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Pezzulla D, Chiloiro G, Lima EM, Macchia G, Romano C, Reina S, Panza G, Cilla S, Morganti AG, Cellini F, Gambacorta MA, Deodato F. Stereotactic radiotherapy for liver oligometastases: a pooled analysis following the estro/eortc consensus recommendations. Clin Exp Metastasis 2024:10.1007/s10585-024-10301-6. [PMID: 39017807 DOI: 10.1007/s10585-024-10301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
A large pooled analysis of liver oligometastases, classified accordingly to the ESTRO/EORTC recommendations, treated by stereotactic radiotherapy (SBRT) and Radiosurgery (SRS) was carried out. The clinical and dosimetric data of patients who underwent SBRT/SRS for liver metastases were analysed in terms of efficacy and toxicity profile. In particular, the Local Control (LC), the Distant Metastases Free Survival (DMFS), the Disease-Free Survival (DFS), the Overall Survival (OS), and the Next Systemic Therapy Free Survival (NEST-FS) rates were analysed. 113 patients (M/F: 49/64), accounting for a total of 150 hepatic lesions (March 2006-February 2023) in two Italian radiotherapy Institutions were evaluated. Median age was 67 years old (36-92) and 48 (42.5%) patients had at least one comorbidity. The majority of the lesions were induced (30.7%) or repeated oligoprogressive (12.7%) metastases. 98 lesions were treated with more than one daily fraction (mainly 50 Gy in 5 fractions), while 52 were radiosurgery treatments (mainly 32 Gy). The treatment response at 3-4 months was evaluable in 147 lesions: complete response was 32.0%, partial response 17.0%, and stable disease 32.0%. Actuarial LC, DMFS, DFS, OS, and NEST-FS at 1 year were 75.8%, 37.7%, 34.9%, 78.7%, and 59.4% respectively; while actuarial LC, DMFS, DFS, OS, and NEST-FS at 2 years were 52.1%, 24.9%, 21.9%, 51.3%, and 36.8%, respectively. The achievement of complete response, synchronous oligometastases, and no treatment interruptions correlated with a more favorable outcomes. As per the toxicity profile, we registered only two acute and one late toxicity cases higher than grade 2. Stereotactic treatment for liver metastases seems to be a safe and promising option in terms of local control. The best results in term of outcomes have been obtained in patients with complete response, synchronous oligometastases, favorable histology, and no treatment interruptions.
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Affiliation(s)
- D Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - G Chiloiro
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - E M Lima
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - G Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy.
| | - C Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - S Reina
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - G Panza
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - S Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - A G Morganti
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, IRCCS Azienda Ospedaliero, Universitaria di Bologna - Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Cellini
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Milano, Italy
| | - M A Gambacorta
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Milano, Italy
| | - F Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Milano, Italy
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Yoshida S, Maezawa Y, Ishihara K, Inoue N, Tanabe K, Izumi K, Fujiwara M, Toide M, Yamamoto T, Uehara S, Araki S, Inoue M, Takazawa R, Numao N, Ohtsuka Y, Tanaka H, Fujii Y. Outcomes and prognostic factors in patients with synchronous and metachronous oligometastatic urothelial carcinoma with visceral metastases. Int J Urol 2024. [PMID: 39010666 DOI: 10.1111/iju.15542] [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: 05/08/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES To evaluate the clinical characteristics of oligometastatic disease (OMD) in metastatic urothelial carcinoma (mUC) with visceral metastases when classified into synchronous and metachronous metastases. METHODS Of 957 cases of de novo mUC treated between 2008 and 2023, 374 with visceral metastases were analyzed. Cases were classified into OMD with up to three metastatic lesions and polymetastatic disease (PMD), and into synchronous and metachronous metastases. The clinical characteristics and overall survival (OS) for each group were analyzed. RESULTS Overall, 196 (52.4%) had synchronous metastasis and 178 (47.6%) had metachronous metastasis. Median OS for synchronous metastases was significantly shorter than for metachronous metastases (12.1 months vs. 15.3 months, p = 0.011). Among the synchronous metastases, 48 (24.5%) were OMD and 148 (75.6%) were PMD. There was no significant difference in OS between the OMDs and PMDs (median 14.9 months vs. 11.7 months, p = 0.32), and only decreased albumin level was identified as a significant predictor of poor OS. Among the metachronous metastases, 64 (36.0%) were OMD and 114 (64.0%) were PMD. There was no significant difference in OS between the OMD and PMD (median 21.2 months vs. 15.0 months, p = 0.35), and no significant predictors of poor OS were identified. CONCLUSIONS For mUC with visceral metastases, the timing of metastasis appearance was associated with prognosis, with synchronous metastases being a poorer prognostic factor compared to metachronous metastases. There was no prognostic difference between OMD and PMD with visceral metastases when classified into synchronous or metachronous metastases.
