursing, Sichuan universityChengduChina
- Nursing Key Laboratory of Sichuan ProvinceSichuan UniversityChengduChina
| | - Weitao Zheng
- Department of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Yongjun Li
- West China School of MedicineWest China HospitalSichuan UniversityChengduChina
| | - Tianhai Lin
- Department of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Qiang Wei
- Department of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Ping Tan
- Department of UrologyWest China Hospital, Sichuan UniversityChengduChina
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13
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Chamois J, Septans A, Schipman B, Gross E, Blanchard N, Passerat V, Debelleix C, Hemery C, Latorzeff I, Pointreau Y. Metastases-directed radiotherapy in castration resistant oligo metastatic prostate cancer: A multicentric retrospective study from the French group COLib. Clin Transl Radiat Oncol 2024; 46:100762. [PMID: 38572302 PMCID: PMC10987832 DOI: 10.1016/j.ctro.2024.100762] [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: 09/07/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024] Open
Abstract
Oligometastases are defined as a number of detectable metastases less or equal to 5. In castrate-resistant oligo metastatic prostate Cancer (CR oligoM PC), Metastases-Directed Ablative radiotherapy (MDRT) is poorly investigated. Our study retrospectively reviewed the cases of CR oligoM PC treated with MDRT in 8 French high-volume radiotherapy centers. OS and PFS are defined as the delay between the first day of MDRT and death (OS) or progression according to PCWG criteria (PFS). OS and PFS are evaluated according to Kaplan Meyer, curves are compared with log rank test. Logistic regression was used to identify predictive factors for outcome: bone versus node metastasis, ISUP grade, PSA doubling Time (PSADT) at the time of MDRT, time to castration resistance. 107 patients were included in the study, among those 197 metastases received MDRT. For the overall population, the median follow-up was 25.2 months (1,4-145). OS was 93 % at 2 years and 81,4% at 3 years. At 2 years, 100 % of patients with node-only metastasis were alive versus 88,7% among those who have bone metastases (p = 0,72). The median PFS was 12,6 months (IC 95 % [9,6; 17]), with no difference among patients with node only disease versus the rest of the cohort. The PFS was 18,2 months (10,0; 32,4) in patients with PSADT >6 months versus 10,7 months (8,9; 14,3) when PSADT was inferior to 6 months. However, this difference did not reach significant. We did not find a correlation neither between ISUP grade (1-2 versus 3-4-5) and PFS, nor between hormone-sensitivity duration and PFS. Patients receiving MDRT for CR oligoM PC have a good prognosis with 81,6% OS at 3 years. PSA DT longer than 6 months could be related to better PFS. MDRT strategy could postpone the onset of new systemic treatment with median PFS >1 year.
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Affiliation(s)
- J. Chamois
- Centre Hospitalier privé, Saint Grégoire, France
| | | | - B. Schipman
- Radiotherapie, Institut de Cancerologie de Bourgogne, Dijon, France
| | - E. Gross
- Radiotherapie, Hopital prive Clairval – Ramsay Sante, Marseille, France
| | - N. Blanchard
- Radiotherapie, Centre de Cancerologie les Dentellieres, Valenciennes, France
| | | | - C. Debelleix
- Radiotherapie, Clinique, Bordeaux Tivoli- Ducos, Bordeaux, France
| | | | - I. Latorzeff
- Radiotherapie, Clinique Pasteur, Toulouse, France
| | - Y. Pointreau
- Radiotherapie, Institut Interrégional de Cancerologie, Le Mans, France
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14
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Calleris G, von Deimling M, Kesch C, Soria F, Gontero P, Ploussard G, Laukhtina E, Pradere B. Definitions, outcomes and perspectives for oligometastatic bladder cancer: towards a standardized terminology. Curr Opin Urol 2024; 34:217-224. [PMID: 38426242 DOI: 10.1097/mou.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW Oligometastatic (om) cancer is considered as a transitional state in between locally confined disease and widespread metastases, accessible to a multimodal treatment, combining systemic and local therapy. In urothelial bladder cancer (BCa), the definitions and the approaches to this condition are poorly standardised and mainly based on retrospective data. We aim to portray the framework for uro-oncologic terminology in omBCa and go through the latest evidence and the future perspectives. RECENT FINDINGS Retrospective and registry data support the potential benefits of multimodality treatment for carefully selected omBCa patients, especially following a good response to systemic treatment. In 2023, a Delphi consensus has defined omBCa, allowing maximum three metastatic lesions, theoretically amenable to radical local treatment. In de-novo omBCa, surgical treatment of primary tumour might improve overall survival (OS), according to a matched registry analysis; also, consolidative radiotherapy was associated with better OS in two recent cohorts. Furthermore, metastasis-directed therapy (MDT) has shown high local control rates and promising OS (14.9-51 months) in a meta-analysis; benefits might be more pronounced for single-site omBCa and nodal or lung lesions. SUMMARY From a clinical perspective, in de-novo omBCa, the local treatment of primary and metastatic sites might improve disease control and survival, in selected patients; in the oligorecurrent setting, MDT achieves good local symptom control with limited side effects; in selected cases, it could convey a survival benefit, too. From a research perspective, well designed prospective evidence is eagerly awaited, based on recently adopted shared definitions for omBCa.
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Affiliation(s)
- Giorgio Calleris
- Department of Urology UROSUD, La Croix du Sud Hospital, Quint-Fonsegrives, France
- Polytechnic and University of Turin, Turin, Italy
| | - Markus von Deimling
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Claudia Kesch
- Department of Urology UROSUD, La Croix du Sud Hospital, Quint-Fonsegrives, France
- Department of Urology and West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Guillaume Ploussard
- Department of Urology UROSUD, La Croix du Sud Hospital, Quint-Fonsegrives, France
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Benjamin Pradere
- Department of Urology UROSUD, La Croix du Sud Hospital, Quint-Fonsegrives, France
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15
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Boggi U, Kauffmann EF, Napoli N, Barreto SG, Besselink MG, Fusai GK, Hackert T, Hilal MA, Marchegiani G, Salvia R, Shrikhande SV, Truty M, Werner J, Wolfgang C, Bannone E, Capretti G, Cattelani A, Coppola A, Cucchetti A, De Sio D, Di Dato A, Di Meo G, Fiorillo C, Gianfaldoni C, Ginesini M, Hidalgo Salinas C, Lai Q, Miccoli M, Montorsi R, Pagnanelli M, Poli A, Ricci C, Sucameli F, Tamburrino D, Viti V, Cameron J, Clavien PA, Asbun HJ. REDISCOVER guidelines for borderline-resectable and locally advanced pancreatic cancer: management algorithm, unanswered questions, and future perspectives. Updates Surg 2024:10.1007/s13304-024-01860-0. [PMID: 38684573 DOI: 10.1007/s13304-024-01860-0] [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: 03/08/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
The REDISCOVER guidelines present 34 recommendations for the selection and perioperative care of borderline-resectable (BR-PDAC) and locally advanced ductal adenocarcinoma of the pancreas (LA-PDAC). These guidelines represent a significant shift from previous approaches, prioritizing tumor biology over anatomical features as the primary indication for resection. Condensed herein, they provide a practical management algorithm for clinical practice. However, the guidelines also highlight the need to redefine LA-PDAC to align with modern treatment strategies and to solve some contradictions within the current definition, such as grouping "difficult" and "impossible" to resect tumors together. Furthermore, the REDISCOVER guidelines highlight several areas requiring urgent research. These include the resection of the superior mesenteric artery, the management strategies for patients with LA-PDAC who are fit for surgery but unable to receive multi-agent neoadjuvant chemotherapy, the approach to patients with LA-PDAC who are fit for surgery but demonstrate high serum Ca 19.9 levels even after neoadjuvant treatment, and the optimal timing and number of chemotherapy cycles prior to surgery. Additionally, the role of primary chemoradiotherapy versus chemotherapy alone in LA-PDAC, the timing of surgical resection post-neoadjuvant/primary chemoradiotherapy, the efficacy of ablation therapies, and the management of oligometastasis in patients with LA-PDAC warrant investigation. Given the limited evidence for many issues, refining existing management strategies is imperative. The establishment of the REDISCOVER registry ( https://rediscover.unipi.it/ ) offers promise of a unified research platform to advance understanding and improve the management of BR-PDAC and LA-PDAC.
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Affiliation(s)
- Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Via Savi 10, 56126, Pisa, PI, Italy.
| | - Emanuele F Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Via Savi 10, 56126, Pisa, PI, Italy
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Via Savi 10, 56126, Pisa, PI, Italy
| | - S George Barreto
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Division of Surgery and Perioperative Medicine, Flinders Medical Center, Beadfor Park, Australia
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Marchegiani
- Hepatopancreatobiliary and Liver Transplant Surgery, Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Shailesh V Shrikhande
- Tata Memorial Centre, Gastrointestinal and HPB Service, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mark Truty
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, LMU, University of Munich, Munich, Germany
| | - Christopher Wolfgang
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Elisa Bannone
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Alice Cattelani
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | | | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Davide De Sio
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Armando Di Dato
- Division of General and Transplant Surgery, University of Pisa, Via Savi 10, 56126, Pisa, PI, Italy
| | - Giovanna Di Meo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari, Bari, Italy
| | - Claudio Fiorillo
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cesare Gianfaldoni
- Division of General and Transplant Surgery, University of Pisa, Via Savi 10, 56126, Pisa, PI, Italy
| | - Michael Ginesini
- Division of General and Transplant Surgery, University of Pisa, Via Savi 10, 56126, Pisa, PI, Italy
| | | | - Quirino Lai
- Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umberto I of Rome, Rome, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Montorsi
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Andrea Poli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Ricci
- Division of Pancreatic Surgery, Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, IRCCS, Azienda Ospedaliero-Universitaria di Bologna (IRCCS AOUBO), Bologna, Italy
| | - Francesco Sucameli
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Domenico Tamburrino
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Virginia Viti
- Division of General and Transplant Surgery, University of Pisa, Via Savi 10, 56126, Pisa, PI, Italy
| | - John Cameron
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Horacio J Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
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16
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Matsumoto C, Iwatsuki M, Morinaga T, Horinouchi T, Hara Y, Baba Y, Miyamoto Y, Yoshida N, Baba H. The relationship between the treatment course and prognosis of oligometastasis after esophageal squamous cell carcinoma resection. Surg Today 2024:10.1007/s00595-024-02803-3. [PMID: 38583108 DOI: 10.1007/s00595-024-02803-3] [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: 10/02/2023] [Accepted: 01/04/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE The concept of oligometastasis, which represents limited metastatic disease, has recently gained interest, accompanied by a more detailed classification. This study aims to investigate the relationship between the treatment course and prognosis in patients with a recurrence of esophageal squamous cell carcinoma (ESCC) after curative esophagectomy. METHODS 126 patients with ESCC recurrence after curative resection were enrolled in this study. Oligometastasis was defined as fewer than five recurrences in a single organ. Patients were classified as having oligometastatic recurrence (OLR) or polymetastatic recurrence (PLR). Patients were further classified into four subgroups according to lesion progression: persistent oligorecurrence (PER-OLR), converted polyrecurrence (CON-PLR), induced oligorecurrence (IND-OLR), and persistent polyrecurrence (PER-PLR). We analyzed the relationship between the recurrence patterns and prognosis according to the progression of oligometastatic lesions. RESULTS OLR was identified in 58 (46%) of 126 patients with recurrence. Patients with OLR had a significantly better prognosis than those with PLR (P < 0.0001). A further subgroup analysis revealed that patients who underwent IND-OLR had a similar prognosis to those who underwent PER-OLR. CONCLUSIONS This study suggests that OLR is a prognostic factor after recurrence following resection of ESCC and that PLR can be converted to OLR by therapeutic intervention to achieve a long-term survival.