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Affiliation(s)
- Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yuya Maezawa
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura-shi, Ibaraki, Japan
| | - Kensaku Ishihara
- Department of Urology, Soka Municipal Hospital, Soka-shi, Saitama, Japan
| | - Naoki Inoue
- Department of Urology, JA Toride Medical Hospital, Toride-shi, Ibaraki, Japan
| | - Kenji Tanabe
- Department of Urology, Saitama Red Cross Hospital, Saitama, Japan
| | - Keita Izumi
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
| | - Motohiro Fujiwara
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Masahiro Toide
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takanobu Yamamoto
- Department of Urology, Tokyo Metropolitan Tama-Nambu Chiiki Hospital, Tama-shi, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Showa General Hospital, Kodaira-shi, Tokyo, Japan
| | - Saori Araki
- Department of Urology, Kohnodai Hospital, Ichikawa-shi, Chiba, Japan
| | - Masaharu Inoue
- Department of Urology, Saitama Prefectural Cancer Center, Kitaadachi-gun-Ina-machi, Saitama, Japan
| | - Ryoji Takazawa
- Department of Urology, Tokyo Metropolitan Ohtsuka Hospital, Toshima-ku, Tokyo, Japan
| | - Noboru Numao
- Department of Urology, Cancer Institute Hospital, Koto-ku, Tokyo, Japan
| | - Yukihiro Ohtsuka
- Department of Urology, Japanese Red Cross Omori Hospital, Ota-ku, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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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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Kim H, Kim SM, Hwang J, Yang DS. Clinical experience of consolidative radiotherapy for localized metastatic non-small cell lung cancer who showed favorable tumor response after systemic treatment. Discov Oncol 2024; 15:64. [PMID: 38443516 PMCID: PMC10914649 DOI: 10.1007/s12672-024-00896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 02/18/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Our study has aimed to assess the effects of consolidative high-dose radiotherapy on clinical outcomes in patients with localized metastatic non-small cell lung cancer (NSCLC) who showed favorable tumor response after systemic treatment. METHODS We retrospectively reviewed the medical records of 83 patients with localized metastatic NSCLC, who received systemic therapy followed by consolidative local radiotherapy at the Korea University Guro Hospital between March 2017 and June 2022. In the current study, we defined localized metastatic disease as the presence of one to three metastatic sites at the time of diagnosis. And patients who showed favorable tumor response after systemic treatment, including oligo-progressive disease at the thoracic site which was amenable to curative high-dose local radiotherapy, were included. The planned total dose and fraction size mainly depended on the location of lesions. RESULTS The median follow-up time after consolidative radiotherapy was 16 months (range: 5-52 months). The overall 2-year progression-free survival rates were 81.4%. Of 83 patients, only four (4.3%), treated with intensity-modulated radiation therapy, showed an in-field local recurrence. Interestingly, only one patient experienced a local failure among the 20 patients who showed an oligo-progressive disease at the thoracic site on the tumor response evaluation after systemic treatment. Regarding treatment-related pulmonary toxicity, three patients with grade-3 and one patient with grade-4 radiation pneumonitis were presented. CONCLUSIONS If the disease is sufficiently controlled and localized by systemic therapy, local consolidative radiotherapy is thought to improves local control rates with acceptable treatment-related toxicities in patients with localized metastatic NSCLC, especially those with oligo-progressive disease.
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Affiliation(s)
- Hakyoung Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
| | - Sun Myung Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Jeongeun Hwang
- Department of Biomedical Research Center, Korea University Guro Hospital, Seoul, Republic of Korea
- Department of Medical IT Engineering, Soonchunhyang University, Asan, Chungcheongnam-do, Republic of Korea
| | - Dae Sik Yang
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
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Lee JN, Kim MY, Kang JH, Kang JK, Chung JW, Ha YS, Choi SH, Kim BS, Kim HT, Kim TH, Yoo ES, Kim SH, Kwon TG. Progression-directed therapy in patients with oligoprogressive castration-resistant prostate cancer. Investig Clin Urol 2024; 65:132-138. [PMID: 38454822 PMCID: PMC10925732 DOI: 10.4111/icu.20230337] [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: 10/10/2023] [Revised: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Oligoprogressive lesions are observed in a subset of patients who progress to castration-resistant prostate cancer (CRPC), while other lesions remain controlled by systemic therapy. This study evaluates the impact of progression-directed therapy (PDT) on these oligoprogressive lesions. MATERIALS AND METHODS This retrospective study included 40 patients diagnosed with oligoprogressive CRPC. PDT was performed for treating all progressive sites using radiotherapy. Fifteen patients received PDT using radiotherapy for all progressive sites (PDT group) while 25 had additional first-line systemic treatments (non-PDT group). In PDT group, 7 patients underwent PDT and unchanged systemic therapy (PDT-A group) and 8 patients underwent PDT with additional new line of systemic therapy on CRPC (PDT-B group). The Kaplan-Meier method was used to assess treatment outcomes. RESULTS The prostate specific antigen (PSA) nadir was significantly lower in PDT group compare to non-PDT group (p=0.007). A 50% PSA decline and complete PSA decline were observed in 13 patients (86.7%) and 10 patients (66.7%) of PDT group and in 18 patients (72.0%) and 11 patients (44.0%) of non-PDT group, respectively. The PSA-progression free survival of PDT-B group was significantly longer than non-PDT group. The median time to failure of first-line systemic therapy on CRPC was 30.2 months in patients in PDT group and 14.9 months in non-PDT group (p=0.014). PDT-B group showed a significantly longer time to progression than non-PDT group (p=0.025). Minimal PDT-related adverse events were observed. CONCLUSIONS PDT can delay progression of disease and enhance treatment efficacy with acceptable tolerability in oligoprogressive CRPC.
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Affiliation(s)
- Jun Nyung Lee
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Mi Young Kim
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jae Hoon Kang
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun-Koo Kang
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Wook Chung
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seock Hwan Choi
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae-Hwan Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Sang Yoo
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Gyun Kwon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
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Borghetti P, Facheris G, Ciammella P, Galaverni M, Granello L, Scotti V, Franceschini D, Romei A, Giaj Levra N, Federico M, La Vecchia M, Merlotti A, Sepulcri M, Piperno G, Marvaso G, Simoni N, Alì E, Pontoriero A, Cappelli A, Dionisi V, Menis J, Martino A, Vagge S, Canova S, Montesi G, Cuccia F, Boldrini L, Franzese C, Grisanti S, Bruni A, Scorsetti M. Sterotactic Ablative Radiotherapy in a Multicentric Series of Oligometastatic SCLC: The SAMOS Cohort. Clin Lung Cancer 2024; 25:151-158. [PMID: 38052684 DOI: 10.1016/j.cllc.2023.11.005] [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: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023]
Abstract
AIMS SCLC is the most aggressive lung cancer histology with a 5-year OS <10%. At the diagnosis, almost two-thirds of the SCLC an Extended Disease presentation. Two randomized studies (CASPIAN and ImPower133) demonstrated an OS improvement, when immunotherapy was prescribed as maintenance therapy after standard chemotherapy. To date, SABR has had a limited indication in managing metastatic SCLC, although recent reports proposed it as a valid treatment option in selected patients. We propose a retrospective multicentric analysis of patients treated with SABR for oligometastatic SCLC. METHOD Data of patients affected by oligometastatic-SCLC treated with SABR between 2017 and 2022 in 11 Italian centers were collected. Clinical and therapeutic variables together with OS and time to next treatment were analyzed. Univariate analysis with Kaplan-Meier curve were calculated, and log-rank test were applied. Cox proportional hazard model was used for multivariate analysis. RESULTS Data from 93 patients and 132 metastatic lesions were analyzed. The median age was 64 years (36-86) and all but 1 had Performance Status 0 or 1. Fifty-two patients presented ED at diagnosis. The first line treatment was radiochemotherapy in 42%, CHT alone in 24% and CHT-IO in 28%, others treatment accounts for 4% and only 2% of patients underwent best supportive care. Of the 132 lesions treated with SBRT 55 were in brain, 27 in lung, 11 in liver, 10 in lymph nodes, 8 in bones and 20 in adrenal gland. Median OS was 14 months, 1 year-OS and 2 years OS were 53% and 27%, respectively. The median TtNT was 14 months for the entire population. Of all the analyzed variables only, the anatomical site of the metastases and their number showed statistical significance in the univariate analysist, confirmed in the subsequent multivariate. CONCLUSION SABR seems to play a role in delaying further systemic lines in oligometastatic disease and to extend the use of ongoing treatment in oligoprogressive state. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Giorgio Facheris
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda-USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Galaverni
- Radiation Oncology, University Hospital of Parma, Parma, Italy
| | - Lorenzo Granello
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, Brescia, Italy.