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Affiliation(s)
- Chihiro Matsumoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Takeshi Morinaga
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tomo Horinouchi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshihiro Hara
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Morozov A, Chuvalov L, Taratkin M, Enikeev M, Rapoport L, Singla N, Barret E, Poddubskaya E, Borodina M, Salomon G, Rivas JG, Enikeev D. A systematic review of cytoreductive prostatectomy outcomes and complications in oligometastatic disease. Asian J Urol 2024; 11:208-220. [PMID: 38680575 PMCID: PMC11053306 DOI: 10.1016/j.ajur.2022.03.017] [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: 11/23/2021] [Revised: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To analyze outcomes and complications of cytoreductive prostatectomy (CRP) for oligometastatic prostate cancer (PCa) in order to elucidate its role in this space. Methods We performed a systematic literature search using three databases (Medline, Scopus, and Web of Science). The primary endpoints were oncologic outcomes. The secondary endpoints were complication rates and functional results. Results In all studies, overall survival was better or at least comparable variable in the groups with CRP compared to no local treatment. The greatest benefit from CRP in 5-year overall survival in one study was 67.4% for CRP versus 22.5% for no local treatment. Cancer-specific survival (CSS) showed the same trend. Several authors found significant benefits from CSS in the CRP group: from 79% vs. 46% to 100% vs. 61%. CRP was a predictor of better CSS (hazard ratio 0.264, p=0.004). Positive surgical margin rates differed widely from 28.6% to 100.0%. Urinary continence in CRP versus RP for localized PCa was significantly lower (57.4% vs. 90.8%, p<0.0001). Severe incontinence occurred seldom (2.5%-18.6%). Total complication rates after CRP differed widely, from 7.0% to 43.6%. Rates of grades 1 and 2 events prevailed. Patients on ADT alone also showed a considerable number of complications varying from 5.9% to 57.7%. Conclusion CRP improves medium-term cancer control in patients with oligometastatic PCa. The morbidity and complication rates of this surgery are comparable with other approaches, but postoperative incontinence rate is higher compared with RP for localized disease.
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Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Leonid Chuvalov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Young Academic Urologists, EAU, the Netherlands
| | - Mikhail Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nirmish Singla
- Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Maria Borodina
- Hertsen Moscow Oncology Research Institute, Moscow, Russia
| | - Georg Salomon
- Martini Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Juan Gomez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Medical University of Vienna, Vienna, Austria
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18
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Rim CH, Cho WK, Lee JH, Kim YS, Suh YG, Kim KH, Chang AR, Chie EK, Ahn YC. Radiation Oncologists' Perspectives on Oligometastatic Disease: A Korean Survey Study. Cancer Res Treat 2024; 56:414-421. [PMID: 37997326 PMCID: PMC11016661 DOI: 10.4143/crt.2023.876] [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: 07/25/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE Perspectives of radiation oncologists on oligometastatic disease was investigated using multi-layered survey. MATERIALS AND METHODS Online survey on the oligometastatic disease was distributed to the board-certified regular members of the Korean Society for Radiation Oncology. The questionnaire consisted of four domains: five questions on demographics; five on the definition of oligometastatic disease; four on the role of local therapy; and three on the oligometastatic disease classification, respectively. RESULTS A total of 135 radiation oncologists participated in the survey. The median length of practice after board certification was 22.5 years (range, 1 to 44 years), and the vast majority (94.1%) answered affirmatively to the clinical experience in oligometastatic disease management. Nearly two-thirds of the respondents considered the number of involved organs as an independent factor in defining oligometastasis. Most frequently perceived upper limit on the numerical definition of oligometastasis was 5 (64.2%), followed by 3 (26.0%), respectively. Peritoneal and brain metastasis were nominated as the sites to be excluded from oligometastastic disease by 56.3% and 12.6% of the participants, respectively. Vast majority (82.1%) agreed on the role of local treatment in the management of oligometastatic disease. Majority (72%) of the participants acknowledged the European Society for Radiotherapy and Oncology (ESTRO)-European Organisation for Research and Treatment of Cancer (EORTC) classification of oligometastatic disease, however, only 43.3% answered that they applied this classification in their clinical practice. Underlying reasons against the clinical use were 'too complicated' (66.0%), followed by 'insufficient supporting evidence' (30.0%), respectively. CONCLUSION While most radiation oncologists supported the role of local therapy in oligometastatic disease, there were several inconsistencies in defining and categorizing oligometastatic disease. Continued education and training on oligometastatic disease would be also required to build consensus among participating caregivers.
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Affiliation(s)
- Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yang-Gun Suh
- Department of Radiation Oncology, Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Ram Chang
- Department of Radiation Oncology/Cyberknife Center, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - on behalf of the Oligometastasis Working Group, Korean Cancer Association
- Department of Radiation Oncology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology/Cyberknife Center, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
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19
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Tang B, Duan R, Fan Z, Yan X, Li S, Zhou L, Li J, Xu H, Mao L, Lian B, Wang X, Bai X, Wei X, Li C, Cui C, Si L, Chi Z, Guo J, Sheng X. Natural history of bone-only metastasis in renal cell carcinoma. Urol Oncol 2024; 42:119.e17-119.e22. [PMID: 38383241 DOI: 10.1016/j.urolonc.2024.01.030] [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: 09/01/2023] [Revised: 11/29/2023] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Bone metastasis (BM) is considered a poor prognostic factor of renal cell carcinoma (RCC). Confusion exists regarding how to deal with RCC patients with bone-only metastasis. PATIENTS AND METHODS The clinical data of consecutive RCC patients with bone-only metastasis at Peking University Cancer Hospital between 2006 and 2018 were retrospectively collected and analyzed. RESULTS Fifty-four eligible patients were screened from an RCC database of 1,878 metastatic patients. After a median follow-up of 43.6 m, 61.1% of the patients were presented with progression of prior BM or new BM. The progression-free survival (PFS) and overall survival (OS) was 16.2 m (95%CI: 11.4-21.0) and 65.2 m, respectively. For the 30 patients with oligo-metastasis (≤3 loci) and 24 ones with multiple-metastasis (>3 loci), the median OS was not reached and 42.0m (95%CI: 12.7-71.2) with statistical difference (P < 0.001). In the oligo-metastasis group, the median PFS of the 15 patients treated with local therapy and of the 13 patients treated with systemic therapy was 14.2 m (95%CI: 5.3-23.3) and 18.0 m (95%CI:15.4-20.6), respectively. In the multiple-metastasis group, the median PFS and OS of the 18 patients treated with systemic therapy was 16.6 m (95%CI: 7.5-25.7) and 63.9 m (95%CI: 21.8-106.0), respectively. Univariate analysis and multivariate analysis showed that the number of metastatic sites (oligo/multiple) and International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score, RCC pathological subtype were significantly associated with prognosis (P < 0.05). CONCLUSION RCC patients with bone-only metastases have a favorable prognosis. The number of metastatic sites, IMDC, RCC pathological subtype could serve as survival predictors, which might provide clue of treatment modality.
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Affiliation(s)
- Bixia Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Rong Duan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zenan Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xieqiao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Siming Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Li Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Juan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Huayan Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bin Lian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xue Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoting Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Caili Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chuanliang Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhihong Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xinan Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
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20
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Farooqi AS, Yoder AK, Lin HY, Pasalic D, Erasmus J, Betancourt S, Wernz C, Mitra D, Zarzour MA, Somaiah N, Conley A, Ratan R, Livingston A, Araujo DM, Roland C, Scally C, Keung E, Gandhi SN, Ashleigh Guadagnolo B, Nguyen QN, Bishop AJ. SABR for Sarcoma Lung Metastases: Indications for Treatment and Guidance for Patient Selection. Int J Radiat Oncol Biol Phys 2024; 118:971-978. [PMID: 37914142 DOI: 10.1016/j.ijrobp.2023.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/26/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE The lungs are the most common site of metastasis for patients with soft tissue sarcoma. SABR is commonly employed to treat lung metastases among select patients with sarcoma with limited disease burden. We sought to evaluate outcomes and patterns of failure among patients with sarcoma treated with SABR for their lung metastases. METHODS AND MATERIALS We performed a retrospective review of patients treated at a tertiary cancer center between 2006 and 2020. Patient disease status at the time of SABR was categorized as either oligorecurrent or oligoprogressive. The Kaplan-Meier method was used to estimate disease outcomes. Uni- and multivariable analyses were conducted using the Cox proportional hazards model. RESULTS We identified 70 patients with soft tissue sarcoma treated with SABR to 98 metastatic lung lesions. Local recurrence-free survival after SABR treatment was 83% at 2 years. On univariable analysis, receipt of comprehensive SABR to all sites of pulmonary metastatic disease at the time of treatment was associated with improved progression-free survival (PFS; hazard ratio [HR], 0.51 [0.29-0.88]; P = .02). On multivariable analysis, only having systemic disease controlled at the time of SABR predicted improved PFS (median PFS, 14 vs 4 months; HR, 0.37 [0.20-0.69]; P = .002) and overall survival (median overall survival, 51 vs 14 months; HR, 0.17 [0.08-0.35]; P < .0001). CONCLUSIONS SABR provides durable long-term local control for sarcoma lung metastases. The most important predictor for improved outcomes was systemic disease control. Careful consideration of these factors should help guide decisions in a multidisciplinary setting to appropriately select the optimal candidates for SABR.
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Affiliation(s)
- Ahsan S Farooqi
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Alison K Yoder
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heather Y Lin
- Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dario Pasalic
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeremy Erasmus
- Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sonia Betancourt
- Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cort Wernz
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Devarati Mitra
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria A Zarzour
- Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neeta Somaiah
- Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anthony Conley
- Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ravin Ratan
- Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew Livingston
- Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dejka M Araujo
- Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christina Roland
- Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christopher Scally
- Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emily Keung
- Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Saumil N Gandhi
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - B Ashleigh Guadagnolo
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Quynh-Nhu Nguyen
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Bishop
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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21
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Trentesaux V, Maiezza S, Bogart E, Le Deley MC, Meyer E, Vanquin L, Pasquier D, Mortier L, Mirabel X. Stereotactic body radiotherapy as a viable treatment on extracranial oligometastases in melanoma patients: a retrospective multicentric study. Front Oncol 2024; 14:1322515. [PMID: 38505592 PMCID: PMC10949887 DOI: 10.3389/fonc.2024.1322515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/14/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Stereotactic radiotherapy (SBRT) potentially has a role in the management of oligometastatic melanoma. However, literature with data specific to this management is very limited. The objectives of this study were to evaluate the time to local control (LC) of extra-cranial melanoma metastases after SBRT treatment and to help establish if SBRT is a useful therapy for oligometastatic melanoma. Methods A retrospective study was conducted with data collected from two referral centers in France between 2007 and 2020. The oligometastatic status of patients was reported based on the latest recommendations with a maximum of three lesions prior to treatment. Results A total of 69 patients receiving SBRT for 88 oligometastatic melanoma metastases were included. The median follow-up time was 42.6 months. Most patients were treated for metachronous oligometastatic lesions. Occurrence of oligoprogression, oligorecurrence, and oligopersistence was reported in 42.0%, 39.1%, and 17.4% of cases, respectively. Treated lesions were mostly pulmonary (40.6%), followed by lymph node (34.8%) and hepatic sites (24.6%). Progression-free survival at 1, 2, and 3 years were 47.0% (35-59), 27.0% (16-39), and 25.0% (15.0-37.0), respectively. Time to LC rates at 1, 2, and 3 years were 94.2% (87.0-98.1), 90.3% (81.3-96.1), and 90.3% (81.3-96.1), respectively. Overall survival at 1, 2, and 3 years were 87% (76.0-93.0), 74.0% (76.0-93.0), and 61.0% (47.0-73.0), respectively. Only 17.4% of patients experienced acute, grade 1 or grade 2 toxicities with no reports of grade 3 or higher toxicities. Conclusion SBRT demonstrated efficacy in managing melanoma patients with extracranial oligometastases and showed an overall low toxicity profile. Future randomized studies are needed to establish the role of SBRT in therapeutic approaches for patients with oligometastatic melanoma.