| | - Vieri Scotti
- Radiation Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Andrea Romei
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Niccolò Giaj Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Manuela Federico
- U.O. Radioterapia Oncologica, Casa di Cura Macchiarella, Palermo, Italy
| | - Maria La Vecchia
- U.O. Radioterapia Oncologica, Casa di Cura Macchiarella, Palermo, Italy
| | - Anna Merlotti
- Department of Radiation Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Matteo Sepulcri
- Radiotherapy, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Gaia Piperno
- Division of Radiation Oncology, IEO-European Institute of Oncology, IRCCS, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO-European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicola Simoni
- Radiation Oncology, University Hospital of Parma, Parma, Italy
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda-USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Pontoriero
- Department of Biomedical, Radiation Oncology Unit, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Anna Cappelli
- Radiotherapy Unit, University of Modena and Reggio Emilia, Modena, Reggio Emilia, Italy
| | - Valeria Dionisi
- Department of Radiation Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Jessica Menis
- Medical Oncology Department, University and Hospital Trust of Verona, Verona, Italy
| | - Antonella Martino
- Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Vagge
- Radiotherapy Department, E.O. Galliera, Genoa, Italy
| | - Stefania Canova
- Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giampaolo Montesi
- Radiation Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Luca Boldrini
- Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Salvatore Grisanti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Medical Oncology Unit, Brescia, Italy
| | - Alessio Bruni
- Department of Oncology and Ematology, Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
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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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8
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Filoni E, Musci V, Di Rito A, Inchingolo R, Memeo R, Mannavola F. Multimodal Management of Colorectal Liver Metastases: State of the Art. Oncol Rev 2024; 17:11799. [PMID: 38239856 PMCID: PMC10794467 DOI: 10.3389/or.2023.11799] [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: 07/13/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
Liver is the most common site of colorectal cancer (CRC) metastases. Treatment of CRC liver metastases (CRLM) includes different strategies, prevalently based on the clinical and oncological intent. Valid approaches in liver-limited or liver-prevalent disease include surgery, percutaneous ablative procedures (radiofrequency ablation, microwave ablation), intra-arterial perfusional techniques (chemo-embolization, radio-embolization) as well as stereotactic radiotherapy. Systemic treatments, including chemotherapy, immunotherapy and other biological agents, are the only options for patients with no chance of locoregional approaches. The use of chemotherapy in other settings, such as neoadjuvant, adjuvant or conversion therapy of CRLM, is commonly accepted in the clinical practice, although data from several clinical trials have been mostly inconclusive. The optimal integration of all these strategies, when applicable and clinically indicated, should be ever considered in patients affected by CRLM based on clinical evidence and multidisciplinary experience. Here we revised in detail all the possible therapeutic approaches of CRLM focusing on the current evidences, the studies still in progress and the often contradictory data.
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Affiliation(s)
- Elisabetta Filoni
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Bari, Italy
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Vittoria Musci
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Bari, Italy
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Alessia Di Rito
- Radiotherapy Unit, P.O. “Mons A.R. Dimiccoli”, Barletta, Italy
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti, Italy
| | - Francesco Mannavola
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
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9
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Hernando-Requejo O, Chen X, López M, Sánchez E, García J, García P, Alonso R, Montero A, Ciervide R, Álvarez B, Zucca D, García Aranda M, Valero J, Fernández Letón P, Rubio C. Real-world effectiveness and safety of stereotactic body radiotherapy for liver metastases with different respiratory motion management techniques. Strahlenther Onkol 2023; 199:1000-1010. [PMID: 37728734 DOI: 10.1007/s00066-023-02147-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: 03/03/2023] [Accepted: 08/13/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) has been firmly established as a treatment choice for patients with oligometastases, as it has demonstrated both safety and efficacy by consistently achieving high rates of local control. Moreover, it offers potential survival benefits for carefully selected patients in real-world clinical settings. METHODS Between January 2008 and May 2020, a total of 149 patients (with 414 liver metastases) received treatment. The Active Breathing Coordinator device was used for 68 patients, while respiratory gating was used for 65 and abdominal compression was used for 16 patients. The most common histological finding was colorectal adenocarcinoma, with 37.6% of patients having three or more metastases, and 18% having two metastases. The prescribed dose ranged from 36 to 60 Gy, delivered in 3-5 fractions. RESULTS Local control rates at 2 and 3 years were 76.1% and 61.2%, respectively, with no instances of local recurrence after 3 years. Factors negatively impacting local control included colorectal histology, lower prescribed dose, and the occurrence of new liver metastases. The median overall survival from SBRT was 32 months, with the presence of metastases outside the liver and the development of new liver metastases after SBRT affecting survival. The median disease-free survival was 10 months. No substantial differences in both local control and survival were observed between the respiratory motion control techniques employed. Treatment tolerance was excellent, with only one patient experiencing acute grade IV thrombocytopenia and two patients suffering from ≥ grade II chronic toxicity. CONCLUSION For radical management of single or multiple liver metastases, SBRT is an effective and well-tolerated treatment option. Regardless of the technology employed, experienced physicians can achieve similarly positive outcomes. However, additional studies are required to elucidate prognostic factors that can facilitate improved patient selection.
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Affiliation(s)
- O Hernando-Requejo
- Radiation Oncology Department, University Hospital HM Puerta del Sur, Madrid, Spain.
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain.
| | - X Chen
- Radiation Oncology Department, University Hospital HM Puerta del Sur, Madrid, Spain
| | - M López
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - E Sánchez
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - J García
- Radiation Physics Department, University Hospital HM Puerta del Sur, Madrid, Spain
| | - P García
- Radiation Physics Department, University Hospital HM Puerta del Sur, Madrid, Spain
| | - R Alonso
- Radiation Oncology Department, University Hospital HM Puerta del Sur, Madrid, Spain
| | - A Montero
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - R Ciervide
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - B Álvarez
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - D Zucca
- Radiation Physics Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - M García Aranda
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - J Valero
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - P Fernández Letón
- Radiation Physics Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - C Rubio
- Radiation Oncology Department, University Hospital HM Puerta del Sur, Madrid, Spain
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
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10
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Iyengar P, All S, Berry MF, Boike TP, Bradfield L, Dingemans AMC, Feldman J, Gomez DR, Hesketh PJ, Jabbour SK, Jeter M, Josipovic M, Lievens Y, McDonald F, Perez BA, Ricardi U, Ruffini E, De Ruysscher D, Saeed H, Schneider BJ, Senan S, Widder J, Guckenberger M. Treatment of Oligometastatic Non-Small Cell Lung Cancer: An ASTRO/ESTRO Clinical Practice Guideline. Pract Radiat Oncol 2023; 13:393-412. [PMID: 37294262 DOI: 10.1016/j.prro.2023.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/07/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE This joint guideline by American Society for Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) was initiated to review evidence and provide recommendations regarding the use of local therapy in the management of extracranial oligometastatic non-small cell lung cancer (NSCLC). Local therapy is defined as the comprehensive treatment of all known cancer-primary tumor, regional nodal metastases, and metastases-with definitive intent. METHODS ASTRO and ESTRO convened a task force to address 5 key questions focused on the use of local (radiation, surgery, other ablative methods) and systemic therapy in the management of oligometastatic NSCLC. The questions address clinical scenarios for using local therapy, sequencing and timing when integrating local with systemic therapies, radiation techniques critical for oligometastatic disease targeting and treatment delivery, and the role of local therapy for oligoprogression or recurrent disease. Recommendations were based on a systematic literature review and created using ASTRO guidelines methodology. RESULTS Based on the lack of significant randomized phase 3 trials, a patient-centered, multidisciplinary approach was strongly recommended for all decision-making regarding potential treatment. Integration of definitive local therapy was only relevant if technically feasible and clinically safe to all disease sites, defined as 5 or fewer distinct sites. Conditional recommendations were given for definitive local therapies in synchronous, metachronous, oligopersistent, and oligoprogressive conditions for extracranial disease. Radiation and surgery were the only primary definitive local therapy modalities recommended for use in the management of patients with oligometastatic disease, with indications provided for choosing one over the other. Sequencing recommendations were provided for systemic and local therapy integration. Finally, multiple recommendations were provided for the optimal technical use of hypofractionated radiation or stereotactic body radiation therapy as definitive local therapy, including dose and fractionation. CONCLUSIONS Presently, data regarding clinical benefits of local therapy on overall and other survival outcomes is still sparse for oligometastatic NSCLC. However, with rapidly evolving data being generated supporting local therapy in oligometastatic NSCLC, this guideline attempted to frame recommendations as a function of the quality of data available to make decisions in a multidisciplinary approach incorporating patient goals and tolerances.