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Affiliation(s)
| | - Sophie Maiezza
- Department of Dermatology, Hôpital Claude Huriez du Centre hospitalo-universitaire (CHU) de Lille, Lille, France
| | - Emilie Bogart
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | | | - Emmanuel Meyer
- Department of Radiotherapy, Centre Francois Baclesse, Caen, France
| | - Ludovic Vanquin
- Department of Medical Physics, Centre Oscar Lambret, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
- Centre de Recherche en Informatique, Signal et Automatique de Lille (CRIStAL), Centre national de recherche scientifique (CNRS-UMR) 9189, University of Lille, Lille, France
| | - Laurent Mortier
- Department of Dermatology, Hôpital Claude Huriez du Centre hospitalo-universitaire (CHU) de Lille, Lille, France
- Department of Medicine, University of Lille, Lille, France
| | - Xavier Mirabel
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
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22
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Igaue S, Nozaki R, Utsunomiya D, Kubo Y, Kubo K, Kurita D, Yamamoto S, Ishiyama K, Oguma J, Kato K, Daiko H. Significance of Surgery for Resectable M1 Lymph Node Metastases Without Organ Metastasis in Esophageal Carcinoma in the Era of Neoadjuvant Treatment. Ann Surg Oncol 2024; 31:1525-1535. [PMID: 37996638 DOI: 10.1245/s10434-023-14562-5] [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: 09/26/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND M1 esophageal carcinoma goes beyond localized disease and requires treatment with systemic therapy. M1 status is primarily divided into two categories: M1 lymph node metastasis and distant organ metastasis. Oligometastasis is defined as a state of limited metastatic disease, and surgery for oligometastasis of distant organs is reported to be beneficial in limited conditions. The aim of this study was to investigate resected cases of M1 lymph node metastases as the only metastatic site in stage IVB esophageal carcinoma. PATIENTS AND METHODS This study was a single-center retrospective cohort study. Patients with esophageal carcinoma who underwent esophagectomy with curative intent between April 2017 and December 2021 were examined. Neoadjuvant chemotherapy was our standard therapy and administered in almost all cases. We hypothesized that four sites of metastatic M1LN (supraclavicular (no. 104), pretracheal (no. 106pre), posterior thoracic para-aortic (no. 112aoP), and abdominal para-aortic (no. 16a2lat) LNs) were potentially resectable M1LN (rM1LN) metastases with curative intent and compared the prognosis of patients with and without rM1LN metastasis. RESULTS Six hundred eight-two patients were included in the study. Among these patients, 80 had rM1LN metastasis and received surgery for curative intent. Short-term safety outcomes were equivalent between patients with and without rM1LN metastases. After propensity score matching, there were no significant differences in overall survival between patients with and without rM1LN metastasis. Multivariate analyses revealed that the only independent prognostic factor was ypN status. CONCLUSION The present study suggests the feasibility and favorable OS in the patients with resection of rM1LN metastasis.
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Affiliation(s)
- Shota Igaue
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryoko Nozaki
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Daichi Utsunomiya
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yuto Kubo
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kentaro Kubo
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Daisuke Kurita
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shun Yamamoto
- Department Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koshiro Ishiyama
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Junya Oguma
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Ken Kato
- Department Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan.
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
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23
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Falkenbach F, Steuber T, Graefen M. [Local therapies for oligometastatic hormone-sensitive prostate cancer]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:215-224. [PMID: 38329485 DOI: 10.1007/s00120-024-02280-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Oligometastatic, hormone-sensitive prostate cancer (omHSPC) is increasingly diagnosed due to the implementation of molecular imaging. OmHSPC is mostly defined as a maximum of four bone metastases without visceral metastases on conventional imaging. OBJECTIVES This study highlights the existing evidence regarding local treatment of omHSPC, taking into account molecular imaging and modern therapies. MATERIALS AND METHODS Narrative review article based on expert consensus and national/international guideline recommendations, supported by a nonsystematic literature search in PubMed (MEDLINE). The authors consider the cited studies as the most significant works in this regard and these were selected to illustrate developments and fundamental concepts, without claiming completeness. RESULTS Initially, the STAMPEDE study prospectively demonstrated an oncologic benefit of radiotherapy (RT) to the prostate in addition to androgen deprivation therapy for omHSPC. At 3 years, overall survival (OS) was 81% with RT versus 73% without RT (hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.52-0.90; p = 0.007). However, this benefit was not observed in polymetastatic HSPC (HR 1.07; 95% CI 0.90-1.28; p = 0.4). In a study by Dai et al., local therapy for omHSPC was performed surgically in 85% of cases, also demonstrating an OS advantage (HR 0.44; 95% CI 0.24-0.81; p = 0.008). CONCLUSION OmHSPC should be treated using adjunctive RT. Preliminary prospective evidence shows comparable efficacy with prostatectomy. Modern systemic combination therapies challenge the role of local therapy.
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Affiliation(s)
- Fabian Falkenbach
- Martini-Klinik Prostatakarzinomzentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Thomas Steuber
- Martini-Klinik Prostatakarzinomzentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Markus Graefen
- Martini-Klinik Prostatakarzinomzentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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24
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Widder J, Simek IM, Goldner GM, Heilemann G, Ubbels JF. Metastases-directed local therapies (MDT) beyond genuine oligometastatic disease (OMD): Indications, endpoints and the role of imaging. Clin Transl Radiat Oncol 2024; 45:100729. [PMID: 38298549 PMCID: PMC10827679 DOI: 10.1016/j.ctro.2024.100729] [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: 07/29/2023] [Revised: 11/21/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
To further personalise treatment in metastatic cancer, the indications for metastases-directed local therapy (MDT) and the biology of oligometastatic disease (OMD) should be kept conceptually apart. Both need to be vigorously investigated. Tumour growth dynamics - growth rate combined with metastatic seeding efficiency - is the single most important biological feature determining the likelihood of success of MDT in an individual patient, which might even be beneficial in slowly developing polymetastatic disease. This can be reasonably well assessed using appropriate clinical imaging. In the context of considering appropriate indications for MDT, detecting metastases at the edge of image resolution should therefore suggest postponing MDT. While three to five lesions are typically used to define OMD, it could be argued that countability throughout the course of metastatic disease, rather than a specific maximum number of lesions, could serve as a better parameter for guiding MDT. Here we argue that the unit of MDT as a treatment option in metastatic cancer might best be defined not as a single procedure at a single point in time, but as a series of treatments that can be delivered in a single or multiple sessions to different lesions over time. Newly emerging lesions that remain amenable to MDT without triggering the start of a new systemic treatment, a change in systemic therapy, or initiation of best supportive care, would thus not constitute a failure of MDT. This would have implications for defining endpoints in clinical trials and registries: Rather than with any disease progression, failure of MDT would only be declared when there is progression to polymetastatic disease, which then precludes further options for MDT.
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Affiliation(s)
- Joachim Widder
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Inga-Malin Simek
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Gregor M. Goldner
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Gerd Heilemann
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Jan F. Ubbels
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
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25
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Willmann J, Vlaskou Badra E, Adilovic S, Ahmadsei M, Christ SM, Tanadini-Lang S, Mayinger M, Guckenberger M, Andratschke N. Stereotactic body radiotherapy for oligoprogression with or without switch of systemic therapy. Clin Transl Radiat Oncol 2024; 45:100748. [PMID: 38433950 PMCID: PMC10907512 DOI: 10.1016/j.ctro.2024.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 02/04/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
Background Oligoprogression is defined as cancer progression of a limited number of metastases under active systemic therapy. The role of metastasis-directed therapy, using stereotactic body radiotherapy (SBRT), is controversial as is the continuation versus switch of systemic therapy. We report outcomes of oligoprogressive patients after SBRT, and compare those patients that continued or switched their current line of systemic therapy. Material/Methods We included patients who developed up to 5 progressive extracranial metastases under systemic therapy for any solid organ malignancy and were treated with SBRT to all lesions at our institution between 01/2014 and 12/2019. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method, and the interval to the next systemic therapy line determined using cumulative incidence functions. Multivariable Cox regression models were used to analyze the influence of baseline and post-progression variables on OS, PFS and survival with the next systemic therapy after SBRT. Results Among 135 patients with oligoprogressive disease of which the most common primary tumor was lung cancer (n = 46, 34.1 %), 96 continued their current line of systemic therapy after oligoprogression. Among 39 who switched systemic therapy, 28 (71.8 %) paused or discontinued, while 11 (28.2 %) immediately started another systemic treatment. After a median follow-up of 27.2 months, patients that switched and those who continued systemic therapy after oligoprogression had comparable median OS (32.1 vs. 38.2 months, p = 0.47) and PFS (4.3 vs. 3.4 months, p = 0.6). The intervals to the next systemic therapy line were comparable between both cohorts (p = 0.6). An ECOG performance status of 2 and immediately starting a new systemic therapy after oligoprogression were associated with a poorer survival without next systemic therapy, while the de-novo OMD state was associated with better survival without next systemic therapy compared to the induced state. Conclusion Oncological outcomes of patients that continued or switched systemic therapy after SBRT for oligoprogression were comparable, potentially indicating that further lines of treatment may be safely delayed in selected cases.
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Affiliation(s)
- Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Eugenia Vlaskou Badra
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Selma Adilovic
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Sebastian M. Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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26
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Yuste C, Passerat V, Calais G, Schipman B, Vaugier L, Paumier A, Huertas A, Hemery CG, Debelleix C, Chamois J, Blanchard N, Septans AL, Pointreau Y. Stereotactic body radiation therapy for adrenal gland metastases: A multi-institutional outcome analysis. Clin Transl Radiat Oncol 2024; 45:100708. [PMID: 38162282 PMCID: PMC10757246 DOI: 10.1016/j.ctro.2023.100708] [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: 06/27/2023] [Revised: 11/12/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Aim The adrenal gland is a common site of metastasis with a rate of up to 27% in autopsy series. The incidence of these metastases is increasing due to greater use of Positron Emission Tomography scans and improved overall survival of patients with metastatic cancers. Stereotactic body radiation therapy (SBRT) is a non-invasive treatment option for metastasis. The aim of this study is to assess prognostic factors influencing local control, progression-free and overall survival in oligometastatic patients treated with SBRT for an adrenal metastasis. Methods In this multicentric retrospective study, we included patients with adrenal metastases treated with SBRT between 2010 and 2021 in eleven french centers. All primary tumors were included. Results A total of 110 patients treated for 121 adrenal lesions were included. Non-small-cell lung cancer was the predominant histologic type (55.4 %). Eighty-two percent of patients had at least 2 metastatic sites. The median Planning Target Volume was 70 cm3 with a median prescription dose of 40 Gray (Gy). The mean Biologically Effective Dose (BED) 10 dose was 74.2 Gy. Local control at 1 and 2 years was 85.9 % and 72.5 % respectively. The median overall survival and progression-free survival were 31.6 and 8.5 months respectively. Local control was significantly improved by systemic treatment one month before or after SBRT (p = 0.009) and by a BED10 greater than or equal to 50 Gy (p = 0.003).In multivariate analysis, oligometastatic presentation (p = 0.009) and a metachronous metastatic presentation (p = 0.008) were independent factors for progression-free survival.Tolerance was excellent, no grade 3 and 4 toxicities were described due to SBRT. Conclusion Stereotactic radiotherapy of adrenal metastases makes possible a local control of more than 85% at one year and was well tolerated. The factors influencing survival in oligometastatic patients still need to be found in order to better select those who benefit the most from this type of treatment.