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Affiliation(s)
- Puneeth Iyengar
- Department of Radiation Oncology, UT Southwestern, Dallas, Texas.
| | - Sean All
- Department of Radiation Oncology, UT Southwestern, Dallas, Texas
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California
| | - Thomas P Boike
- Department of Radiation Oncology, GenesisCare/MHP Radiation Oncology, Troy, Michigan
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Anne-Marie C Dingemans
- Department of Pulmonology, Erasmus Medical Center Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | | | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul J Hesketh
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Melenda Jeter
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Fiona McDonald
- Department of Radiation Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Bradford A Perez
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, Maastricht and Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Hina Saeed
- Department of Radiation Oncology, Baptist Health South Florida, Boca Raton, Florida
| | - Bryan J Schneider
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Joachim Widder
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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11
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Heidinger M, Simonnet E, Koh LM, Frey Tirri B, Vetter M. Therapeutic approaches in patients with bone metastasis due to endometrial carcinoma - A systematic review. J Bone Oncol 2023; 41:100485. [PMID: 37250286 PMCID: PMC10213377 DOI: 10.1016/j.jbo.2023.100485] [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: 04/24/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Bone metastases (BM) are uncommon in endometrial carcinoma (EC), without information on the optimal oncologic management of patients with BM in EC. Here, we systematically review clinical characteristics, treatment approaches and prognosis in patients with BM in EC. Methods We conducted a systematic literature search until 27th March 2022 on PubMed, MEDLINE, Embase and clinicaltrials.gov. Outcomes included treatment frequency and survival after BM with comparators being treatment approaches (local cytoreductive bone surgery, systemic therapy, and local radiotherapy). Risk of bias was assessed using the NIH Quality Assessment Tool and Navigation Guide methodology. Results We retrieved 1096 records of which 112 retrospective studies (12 cohort studies, 12/12 fair quality; 100 case studies, 100/100 low quality) with a total of 1566 patients were included. The majority had a primary diagnosis of FIGO stage IV, grade 3 endometrioid EC. Singular BM were present in a median of 39.2%, multiple BM in 60.8% and synchronous additional distant metastases in 48.1% of patients respectively. In patients with secondary BM median time to bone recurrence was 14 months. Median survival after BM was 12 months. Local cytoreductive bone surgery was assessed in 7/13 cohorts and performed in a median of 15.8% (interquartile range [IQR] 10.3-43.0) of patients. Chemotherapy was assessed in 11/13 cohorts and administered in a median of 55.5% (IQR 41.0-63.9), hormonal therapy (7/13 cohorts) in 24.7% (IQR 16.3-36.0), and osteooncologic therapy (4/13 cohorts) in 2.7% (IQR 0.0-7.5) of patients respectively. Local radiotherapy was assessed in 9/13 cohorts and performed in a median of 66.7% (IQR 55.6-70.0) of patients. Survival benefits were seen in 2/3 cohorts after local cytoreductive bone surgery, and in 2/7 cohorts after chemotherapy without survival benefits in the remaining cohorts and investigated therapies. Limitations include the lack of controlled intervention studies, the heterogeneity and retrospective nature of the investigated populations. Conclusions This systematic review shows heterogenous therapeutic approaches in clinical practice without clear evidence for optimal oncologic management for patients with BM in EC.
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Affiliation(s)
- Martin Heidinger
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Elisa Simonnet
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Li Mei Koh
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Brigitte Frey Tirri
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Marcus Vetter
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
- Medical Oncology, Cantonal Hospital Baselland, Medical University Clinic, Muehlemattstrasse 13, 4410 Liestal, Switzerland
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12
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Marvaso G, Mastroleo F, Corrao G, Zaffaroni M, Vincini MG, Borghetti P, Cuccia F, Federico M, Montesi G, Pontoriero A, Franceschini D, Franzese C, Scorsetti M, Jereczek-Fossa BA. A Bibliometric Analysis of the Oligometastatic State over the Last Two Decades: A Shifting Paradigm for Oncology? An AIRO Oligometastatic Study Group. Cancers (Basel) 2023; 15:3902. [PMID: 37568718 PMCID: PMC10417037 DOI: 10.3390/cancers15153902] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
The term "oligometastasis" represents a relatively novel idea, which denotes a condition characterized by cancer dissemination with a limited number of lesions (usually fewer than five). The aim of the present study is to report a bibliometric analysis of the oligometastatic disease/state, incorporating all relevant studies on the topic for more than 20 years. The research strategy included at least one the terms "Oligmetastases", "Oligometastasis", "Oligometastatic", "Oligoprogression, "Oligoprogressive", "Oligorecurrent", or "Oligorecurrency" in the title, abstract, and/or keywords. All English-language documents from 1 January 1995 (the year of the earliest available document in Scopus) to 31 December 2022 were considered for the analysis. R code (R version 4.2.0) with R Studio (version 2022.12.0-353) and the Bibliometrix package (version 4.0.1) were used for the analysis. A total of 3304 documents, mainly articles (n = 2083, 63.0%) and reviews (n = 813, 24.6%), were collected from 1995 to 2022. The average annual growth rate of literature on the topic was 26.7%. Overall 15,176 authors published on the topic, with an average of eight authors/publication. From 1995, 69 countries contributed to the literature, with the USA and Italy being the top contributors. Among all keywords used by authors, the top three were oligometastases (19%), SBRT (18%), and radiation therapy (8%). Themes regarding "locoregional treatment", "organ motion", and "immunotherapy" were the most recent trend topics, mainly developed from 2019 to 2022, while "high-dose chemotherapy", "whole-brain radiotherapy", and "metastatic breast cancer" saw their main development during 2009-2018. Our study shows the exceptionally flourishing scientific production on the oligometastatic state, summarizing the most influential studies and highlighting the future developments and interests. This analysis will serve as a benchmark to identify this area for the attention of researchers worldwide and contribute to the increasing scientific work.