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Affiliation(s)
- C. Yuste
- Institut de Cancérologie de l'Ouest, Angers, France
| | - V. Passerat
- Centre Bayard, Orlam, Villeurbanne, France
- Colib – Club des Oncologues Libéraux, Le Mans, France
| | - G. Calais
- Colib – Club des Oncologues Libéraux, Le Mans, France
- Hôpital Bretonneau 2, clinique d'oncologie et de radiothérapie (CORAD), Tours, France
| | - B. Schipman
- Institut de Cancérologie de Bourgogne, Dijon, France
| | - L. Vaugier
- Institut de Cancérologie de l’Ouest, St Herblain, France
| | - A. Paumier
- Institut de Cancérologie de l'Ouest, Angers, France
| | - A. Huertas
- Institut de Radiothérapie Sud de l'Oise, Creil, France
| | - CG. Hemery
- Polyclinique de Courlancy, Reims, France
| | - C. Debelleix
- Clinique Bordeaux Tivoli-Ducos, Bordeaux, France
| | - J. Chamois
- Private Hospital, Saint-Grégoire, France
| | | | | | - Y. Pointreau
- Colib – Club des Oncologues Libéraux, Le Mans, France
- Hôpital Bretonneau 2, clinique d'oncologie et de radiothérapie (CORAD), Tours, France
- Weprom, Angers, France
- Institut inter-régional de Cancérologie (ILC) - Centre Jean Bernard, Le Mans, France
- Centre de Cancérologie de la Sarthe (CCS), Le Mans, France
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27
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Rossebo AE, Zlevor AM, Knott EA, Mao L, Couillard AB, Ziemlewicz TJ, Hinshaw JL, Abel EJ, Lubner MG, Knavel Koepsel EM, Wells SA, Stratchko LM, Laeseke PF, Lee FT. Percutaneous Microwave Ablation for Treatment of Retroperitoneal Tumors. Radiol Imaging Cancer 2024; 6:e230080. [PMID: 38334471 PMCID: PMC10988338 DOI: 10.1148/rycan.230080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/05/2023] [Accepted: 12/15/2023] [Indexed: 02/10/2024]
Abstract
Purpose To determine if microwave ablation (MWA) of retroperitoneal tumors can safely provide high rates of local tumor control. Materials and Methods This retrospective study included 19 patients (median age, 65 years [range = 46-78 years]; 13 [68.4%] men and six [31.6%] women) with 29 retroperitoneal tumors treated over 22 MWA procedures. Hydrodissection (0.9% saline with 2% iohexol) was injected in 17 of 22 (77.3%) procedures to protect nontarget anatomy. The primary outcomes evaluated were local tumor progression (LTP) and complication rates. Oncologic outcomes, including overall survival (OS), progression-free survival (PFS), and treatment-free interval (TFI), were examined as secondary outcome measures. Results Median follow-up was 18 months (range = 0.5-113). Hydrodissection was successful in displacing nontarget anatomy in 16 of 17 (94.1%) procedures. The LTP rate was 3.4% (one of 29; 95% CI: 0.1, 17.8) per tumor and 5.3% (one of 19; 95% CI: 0.1, 26.0) per patient. The overall complication rate per patient was 15.8% (three of 19), including two minor complications and one major complication. The OS rate at 1, 2, and 3 years was 81.8%, 81.8%, and 72.7%, respectively, with a median OS estimated at greater than 7 years. There was no evidence of a difference in OS (P = .34) and PFS (P = .56) between patients with renal cell carcinoma (six of 19 [31.6%]) versus other tumors (13 of 19 [68.4%]) and patients treated with no evidence of disease (15 of 22 [68.2%]) versus patients with residual tumors (seven of 22 [31.8%]). Median TFI was 18 months (range = 0.5-108). Conclusion Treatment of retroperitoneal tumors with MWA combined with hydrodissection provided high rates of local control, prolonged systemic therapy-free intervals, and few serious complications. Keywords: Ablation Techniques (ie, Radiofrequency, Thermal, Chemical), Retroperitoneum, Microwave Ablation, Hydrodissection © RSNA, 2024.
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Affiliation(s)
- Annika E. Rossebo
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Annie M. Zlevor
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Emily A. Knott
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Lu Mao
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Allison B. Couillard
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Timothy J. Ziemlewicz
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - J. Louis Hinshaw
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - E. Jason Abel
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Meghan G. Lubner
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Erica M. Knavel Koepsel
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Shane A. Wells
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Lindsay M. Stratchko
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Paul F. Laeseke
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
| | - Fred T. Lee
- From the Departments of Radiology (A.E.R., A.M.Z., A.B.C., T.J.Z.,
J.L.H., E.J.A., M.G.L., E.M.K.K., S.A.W., L.M.S., P.F.L., F.T.L.), Biomedical
Engineering (A.E.R., F.T.L.), Biostatistics and Medical Informatics (L.M.), and
Urology (J.L.H., E.J.A., F.T.L.), University of Wisconsin–Madison School
of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center,
Madison, WI 53792-3252; and Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (E.A.K.)
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28
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Kim MJ, Kang SH, Kwon M, Jung YH, Choi SH, Nam SY, Lee YS. Clinical implication of neck dissection for metastatic lymph nodes originating from non-head and neck regions. Acta Otolaryngol 2024; 144:153-157. [PMID: 38491920 DOI: 10.1080/00016489.2024.2327406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Cervical lymph node metastasis (CLNM) from remote primary sites is rare in head and neck cancer. The efficacy of neck dissection is still being investigated for therapeutic benefits of local management in oligometastasis from non-head and neck cancer. OBJECTIVES To evaluate the clinical efficacy of neck dissection (ND) in CLNM from distant primary cancers and identify factors contributing to improved survival. MATERIALS AND METHODS This retrospective case-control study enrolled patients who underwent ND for CLNM from distant primary cancer at Asan Medical Centre between January 2010 and December 2020. We analysed overall survival and association between clinical covariate and survival. RESULTS The study included 31 (14 males, 17 females) among 114 patients. Ovarian cancer was the most common primary malignancy (32.3%). Patients with fewer than three metastatic lymph nodes, without extranodal extension and with adjuvant therapy after surgery had better survival rates. CONCLUSION AND SIGNIFICANCE In patients with CLNM from a distant primary cancer, ND is beneficial as local treatment. And adequate selection of patients for ND is pivotal to improve prognosis.
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Affiliation(s)
- Min Ji Kim
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - So Hee Kang
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - MinSu Kwon
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Ho Jung
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Ho Choi
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoon Se Lee
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
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Miszczyk M, Rajwa P, Yanagisawa T, Nowicka Z, Shim SR, Laukhtina E, Kawada T, von Deimling M, Pradere B, Rivas JG, Gandaglia G, van den Bergh RCN, Goldner G, Supiot S, Zilli T, Trinh QD, Nguyen PL, Briganti A, Ost P, Ploussard G, Shariat SF. The Efficacy and Safety of Metastasis-directed Therapy in Patients with Prostate Cancer: A Systematic Review and Meta-analysis of Prospective Studies. Eur Urol 2024; 85:125-138. [PMID: 37945451 DOI: 10.1016/j.eururo.2023.10.012] [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: 03/28/2023] [Revised: 09/15/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
CONTEXT Despite the lack of level 1 evidence, metastasis-directed therapy (MDT) is used widely in the management of metastatic prostate cancer (mPCa) patients. Data are continuously emerging from well-designed prospective studies. OBJECTIVE To summarise and report the evidence on oncological and safety outcomes of MDT in the management of mPCa patients. EVIDENCE ACQUISITION We searched the PubMed, Scopus, and Web of Science databases for prospective studies assessing progression-free survival (PFS), local control (LC), androgen deprivation therapy (ADT)-free survival (ADT-FS), overall survival (OS), and/or adverse events (AEs) in mPCa patients treated with MDT. A meta-analysis was performed for 1- and 2-yr PFS, LC, ADT-FS, OS, and rate of AEs. Meta-regression and sensitivity analysis were performed to account for heterogeneity and identify moderators. EVIDENCE SYNTHESIS We identified 22 prospective studies (n = 1137), including two randomised controlled trials (n = 116). Two studies were excluded from the meta-analysis (n = 120). The estimated 2-yr PFS was 46% (95% confidence interval [CI]: 36-56%) or 42% (95% CI: 33-52%) after excluding studies using biochemical or ADT-related endpoints. The estimated 2-yr LC, ADT-FS, and OS were 97% (95% CI: 94-98%), 55% (95% CI: 44-65%), and 97% (95% CI: 95-98%), respectively. Rates of treatment-related grade 2 and ≥3 AEs were 2.4% (95% CI: 0.2-7%) and 0.3% (95% CI: 0-1%), respectively. CONCLUSIONS MDT is a promising treatment strategy associated with favourable PFS, excellent LC, and a low toxicity profile that allows oligorecurrent hormone-sensitive patients to avoid or defer ADT-related toxicity. Integration of MDT with other therapies offers a promising research direction, in particular, in conjunction with systemic treatments and as a component of definitive care for oligometastatic PCa. However, in the absence of randomised trials, using MDT for treatment intensification remains an experimental approach, and the impact on OS is uncertain. PATIENT SUMMARY Direct treatment of metastases is a promising option for selected prostate cancer patients. It can delay hormone therapy and is being investigated as a way of intensifying treatment at the expense of manageable toxicity.
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Affiliation(s)
- Marcin Miszczyk
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix Du Sud Hospital, Quint-Fonsegrives, France
| | - Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Gregor Goldner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Stephane Supiot
- Department of Radiotherapy, ICO René Gauducheau, Saint-Herblain, France
| | - Thomas Zilli
- Department of Radiation Oncology, Oncological Institute of Southern Switzerland (IOSI-EOC), Bellinzona, Switzerland
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Piet Ost
- Department of Radiation Oncology, Iridium Network, Wilrijk, Belgium
| | | | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
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Jaksic N, Modesto A, Meillan N, Bordron A, Michalet M, Riou O, Lisbona A, Huguet F. Stereotactic body radiation therapy for liver metastases in oligometastatic disease. Cancer Radiother 2024; 28:75-82. [PMID: 37865603 DOI: 10.1016/j.canrad.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/25/2023] [Indexed: 10/23/2023]
Abstract
Oligometastatic cancers designate cancers in which the number of metastases is less than five, corresponding to a particular biological entity whose prognosis is situated between a localized and metastatic disease. The liver is one of the main sites of metastases. When patients are not suitable for surgery, stereotactic body radiotherapy provides high local control rate, although these data come mainly from retrospective studies, with no phase III study results. The need for a high therapeutic dose (biologically effective dose greater than 100Gy) while respecting the constraints on the organs at risk, and the management of respiratory movements require expertise and sufficient technical prerequisites. The emergence of new techniques such as MRI-guided radiotherapy could further increase the effectiveness of stereotactic radiotherapy of liver metastases, and thus improve the prognosis of these oligometastatic cancers.
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Affiliation(s)
- N Jaksic
- Institut de cancérologie et radiothérapie Brétillien, 35400 Saint-Malo, France.
| | - A Modesto
- Département de radiothérapie, institut régional du cancer, 31100 Toulouse, France
| | - N Meillan
- Département de radiothérapie, centre hospitalier d'Argenteuil, 95107 Argenteuil, France
| | - A Bordron
- Département de radiothérapie, centre hospitalier universitaire de Brest, 29200 Brest, France
| | - M Michalet
- Département de radiothérapie, institut régional du cancer, 34000 Montpellier, France
| | - O Riou
- Département de radiothérapie, institut régional du cancer, 34000 Montpellier, France
| | - A Lisbona
- Département de radiothérapie, institut régional du cancer, 44800 Saint-Herblain, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, Sorbonne université, 75020 Paris, France
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Sargos P, Le Guevelou J, Khalifa J, Albiges L, Azria D, de Crevoisier R, Supiot S, Créhange G, Roubaud G, Chapet O, Pasquier D, Blanchard P, Latorzeff I. The role of radiation therapy for de novo metastatic bladder and renal cancers. Cancer Radiother 2024; 28:56-65. [PMID: 37286452 DOI: 10.1016/j.canrad.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/21/2023] [Indexed: 06/09/2023]
Abstract
Metastatic bladder and renal cancers account respectively for 2.1% and 1.8% of cancer deaths worldwide. The advent of immune checkpoint inhibitors has revolutionized the management of metastatic disease, by demonstrating considerable improvements in overall survival. However, despite initial sensitivity to immune checkpoint inhibitors for most patients, both bladder and renal cancer are associated with short progression-free survival and overall survival, raising the need for further strategies to improve their efficacy. Combining systemic therapies with local approaches is a longstanding concept in urological oncology, in clinical settings including both oligometastatic and polymetastatic disease. Radiation therapy has been increasingly studied with either cytoreductive, consolidative, ablative or immune boosting purposes, but the long-term impact of this strategy remains unclear. This review intends to address the impact of radiation therapy with either curative or palliative intent, for synchronous de novo metastatic bladder and renal cancers.
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Affiliation(s)
- P Sargos
- Department of Radiation Oncology, institut Bergonié, Bordeaux, France.
| | - J Le Guevelou
- Faculty of Medicine, Geneva, Switzerland; Department of Radiation Oncology, centre Eugène-Marquis, Rennes, France
| | - J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud, Institut universitaire du cancer de Toulouse - Oncopole, Toulouse, France
| | - L Albiges
- Department of Cancer Medicine, institut Gustave-Roussy, Villejuif, France
| | - D Azria
- Department of Radiation Oncology, Institut du cancer de Montpellier (ICM), IRCM U1194 Inserm, université de Montpellier, Montpellier, France
| | - R de Crevoisier
- Department of Radiation Oncology, centre Eugène-Marquis, Rennes, France
| | - S Supiot
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, Saint-Herblain, France; CRCINA CNRS, Nantes, France; Inserm, Nantes, France; Université de Nantes et d'Angers, Nantes, France
| | - G Créhange
- Department of Radiation Oncology, institut Curie, Saint-Cloud, France
| | - G Roubaud
- Department of Medical Oncology, institut Bergonié, Bordeaux, France
| | - O Chapet
- Department of Oncology Department, centre hospitalier Lyon Sud, Pierre-Bénite, France
| | - D Pasquier
- Department of Radiation Oncology, centre Oscar-Lambret, Lille, France; Cristal UMR 9189, université de Lille, Lille, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy Cancer Campus, université Paris-Saclay, Oncostat U1018 Inserm, Villejuif, France
| | - I Latorzeff
- Department of Radiation Oncology, clinique Pasteur, Toulouse, France
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Bourbonne V, Lévy A, Khalifa J, Antoni D, Blais E, Darréon J, Le Péchoux C, Lerouge D, Giraud P, Marguerit A, Pourel N, Riet FG, Thureau S. Radiotherapy in the management of lung oligometastases. Cancer Radiother 2024; 28:36-48. [PMID: 38228422 DOI: 10.1016/j.canrad.2023.06.030] [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: 02/26/2023] [Revised: 06/07/2023] [Accepted: 06/29/2023] [Indexed: 01/18/2024]
Abstract
In recent years, the development of both medical imaging and new systemic agents (targeted therapy and immunotherapy) have revolutionized the field of oncology, leading to a new entity: oligometastatic disease. Adding local treatment of oligometastases to systemic treatment could lead to prolonged survival with no significant impact on quality of life. Given the high prevalence of lung oligometastases and the new systemic agents coming with increased pulmonary toxicity, this article provides a comprehensive review of the current state-of-art for radiotherapy of lung oligometastases. After reviewing pretreatment workup, the authors define several radiotherapy regimen based on the localization and size of the oligometastases. A comment on the synergistic combination of medical treatment and radiotherapy is also made, projecting on future steps in this specific clinical setting.
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Affiliation(s)
- V Bourbonne
- Radiation Oncology Department, CHU de Brest, Brest, France; LaTim, Inserm, UMR 1101, université de Bretagne occidentale, Brest, France
| | - A Lévy
- Department of Radiation Oncology, Centre international des cancers thoraciques (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud, institut universitaire du cancer Toulouse-Oncopôle, Toulouse, France
| | - D Antoni
- Department of Radiation Oncology, Institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - E Blais
- Department of Radiation Oncology, polyclinique Marzet, Pau, France
| | - J Darréon
- Department of Radiation Oncology, institut Paoli-Calmettes, Marseille, France
| | - C Le Péchoux
- Department of Radiation Oncology, Centre international des cancers thoraciques (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - D Lerouge
- Department of Radiation Oncology, centre François-Baclesse, Caen, France
| | - P Giraud
- Department of Radiation Oncology, hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Paris, France
| | - A Marguerit
- Department of Radiation Oncology, Institut de cancérologie de Montpellier, Montpellier, France
| | - N Pourel
- Department of Radiation Oncology, institut Sainte-Catherine, Avignon, France
| | - F-G Riet
- Department of Radiation Oncology, centre hospitalier privé Saint-Grégoire, 35760 Saint-Grégoire, France
| | - S Thureau
- Radiotherapy Department, centre Henri-Becquerel, Rouen, France; QuantIF-Litis EA4108, université de Rouen, Rouen, France.
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Weiner AB, Agrawal R, Valle LF, Sonni I, Kishan AU, Rettig MB, Raman SS, Calais J, Boutros PC, Reiter RE. Impact of PSMA PET on Prostate Cancer Management. Curr Treat Options Oncol 2024; 25:191-205. [PMID: 38270802 PMCID: PMC11034977 DOI: 10.1007/s11864-024-01181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
OPINION STATEMENT PSMA-PET has been a practice-changing imaging biomarker for the management of men with PCa. Research suggests improved accuracy over conventional imaging and other PET radiotracers in many contexts. With multiple approved PSMA-targeting radiotracers, PSMA PET will become even more available in clinical practice. Its increased use requires an understanding of the prospective data available and caution when extrapolating from prior trial data that utilized other imaging modalities. Future trials leveraging PSMA PET for treatment optimization and management decision-making will ultimately drive its clinical utility.
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Affiliation(s)
- Adam B Weiner
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
- Institute for Precision Health, University of California-Los Angeles, Los Angeles, CA, USA.
| | - Raag Agrawal
- Institute for Precision Health, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, CA, USA
| | - Luca F Valle
- Department of Radiation Oncology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ida Sonni
- Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Amar U Kishan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Matthew B Rettig
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Paul C Boutros
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
- Institute for Precision Health, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, CA, USA
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, CA, USA
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Tonneau M, Nebbache R, Larnaudie A, Thureau S, Pointreau Y, Blanchard P, Thariat J. Management of head and neck carcinomas with synchronous or metachronous oligometastatic disease: Role of locoregional radiotherapy and metastasis-directed radiotherapy. Cancer Radiother 2024; 28:83-92. [PMID: 37620212 DOI: 10.1016/j.canrad.2023.03.004] [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: 12/31/2022] [Revised: 02/19/2023] [Accepted: 03/28/2023] [Indexed: 08/26/2023]
Abstract
Head and neck carcinomas are initially metastatic in about 15% of cases. Radiotherapy is a cornerstone in the multimodal strategy at the locoregional phase. In patients with head and neck cancer, often heavily pretreated and with comorbidities, who relapse locoregionally or at distant sites, radiotherapy has also become increasingly important at the metastatic phase. Data on the optimal sequence of systemic treatments and metastasis-directed treatments including stereotactic irradiation are still lacking. Several randomized head and neck trials have been initiated that should provide important answers, including one recent GORTEC trial.
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Affiliation(s)
- M Tonneau
- Service d'oncologie radiothérapie, CRLCC Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - R Nebbache
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - A Larnaudie
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France
| | - S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, Rouen, France; Unité QuantIF Litis EA 4108, université de Rouen, Rouen, France; Département d'imagerie, centre Henri-Becquerel, Rouen, France
| | - Y Pointreau
- Institut inter-régional de cancérologie (ILC), centre Jean-Bernard, centre de cancérologie de la Sarthe (CCS), 64, rue de Degré, 72000 Le Mans, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy, université Paris Saclay, Inserm U1018 Oncostat, Villejuif, France
| | - J Thariat
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France; Laboratoire de physique corpusculaire/IN2P3-CNRS UMR 6534, Unicaen-université de Normandie, 14000 Caen, France.
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Latorzeff I, Bayart É, Azria D. Indication of radiotherapy for de novo metastatic cancer. The « Recommendations » Commission first issue. Cancer Radiother 2024; 28:1-2. [PMID: 38307639 DOI: 10.1016/j.canrad.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/04/2024]
Affiliation(s)
- I Latorzeff
- Department of Radiation Oncology, groupe Orion, clinique Pasteur, Toulouse, France.
| | - É Bayart
- Société française de radiothérapie oncologique - RadioTransNet, centre Antoine-Béclère, Paris, France
| | - D Azria
- Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, ICM, Inserm U1194 ICRM, Montpellier, France
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36
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Schuler A, Huser J, Schmid S, Schär S, Scherz A, Gautschi O, Mauti L, von Briel T, Waibel C, Wannesson L, Pankovics J, Mark MT, Rothschild SI, Addeo A, Janthur WD, Siano M, Boos L, Britschgi C, Früh M. Patterns of progression on first line osimertinib in patients with EGFR mutation-positive advanced non-small cell lung cancer (NSCLC): A Swiss cohort study. Lung Cancer 2024; 187:107427. [PMID: 38043395 DOI: 10.1016/j.lungcan.2023.107427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023]
Abstract
AIM Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) approved for patients with EGFR mutated non-small cell lung cancer as first-line treatment. However, treatment resistance inevitably emerges and may present as oligo-progressive disease (OPD) or systemic progressive disease (SPD). The incidence of OPD on first-line osimertinib is unknown. METHODS We retrospectively analyzed patients who received first-line osimertinib at 13 Swiss centers. The rate of OPD (PD in ≤ 5 lesions) and treatment outcomes were analyzed. RESULTS The median age of the 148 patients was 68.2 years (range. 38.0-93.3). There were 62 % females, 83 % with a PS ≤ 1, 59 % never smokers, 57 % of patients with an EGFR exon 19 deletion and 37 % with EGFR p.L858R exon 21. 77 % experienced OPD. Median overall survival (OS) was 51.6 months (95 % CI, 38.4-65.0). Median progression-free survival (PFS) was 19.2 (95 % CI, 14.3-23.5) and 8.7 (95 % CI, 2.8-15.6) months for patients with common and uncommon EGFR mutations. Patients with OPD compared to SPD had a significantly longer time to treatment failure and longer OS of (22.9 vs. 10.8 months, p < 0.001 and 51.6 vs. 26.4 months, p = 0.004, respectively). The most common organ sites of PD were lung (62 %), brain (30 %), lymph nodes (30 %), bone (27 %) and pleura (27 %). Twenty-six patients (45 %) with OPD received local ablative treatment (LAT). The OS of OPD patients with LAT was 60.0 (95 % CI, 51.6-NA) vs. 51.4 (95 % CI 38.4-65.3) months (p = 0.43) without LAT. CONCLUSION The rate of OPD of patients receiving first line osimertinib was 77 %. Patients with OPD had a significantly better OS compared to patients with SPD (51.6 vs. 26.4 months). Patients with OPD receiving LAT had the longest median OS (60.0 months).