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Affiliation(s)
- Giulia Marvaso
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 13100 Novara, Italy
| | - Giulia Corrao
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy
| | | | - Manuela Federico
- Casa di cura Macchiarella, U.O. Radioterapia Oncologica, 90127 Palermo, Italy
| | - Giampaolo Montesi
- Radiation Oncology Department, 'S.M. Della Misericordia' Hospital, AULSS 5 Veneto, 45100 Rovigo, Italy
| | - Antonio Pontoriero
- Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
- Radiation Oncology Unit, A.O.U. Policlinico "G. Martino" Messina, 98124 Messina, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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13
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Zayed S, Louie AV, Breadner DA, Palma DA, Correa RJM. Radiation and immune checkpoint inhibitors in the treatment of oligometastatic non-small-cell lung cancer: a practical review of rationale, recent data, and research questions. Ther Adv Med Oncol 2023; 15:17588359231183668. [PMID: 37435562 PMCID: PMC10331344 DOI: 10.1177/17588359231183668] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 05/31/2023] [Indexed: 07/13/2023] Open
Abstract
The combined use of stereotactic ablative radiotherapy (SABR) and immune checkpoint inhibitors (ICIs) is an emerging treatment paradigm for oligometastatic non-small-cell lung cancer (NSCLC). Recent phase I and II trial data suggest that SABR to multiple metastases in addition to ICI use is safe and effective with promising progression-free survival and overall survival signals. There is great interest in capitalizing on combined immunomodulation from these two modalities for the treatment of oligometastatic NSCLC. Ongoing trials seek to validate the safety, efficacy, and preferred sequencing of SABR and ICI. This narrative review of the role of SABR when combined with ICI in oligometastatic NSCLC discusses the rationale for this bimodality treatment, summarizes recent clinical trial evidence, and proposes key principles of management based on the available evidence.
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Affiliation(s)
- Sondos Zayed
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, Sunnybrook Hospital Odette Cancer Centre, Toronto, ON, Canada
| | - Daniel A. Breadner
- Department of Medical Oncology, London Health Sciences Centre, London, ON, Canada
| | - David A. Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
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14
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Wachtel H, Dickson P, Fisher SB, Kiernan CM, Solórzano CC. Adrenal Metastasectomy in the Era of Immuno- and Targeted Therapy. Ann Surg Oncol 2023:10.1245/s10434-023-13474-8. [PMID: 37079202 DOI: 10.1245/s10434-023-13474-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/26/2023] [Indexed: 04/21/2023]
Abstract
Adrenal metastasectomy has an increasing role in multimodality oncologic care for diverse primary cancer types. In this review, we discuss the epidemiology, evaluation, and contemporary best practices in the management of adrenal metastases from various primaries. Initial evaluation of suspected adrenal metastases should include diagnostic imaging to assess the extent of tumor involvement and determine surgical resectability, as well as biochemical evaluation for hormone secretion. Biopsy has a minimal role and should only be performed in tumors that are established to be non-hormone secreting and when the biopsy results would change clinical management. Adrenal metastasectomy is associated with survival benefit in selected patients. We suggest that adrenal metastasectomy has the greatest benefit in four clinical scenarios: (1) disease limited to the adrenal gland in which adrenalectomy renders the patient disease-free; (2) isolated progression in the adrenal gland in the setting of otherwise controlled metastatic extra-adrenal disease; (3) need for palliation of symptoms related to adrenal metastases; or (4) in the context of tissue-based clinical trials. Both minimally invasive and open adrenalectomy techniques are safe and appear to have equivalent oncologic outcomes. Minimally invasive approaches are favored when technically feasible while maintaining oncologic principles. A multidisciplinary evaluation including clinicians with expertise in the primary cancer type is essential to the successful management of adrenal metastases.