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Affiliation(s)
- A Schuler
- Cantonal Hospital St. Gallen, Department of Medical Oncology and Haematology, Switzerland.
| | - J Huser
- Cantonal Hospital St. Gallen, Department of Medical Oncology and Haematology, Switzerland
| | - S Schmid
- Cantonal Hospital St. Gallen, Department of Medical Oncology and Haematology, Switzerland; Inselspital, University Hospital Bern, Department of Medical Oncology, Switzerland
| | - S Schär
- Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung (SAKK) , Switzerland
| | - A Scherz
- Inselspital, University Hospital Bern, Department of Medical Oncology, Switzerland
| | - O Gautschi
- Cantonal Hospital Luzern, Department of Medical Oncology, Switzerland
| | - L Mauti
- Cantonal Hospital Winterthur, Department of Medical Oncology and Haematology, Switzerland
| | | | - C Waibel
- Cantonal Hospital Baden, Department of Medical Oncology and Haematology, Switzerland
| | - L Wannesson
- Istituto Oncologico d. Svizzera Italiana, Switzerland
| | - J Pankovics
- Istituto Oncologico d. Svizzera Italiana, Switzerland
| | - M T Mark
- Cantonal Hospital Graubünden, Department of Medical Oncology and Haematology, Switzerland
| | - S I Rothschild
- University Hospital Basel, Department of Medical Oncology, Switzerland
| | - A Addeo
- University Hospital Geneva, Department of Medical Oncology, Switzerland
| | - W D Janthur
- Cantonal Hospital Aarau, Department of Medical Oncology, Switzerland
| | - M Siano
- Seeland Cancer Center, Bern-Biel, Switzerland
| | - L Boos
- Comprehensive Cancer Center Zurich, Department of Medical Oncology and Haematology, Switzerland
| | - C Britschgi
- Comprehensive Cancer Center Zurich, Department of Medical Oncology and Haematology, Switzerland
| | - M Früh
- Cantonal Hospital St. Gallen, Department of Medical Oncology and Haematology, Switzerland; Inselspital, University Hospital Bern, Department of Medical Oncology, Switzerland
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Tramontano S, Sarno G, Prisco V, Tedesco AM, Gargiulo A, Bracale U. Case Report: Recurrent colonic metastasis from lung cancer-diagnostic pitfalls and therapeutic challenge of a peculiar case. Front Surg 2023; 10:1288940. [PMID: 38186393 PMCID: PMC10766848 DOI: 10.3389/fsurg.2023.1288940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 01/09/2024] Open
Abstract
Lung cancer (LC) mortality exceeds 20%, and detecting metastases from LC is becoming a challenging step in understanding the real prognostic role of specific localization. We report a case of a patient with lung metastasis to the colon with local recurrence at the anastomosis after radical resection for metastasis. In both cases, the diagnosis was on oncological follow-up, and surgery was offered in consideration of reasonable life expectancy, good control of LC, and high risk of intestinal occlusion. A 67-year-old male, with a history of LC 18 months ago, was referred to our surgical unit after a positron emission tomography CT total body, where an area of intense glucose metabolism (SUV max: 35.6) at the hepatic colic flexure was reported. A colonoscopy revealed an ulcerated, bleeding large neoplasm distally to hepatic flexure, almost causing resulting total occlusion. Histologic examination revealed a tumor with complete wall thickness infiltration, which appears extensively ulcerated, from poorly differentiated squamous carcinoma (G3), not keratinizing, with growth in large solid nests, often centered by central necrosis. Two of the 30 isolated lymph nodes were metastatic. The omental flap and resection margins were free from infiltration. The malignant cells exhibited strong positive immunoreactivity only for p40. The features supported metastatic squamous carcinoma of lung origin rather than primary colorectal adenocarcinoma. After 8 months from surgery, intense Fluorodeoxyglucose (FDG) uptake of tissue was confirmed in the transverse colon. Colonoscopy evidenced an ulcerated substenotic area that involved ileocolic anastomosis on both sides. Reoperation consisted of radical resection of ileocolic anastomosis with local lymphadenectomy and ileotransverse anastomosis. The second histologic examination also revealed poorly differentiated squamous carcinoma (G3), not keratinizing, with positive immunoreactivity only for p40, suggesting the origin of LC. This case report confirmed that the possibility of colonic secondary disease should be part of the differential diagnosis in asymptomatic patients and those with a history of LC diagnosis. In addition, relapse of colonic metastasis is infrequent but should be considered during follow-up of LC. More studies on colonic metastasis of LC are required to better understand the clinical features and outcomes.
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Affiliation(s)
- Salvatore Tramontano
- Department of Physics, University of Salerno, Salerno, Italy
- Department of General and Emergency Surgery, Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gerardo Sarno
- Department of Physics, University of Salerno, Salerno, Italy
- Department of General and Emergency Surgery, Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Vera Prisco
- Department of Physics, University of Salerno, Salerno, Italy
| | | | - Antonio Gargiulo
- Department of Surgery, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Department of Physics, University of Salerno, Salerno, Italy
- Department of General and Emergency Surgery, Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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Liu L, Xie L, Zhou Y, Li Q, Lei X, Tang H, Wu J, Zhao X, Yang P, Mao Y. Outcomes of different parenchymal-sparing hepatectomies in patients with colorectal liver metastases and prognostic impact of peritumoral imaging features. Abdom Radiol (NY) 2023; 48:3728-3745. [PMID: 37750923 DOI: 10.1007/s00261-023-04044-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES Parenchymal-sparing hepatectomy (PSH) is recommended in patients with colorectal liver metastases (CRLM). Based on the principle of PSH, to investigate the impact of anatomical resection (AR) and non-anatomic resection (NAR) on the outcome of CRLM and to evaluate the potential prognostic impact of three peritumoral imaging features. METHODS Fifty-six patients who had abdominal gadoxetic acid-enhanced magnetic resonance imaging (MRI) before CRLM surgery were included in this retrospective research. Peritumoral early enhancement, peritumoral hypointensity on hepatobiliary phase (HBP), and biliary dilatation to the CRLM at MRI were evaluated. Survival estimates were calculated using the Kaplan-Meier method, and multivariate analysis was conducted to identify independent predictors of liver recurrence-free survival (LRFS), recurrence-free survival (RFS) and overall survival (OS). RESULTS NAR had a lower 3-year LRFS compared with AR (36.6% vs. 78.6%, p = 0.012). No significant differences were found in 3-year RFS (34.1% vs. 41.7%) and OS (61.7% vs. 81.3%) (p > 0.05). In NAR group, peritumoral early enhancement was associated with poor LRFS (p = < 0.001, hazard ratio [HR] = 6.260; 95% confidence interval [CI], 2.322,16.876]) and poor RFS (p = 0.035, HR =2.516; 95% CI, 1.069,5.919). No independent predictors of CRLM were identified in the AR group. CONCLUSIONS In patients with CRLM, peritumoral early enhancement was a predictor of LRFS and RFS after NAR according to the principle of PSH.
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Affiliation(s)
- Liu Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, China
| | - Lianghua Xie
- Department of Radiology, Affiliated Hospital of Guilin Medical University, No 15, Lequn Road, Guilin Guangxi, China
| | - Yin Zhou
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, China
| | - Qingshu Li
- Department of Pathology, College of Basic Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, China
- Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, China
| | - Xun Lei
- School of Public Health, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, China
| | - Huali Tang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, China
| | - Jiamei Wu
- Department of Radiology, Chongqing Dongnan Hospital, No.98 Tongjiang Avenue, Chayuan New District, Nan'an District, Chongqing, China
| | - Xiaofang Zhao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, China
| | - Ping Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yun Mao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, China.
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Yamaguchi H, Kato T, Honda M, Hamada K, Ishikawa Y, Seto I, Takagawa Y, Suzuki M, Kikuchi Y, Murakami M. Proton Beam Therapy for Lung Oligometastatic Recurrence in Patients With Esophageal Cancer. Cureus 2023; 15:e50343. [PMID: 38205500 PMCID: PMC10781415 DOI: 10.7759/cureus.50343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
Local treatment of oligometastatic esophagogastric cancer has been reported to improve overall survival (OS) compared to systemic therapy alone. This study evaluated the feasibility and safety of proton beam therapy (PBT) for the treatment of lung oligometastatic recurrence in esophageal cancer patients. This single-center historical cohort study enrolled 11 patients who underwent PBT for lung oligometastasis from esophageal cancer between 2010 and 2019. The selection criteria were that the primary esophageal cancer was controlled and no more than three lung metastases without outside lung tumors were present. OS, progression-free survival (PFS), and local control (LC) rates and adverse events (AEs) were assessed. Factors that may be related to OS were also investigated. The median follow-up period was 27.8 months (8.8-141.3 months). The one-, two-, and three-year OS rates were 81.8%, 72.7%, and 51.9%, respectively (median OS time: 43.7 months); PFS rates were 45.5%, 27.3%, and 27.3%, respectively (median PFS time: 8.8 months); and LC rates were 92.3%, 72.7%, and 72.7%, respectively. The eighth edition of tumor-node-metastasis (TNM) classification for esophageal cancer was the only significant OS-related factor (p = 0.0309). No grade ≥ 3 AEs were observed. Based on the low incidence of AEs and acceptable LC rate, PBT is a feasible option for the treatment of lung oligometastasis in esophageal cancer patients.
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Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, JPN
| | - Takahiro Kato
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, JPN
- Department of Surgery, Southern Tohoku General Hospital, Koriyama, JPN
| | - Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, JPN
- Department of Gastroenterology, Southern Tohoku General Hospital, Koriyama, JPN
| | - Yojiro Ishikawa
- Department of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
| | - Ichiro Seto
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Yoshiaki Takagawa
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
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Cuccia F, Pastorello E, Franzese C, Belgioia L, Bignardi M, Federico M, Figlia V, Giaj Levra N, Badellino S, Borghetti P, Marvaso G, Montesi G, Pontoriero A, Fazio I, Ferrera G, Alongi F, Scorsetti M. Stereotactic Body Radiotherapy for Spine Oligometastases: A Multicentre Retrospective Study From the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Clin Oncol (R Coll Radiol) 2023; 35:794-800. [PMID: 37714793 DOI: 10.1016/j.clon.2023.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/26/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023]
Abstract
AIM To evaluate the efficacy of stereotactic body radiotherapy (SBRT) for spine oligometastases. MATERIALS AND METHODS This was a multicentre retrospective study of a series of patients who received SBRT for spine oligometastases. The efficacy of SBRT was evaluated in terms of local control as the primary endpoint. Survival outcomes were also analysed to identify predictive factors for clinical outcomes. Toxicity was assessed according to CTCAE v4.0. RESULTS Between March 2018 and July 2022, 183 lesions in 177 patients were analysed. In most patients, SBRT was delivered to a single spine metastasis (82%) for a median total dose of 21 Gy (14-35 Gy) in three fractions (one to five fractions) and a median BED10 = 119 Gy (57.7-152 Gy). Local control rates were 90.3% at 1 year, 84.3% at 2 years and 84.3% at 3 years. Distant progression-free survival rates were 33.1%, 18.5% and 12.4% at 1, 2 and 3 years, with prostate histology (P = 0.023), oligorecurrent disease (P = 0.04) and BED10 > 100 Gy (P = 0.04) found to be predictive on univariate analysis. A further oligometastatic progression was observed in 33 patients (18.6%) treated with a second course of SBRT, reporting at univariate analysis improved overall survival rates (P = 0.01). Polymetastases-free survival rates were 57.8%, 43.4% and 32.4%; concurrent therapy was related to improved outcomes at multivariate analysis (P = 0.009). Overall survival rates were 91.8%, 79.6% and 65.9%, with prostate histology and non-cervical metastases related to better overall survival at multivariate analysis. Pain-flare after SBRT was recorded in 3.3%; five patients underwent surgical decompression after SBRT; there were no grade ≥3 adverse events. CONCLUSIONS In our experience of only oligometastatic patients, spine SBRT gave excellent results in terms of safety and efficacy. Prostate histology and oligorecurrent disease were predictive factors for improved clinical outcomes; also, patients who experienced a further oligoprogression after SBRT maintained a survival advantage compared with polymetastatic progression. No severe adverse events were reported.
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Affiliation(s)
- F Cuccia
- Radiotherapy Unit, ARNAS Civico Hospital, Palermo, Italy.
| | - E Pastorello
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (VR), Italy
| | - C Franzese
- IRCCS Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Milan, Italy
| | - L Belgioia
- Radiation Oncology Department, San Martino Teaching Hospital, Genova University (DISSAL), Genoa, Italy
| | - M Bignardi
- Radiation Oncology Center, Fondazione Poliambulanza, Brescia, Italy
| | - M Federico
- Radiation Therapy Unit, Clinica Macchiarella, Palermo, Italy
| | - V Figlia
- Radiotherapy Unit, ARNAS Civico Hospital, Palermo, Italy
| | - N Giaj Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (VR), Italy
| | - S Badellino
- Department of Oncology, University of Turin, Turin, Italy
| | - P Borghetti
- Radiation Oncology Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - G Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - G Montesi
- Radiation Oncology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - A Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - I Fazio
- Radiation Therapy Unit, Clinica Macchiarella, Palermo, Italy
| | - G Ferrera
- Radiotherapy Unit, ARNAS Civico Hospital, Palermo, Italy
| | - F Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (VR), Italy; University of Brescia, Brescia, Italy
| | - M Scorsetti
- IRCCS Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Orsi F. Interventional oncology in breast cancer. J Med Imaging Radiat Oncol 2023; 67:876-885. [PMID: 37964687 DOI: 10.1111/1754-9485.13600] [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: 05/15/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
Breast cancer (BC) is the most common cancer and one of the most important causes of death in women. Surgery is the standard therapy for breast cancer and in the last decades evolved towards a more conservative approach, with lumpectomy, followed by radiation therapy, the most common option. Unfortunately, up to 40% of women affected by BC will develop metastases and will receive systemic therapy, which improves survival and quality of life. Interventional oncology (IO), thanks to the improvement in technology and clinical experience, is gaining an important role in the field of breast cancer, both in treating the primary tumour and also in metastasis in well-selected cases. Percutaneous thermal ablation and more recently cryoablation are reported to achieve promising results in the radical treatment of small breast cancer, with optimal cosmetic outcome and a very high safety profile. Percutaneous ablation as well as intra-arterial therapies, such as chemoembolization and radioembolization, might also be indicated in metastatic BC patients. In advanced stage disease, breast cancer liver metastases (BCLM) represent the main factor affecting the overall survival. Metastatic breast disease is a systemic disease, with tumour deposits potentially spread into different organs and tissues for which systemic therapy is the standard approach. Local therapies for liver metastases might have an important role in improving survival and quality of life in well-selected patients. Clinical and technical indications with their limitations, results and potential complications in local IO treatment for BCLM, will be also described.
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Affiliation(s)
- Franco Orsi
- IRCCS Istituto Europeo di Oncologia, Milan, Italy
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Vanden Berg RNW, Zilli T, Achard V, Dorff T, Abern M. The diagnosis and treatment of castrate-sensitive oligometastatic prostate cancer: A review. Prostate Cancer Prostatic Dis 2023; 26:702-711. [PMID: 37422523 DOI: 10.1038/s41391-023-00688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Oligometastatic prostate cancer (OMPCa) is emerging as a transitional disease state between localized and polymetastatic disease. This review will assess the current knowledge of castrate-sensitive OMPCa. METHODS A review of the current literature was performed to summarize the definition and classification of OMPCa, assess the diagnostic methods and imaging modalities utilized, and to review the treatment options and outcomes. We further identify gaps in knowledge and areas for future research. RESULTS Currently there is no unified definition of OMPCa. National guidelines mostly recommend systemic therapies without distinguishing oligometastatic and polymetastatic disease. Next generation imaging is more sensitive than conventional imaging and has led to early detection of metastases at initial diagnosis or recurrence. While mostly retrospective in nature, recent studies suggest that treatment (surgical or radiation) of the primary tumor and/or metastatic sites might delay initiation of androgen deprivation therapy while increasing survival in selected patients. CONCLUSIONS Prospective data are required to better assess the incremental improvement in survival and quality of life achieved with various treatment strategies in patients with OMPCa.
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Affiliation(s)
| | - Thomas Zilli
- Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vérane Achard
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland
| | - Tanya Dorff
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Michael Abern
- Department of Urology, Duke University, Durham, NC, USA.
- Duke Cancer Institute, Durham, NC, USA.
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de Baere T, Bonnet B, Tselikas L, Deschamps F. The percutaneous management of pulmonary metastases. J Med Imaging Radiat Oncol 2023; 67:870-875. [PMID: 37742316 DOI: 10.1111/1754-9485.13588] [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: 06/15/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
Local treatment of lung metastases has been in the front scene since late 90s when an international registry of thoracic surgery reported a median overall survival of 35 months in resected patients versus 15 months in non-resected patients. Today, other local therapies are available for patients with oligometastatic lung disease, including image guided thermal ablation, such as ablation, microwave ablation, and cryoablation. Image-guided ablation is increasingly offered, and now recommended in guidelines as option to surgery. Today, the size of the target tumour remains the main driver of success and selection of patients with limited tumour size allowing for local tumour control in the range of 90% in most recent and larger series targeting lung metastases up to 3.5 cm. Overall survival exceeding five-years in large series of thermal ablation for lung metastases from colorectal origin are align with outcome of same patients treated with surgical resection. Moreover, thermal ablation in such population allows for one-year chemotherapy holidays in all comers and over 18 months in lung only metastatic patients, allowing for improved patient quality of life and preserving further lines of systemic treatment when needed. Tolerance of thermal ablation is excellent and better than surgery with no lost in respiratory function, allowing for repeated treatment when needed. In the future, it is likely that practice of lung surgery for small oligometastatic lung disease will decrease, and that minimally invasive techniques will replace surgery in such indications. Randomized study will be difficult to obtain as demonstrated by discontinuation of many studies testing the hypothesis of surgery versus observation, or surgery versus SBRT.
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Affiliation(s)
- Thierry de Baere
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
- University of Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Villejuif, France
| | - Baptiste Bonnet
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
- University of Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Villejuif, France
| | - Frederic Deschamps
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
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Franzese C, Lucchini R, Roghi M, Badalamenti M, Baldaccini D, Comito T, Franceschini D, Navarria P, Di Cristina L, Lo Faro L, Galdieri C, Reggiori G, Mancosu P, Tomatis S, Scorsetti M. Oligometastatic Prostate Cancer Treated with Stereotactic Body Radiation Therapy: The Role of Three-Dimensional Tumour Volume in Patient Survival. Clin Oncol (R Coll Radiol) 2023; 35:e649-e656. [PMID: 37775459 DOI: 10.1016/j.clon.2023.09.004] [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: 04/17/2023] [Revised: 07/25/2023] [Accepted: 09/13/2023] [Indexed: 10/01/2023]
Abstract
AIMS The definition of oligometastatic prostate cancer (OPCa) is currently based solely on the maximum number of detectable metastases, as there are no validated biomarkers available. The aim of this study was to identify novel predictive factors for OPCa patients who underwent metastases-directed therapy. MATERIALS AND METHODS This monocentre, retrospective study included consecutive OPCa patients with a maximum of five metastases in up to two organs, detected with choline- or PSMA-positron emission tomography, who were treated with metastases-directed stereotactic body radiation therapy. Endpoints were overall survival and progression-free survival, assessed with Kaplan-Meier analysis. Univariate and multivariable Cox regression was carried out to evaluate the association between clinical factors and survival outcomes. RESULTS Between 2009 and 2021, 163 patients and 320 metastases were treated with 226 stereotactic body radiation therapy courses. The median three-dimensional metastatic tumour volume was 4.1 cm3, with a range from 0.01 to 233.4 cm3. In total, 87 (53.4%), 21 (12.9%) and 55 (33.7%) metastases were classified as cN1, cM1a and cM1b, respectively. The median follow-up was 28.5 months. The rates of overall survival at 1, 3 and 5 years were 89.5% (95% confidence interval 83.4-93.4), 74.9% (95% confidence interval 66.1-81.7) and 57.2% (95% confidence interval 45.8-67.1), respectively. Multivariable analysis showed that overall survival reduced with the increase in three-dimensional total tumour volume (hazard ratio 1.93, 95% confidence interval 1.06-3.52; P = 0.030) and confirmed a significant difference between cN1 versus cM1a-b disease (hazard ratio 1.81, 95% confidence interval 1.01-3.25; P = 0.046). The cut-off value of total volume correlated with the highest risk of death was 20 cm3 (hazard ratio 2.37, 95% confidence interval 1.34-4.18; P = 0.003). The median progression-free survival was 17.8 months, with 1-, 3- and 5-year rates of 63.7% (95% confidence interval 55.4-70.9), 31.5% (95% confidence interval 22.8-40.6) and 24.7% (95% confidence interval 16.0-34.3). CONCLUSIONS This study identified three-dimensional total tumour volume and the site of oligometastases as significant predictors of survival in OPCa patients treated with metastases-directed therapy. These parameters can potentially be used to personalised treatment and improve patient outcome.
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Affiliation(s)
- C Franzese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy.
| | - R Lucchini
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - M Roghi
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - M Badalamenti
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - D Baldaccini
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - T Comito
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - D Franceschini
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - P Navarria
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - L Di Cristina
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - L Lo Faro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - C Galdieri
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - G Reggiori
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - P Mancosu
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - S Tomatis
- IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
| | - M Scorsetti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy
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Yamaguchi H, Fukumitsu N, Numajiri H, Ogino H, Katoh N, Okimoto T, Suzuki M, Sakurai H. The Japanese nationwide cohort data of proton beam therapy for liver oligometastasis in esophagogastric cancer patients. JOURNAL OF RADIATION RESEARCH 2023; 64:926-932. [PMID: 37697668 PMCID: PMC10665303 DOI: 10.1093/jrr/rrad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/03/2023] [Indexed: 09/13/2023]
Abstract
A nationwide multicenter cohort study on particle therapy was launched by the Japanese Society for Radiation Oncology in Japan in May 2016. We analyzed the outcome of proton beam therapy (PBT) for liver oligometastasis of esophagogastric cancers. Cases in which PBT was performed at all PBT facilities in Japan between May 2016 and February 2019 were enrolled. The patients were selected based on the following criteria: controlled primary cancer, liver recurrence without extrahepatic tumors and no more than three liver lesions. Twenty-two males and two females with a median age of 69 (range, 52-80) years and 35 lesions were included. This study included 6 patients with esophageal and 18 patients with gastric cancer. The median lesion size, fraction size and biological effective dose (BED)10 were 32 (7-104) mm, 3.8 gray (relative biological effect)/fractions (Gy (RBE)/fr) (2-8 Gy (RBE)/fr) and 96.9 (88.8-115.2) Gy, respectively. The median follow-up period was 18 (4-47) months. The 1-, 2- and 3-year overall survival (OS) rates were 75, 51.8 and 45.3%, respectively, and the median OS was 25.3 months. The 1-, 2- and 3-year cumulative local recurrence (LR) rates were 3, 6 and 6%, respectively. Patients' age (P < 0.01), performance status (P = 0.017) and tumor size (P = 0.024) were significant OS-related factors. No Grade 3 or higher adverse events (AEs) were observed. Owing to the low incidence of AEs and the low LR cumulative incidence, PBT is a feasible option for liver oligometastasis of esophagogastric cancers.
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Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan
- Department of Radiology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima 963-8052, Japan
| | - Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, 1-6-8 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Motohisa Suzuki
- Department of Radiology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima 963-8052, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
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Yao L, Shao H, Zhang X, Huang X. A novel risk model for predicting peritoneal metastasis in colorectal cancer based on the SEER database. J Cancer Res Clin Oncol 2023; 149:15989-16000. [PMID: 37679653 DOI: 10.1007/s00432-023-05368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Early detection and intervention could significantly improve the prognosis of patients with peritoneal metastasis (PM). Our main purpose was to develop a model to predict the risk of PM in patients with colorectal cancer (CRC). METHODS Patients from the Surveillance, Epidemiology, and End Results (SEER) database with CRC classified according to the AJCC 8th TNM staging system were selected for the study. After data pre-processing, the dataset was divided into a training set and a validation set. In the training set, univariate logistic analysis and stepwise multivariate logistic regression analysis were utilized to screen clinical features and construct a risk prediction model. Then, we validated the model using the confusion matrix, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves to examine its performance. RESULTS The model constructed using stepwise multivariate logistic regression analysis incorporated the following eight clinical features: age, tumor location, histological type, T stage, carcinoembryonic antigen (CEA) level, tumor deposits (TDs), log odds (LODDS) of metastatic lymph nodes, and extraperitoneal metastasis (EM). The areas under the curve (AUCs) of the model in the training and validation sets were 0.924 and 0.912, respectively. The accuracy and the recall ratio were higher than 0.8 in both cohorts. DCA and the calibration curves also confirmed its excellent predictive power. CONCLUSIONS Our model can effectively predict the risk of PM in CRC patients, which is of great significance for the timely identification of patients at high risk of PM and further clinical decision-making.
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Affiliation(s)
- Li Yao
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Number 54, Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang Province, China
| | - Huan Shao
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Number 54, Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang Province, China
| | - Xinyi Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Number 54, Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang Province, China
| | - Xuan Huang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Number 54, Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang Province, China.
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Bohlok A, Richard F, Lucidi V, Asmar AE, Demetter P, Craciun L, Larsimont D, Hendlisz A, Van Laethem JL, Dirix L, Desmedt C, Vermeulen P, Donckier V. Histopathological growth pattern of liver metastases as an independent marker of metastatic behavior in different primary cancers. Front Oncol 2023; 13:1260880. [PMID: 37965465 PMCID: PMC10641477 DOI: 10.3389/fonc.2023.1260880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Surgical resection can lead to prolonged survival in patients with isolated liver metastases (LM) from various primary cancers. However, there are currently no validated predictive markers to discriminate between these oligo/argometastatic patients, who will benefit from surgery, and those with diffuse metastatic behavior in whom surgery will be futile. To evaluate whether the tumor microenvironment, or histopathological growth pattern (HGP), of LM reflects the type of metastatic progression independently of the origin of the primary cancer, we analyzed a combined series of patients who underwent surgery for colorectal LM (N=263) or non-colorectal LM (N=66). HGPs of LM were scored in each patient to distinguish between desmoplastic HGP (all LM showing a complete encapsulated pattern) and non-desmoplastic HGP (at least one LM with some infiltrating-replacement component). In the entire series, 5-year overall and progression-free survival were, 44.5% and 15.5%, respectively, with no significant differences between colorectal and non-colorectal LM. In patients with desmoplastic HGP, 5-year overall and progression-free survival were 57% and 32%, respectively, as compared to 41% and 12%, respectively, in patients with non-desmoplastic-HGP (p=0.03 and 0.005). Irrespective of cancer origin and compared to traditional risk factors, desmoplastic HGP was the most significant predictor for better post-operative overall survival (adjusted HR: 0.62; 95% CI: [0.49-0.97]; p=0.035) and progression-free survival (adjusted HR: 0.61; 95% CI: [0.42-0.87], p=0.006). This suggests that the HGP of LM may represent an accurate marker that reflects the mode of metastatic behavior, independently of primary cancer type.
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Affiliation(s)
- Ali Bohlok
- Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - François Richard
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Valerio Lucidi
- Abdominal Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine El Asmar
- Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Pieter Demetter
- Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Ligia Craciun
- Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Denis Larsimont
- Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Hendlisz
- Digestive Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Luc Van Laethem
- Hepatogastroenterology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Luc Dirix
- Translational Cancer Research Unit, Gasthuiszusters Antwerp Hospitals and University of Antwerp, Antwerp, Belgium
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Peter Vermeulen
- Translational Cancer Research Unit, Gasthuiszusters Antwerp Hospitals and University of Antwerp, Antwerp, Belgium
| | - Vincent Donckier
- Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Mheid S, Allen S, Ng SSW, Hall WA, Sanford NN, Aguilera TA, Elamir AM, Bahij R, Intven MPW, Radhakrishna G, Mohamad I, De Leon J, Tan H, Lewis S, Gani C, Stanecu T, Dell’Acqua V, Hosni A. Local Control Following Stereotactic Body Radiation Therapy for Liver Oligometastases: Lessons from a Quarter Century. Curr Oncol 2023; 30:9230-9243. [PMID: 37887567 PMCID: PMC10605011 DOI: 10.3390/curroncol30100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
The utilization of stereotactic body radiation therapy for the treatment of liver metastasis has been widely studied and has demonstrated favorable local control outcomes. However, several predictive factors play a crucial role in the efficacy of stereotactic body radiation therapy, such as the number and size (volume) of metastatic liver lesions, the primary tumor site (histology), molecular biomarkers (e.g., KRAS and TP53 mutation), the use of systemic therapy prior to SBRT, the radiation dose, and the use of advanced technology and organ motion management during SBRT. These prognostic factors need to be considered when clinical trials are designed to evaluate the efficacy of SBRT for liver metastases.
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Affiliation(s)
- Sara Mheid
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (S.M.); (T.S.)
| | - Stefan Allen
- Department of Radiation Oncology, Dalhousie University, Nova Scotia Health, Halifax, NS B3H 4R2, Canada;
| | - Sylvia S. W. Ng
- Department of Radiation Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
| | - William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Nina N. Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75235, USA; (N.N.S.); (T.A.A.); (A.M.E.)
| | - Todd A. Aguilera
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75235, USA; (N.N.S.); (T.A.A.); (A.M.E.)
| | - Ahmed M. Elamir
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75235, USA; (N.N.S.); (T.A.A.); (A.M.E.)
| | - Rana Bahij
- Department of Oncology, Odense University Hospital, 5000 Odense, Denmark;
| | - Martijn P. W. Intven
- Department of Radiotherapy, Division Imaging and Oncology, University Medical Centre, 3584 CX Utrecht, The Netherlands;
| | - Ganesh Radhakrishna
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan;
| | | | - Hendrick Tan
- Department of Radiation Oncology, Fiona Stanley Hospital, Perth, WA 6150, Australia;
- GenesisCare, Perth, WA 6150, Australia
| | - Shirley Lewis
- Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India;
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Teo Stanecu
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (S.M.); (T.S.)
| | - Veronica Dell’Acqua
- Medical Affairs and Clinical Research, Linac-Based RT, Elekta Milan, 20864 Lombardy, Italy;
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (S.M.); (T.S.)
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49
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Paulino J, Mansinho H. Recent Developments in the Treatment of Pancreatic Cancer. ACTA MEDICA PORT 2023; 36:670-678. [PMID: 37788655 DOI: 10.20344/amp.19957] [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: 03/28/2023] [Accepted: 08/22/2023] [Indexed: 10/05/2023]
Abstract
Pancreatic duct adenocarcinoma is currently the sixth-leading cause of cancer death worldwide and the fourth in Europe, with a continuous increase in annual lethality in Portugal during the last two decades. Surgical en-bloc resection of the tumor with microscopic-negative margins and an adequate lymphadenectomy is the only possibility of long-term survival. As this type of cancer is a systemic disease, there is a high rate of recurrence even after curative resection, turning systemic therapy the core of its management, mostly based on chemotherapy. Neoadjuvant strategies for nonmetastatic disease showed significant improvement in overall survival compared with upfront surgery, namely in borderline resectable disease. Moreover, these strategies provided downstaging in several situations allowing R0 resections. Under these new oncologic strategies, several recent surgical issues were introduced, namely more aggressive vascular resections and even tumor resections in oligometastatic disease. This review revisits the state-of-the-art of surgical and oncological interventions in pancreatic duct adenocarcinoma and highlights recent advances in the field aiming to achieve higher survival rates.
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Affiliation(s)
- Jorge Paulino
- General Surgery Department. Hospital da Luz. Lisboa. Portugal
| | - Hélder Mansinho
- Oncology Department. Hospital Garcia de Orta. Almada. Portugal
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50
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Dinakaran D, Wilson BC. The use of nanomaterials in advancing photodynamic therapy (PDT) for deep-seated tumors and synergy with radiotherapy. Front Bioeng Biotechnol 2023; 11:1250804. [PMID: 37849983 PMCID: PMC10577272 DOI: 10.3389/fbioe.2023.1250804] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
Photodynamic therapy (PDT) has been under development for at least 40 years. Multiple studies have demonstrated significant anti-tumor efficacy with limited toxicity concerns. PDT was expected to become a major new therapeutic option in treating localized cancer. However, despite a shifting focus in oncology to aggressive local therapies, PDT has not to date gained widespread acceptance as a standard-of-care option. A major factor is the technical challenge of treating deep-seated and large tumors, due to the limited penetration and variability of the activating light in tissue. Poor tumor selectivity of PDT sensitizers has been problematic for many applications. Attempts to mitigate these limitations with the use of multiple interstitial fiberoptic catheters to deliver the light, new generations of photosensitizer with longer-wavelength activation, oxygen independence and better tumor specificity, as well as improved dosimetry and treatment planning are starting to show encouraging results. Nanomaterials used either as photosensitizers per se or to improve delivery of molecular photosensitizers is an emerging area of research. PDT can also benefit radiotherapy patients due to its complementary and potentially synergistic mechanisms-of-action, ability to treat radioresistant tumors and upregulation of anti-tumoral immune effects. Furthermore, recent advances may allow ionizing radiation energy, including high-energy X-rays, to replace external light sources, opening a novel therapeutic strategy (radioPDT), which is facilitated by novel nanomaterials. This may provide the best of both worlds by combining the precise targeting and treatment depth/volume capabilities of radiation therapy with the high therapeutic index and biological advantages of PDT, without increasing toxicities. Achieving this, however, will require novel agents, primarily developed with nanomaterials. This is under active investigation by many research groups using different approaches.
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Affiliation(s)
- Deepak Dinakaran
- National Cancer Institute, National Institute of Health, Bethesda, MD, United States
- Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Brian C. Wilson
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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