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Affiliation(s)
- Heather Wachtel
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Paxton Dickson
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sarah B Fisher
- Division of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Colleen M Kiernan
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carmen C Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Carconi C, Cerreti M, Roberto M, Arrivi G, D'Ambrosio G, De Felice F, Di Civita MA, Iafrate F, Lucatelli P, Magliocca FM, Picchetto A, Picone V, Catalano C, Cortesi E, Tombolini V, Mazzuca F, Tomao S. The Management of Oligometastatic Disease in Colorectal Cancer: Present Strategies and Future Perspectives. Crit Rev Oncol Hematol 2023; 186:103990. [PMID: 37061075 DOI: 10.1016/j.critrevonc.2023.103990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023] Open
Abstract
Oligometastatic disease has been described as an intermediate clinical state between localized cancer and systemically metastasized disease. Recent clinical studies have shown prolonged survival when aggressive locoregional approaches are added to systemic therapies in patients with oligometastases. The aim of this review is to outline the newest options to treat oligometastatic colorectal cancer (CRC), also considering its molecular patterns. We present an overview of the available local treatment strategies, including surgical procedures, stereotactic body radiation therapy (SBRT), thermal ablation, as well as trans-arterial chemoembolization (TACE) and selective internal radiotherapy (SIRT). Moreover, since imaging methods provide crucial information for the early diagnosis and management of oligometastatic CRC, we discuss the role of modern radiologic techniques in selecting patients that are amenable to potentially curative locoregional treatments.
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Affiliation(s)
- Catia Carconi
- Sant'Andrea University Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Micaela Cerreti
- Sant'Andrea University Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Michela Roberto
- UOC Oncologia A, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy.
| | - Giulia Arrivi
- Oncology Unit, Sant' Andrea University Hospital, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giancarlo D'Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Mattia Alberto Di Civita
- UOC Oncologia A, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Franco Iafrate
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional radiology Unit, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Fabio Massimo Magliocca
- Vascular and Interventional radiology Unit, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Picchetto
- Emergency Department, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Picone
- UOC Oncologia B, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional radiology Unit, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Cortesi
- UOC Oncologia B, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Federica Mazzuca
- Oncology Unit, Sant' Andrea University Hospital, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Silverio Tomao
- Oncology Unit, Sant' Andrea University Hospital, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Lacaze JL, Chira C, Glemarec G, Monselet N, Cassou-Mounat T, De Maio E, Jouve E, Massabeau C, Brac de la Perrière C, Selmes G, Ung M, Nicolai V, Cabarrou B, Dalenc F. Clinical and pathological characterization of 158 consecutive and unselected oligometastatic breast cancers in a single institution. Breast Cancer Res Treat 2023; 198:463-474. [PMID: 36790573 DOI: 10.1007/s10549-023-06880-9] [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: 10/23/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Data about incidence, biological, and clinical characteristics of oligometastatic breast cancer (OMBC) are scarce. However, these data are essential in determining optimal treatment strategy. Gaining knowledge of these elements means observing and describing large, recent, and consecutive series of OMBC in their natural history. METHODS We collected data retrospectively at our institution from 998 consecutive patients diagnosed and treated with synchronous or metachronous metastatic breast cancer (MBC) between January 2014 and December 2018. The only criterion used to define OMBC was the presence of one to five metastases at diagnosis. RESULTS Of 998 MBC, 15.8% were classified OMBC. Among these, 88% had one to three metastases, and 86.7% had only one organ involved. Bone metastases were present in 52.5% of cases, 20.9% had progression to lymph nodes, 14.6% to the liver, 13.3% to the brain, 8.2% to the lungs, and 3.8% had other metastases. 55.7% had HR+/HER2- OMBC, 25.3% had HER2+OMBC, and 19% had HR-/HER2- OMBC. The HR+/HER2- subtype statistically correlated with bone metastases (p = 0.001), the HER2+subtype with brain lesions (p = 0.001), and the HR-/HER2- subtype with lymph node metastases (p = 0.008). Visceral metastases were not statistically associated with any OMBC subtypes (p = 0.186). OMBC-SBR grade III was proportionally higher than in the ESME series of 22,109 MBC (49.4% vs. 35.1%, p < 0.001). CONCLUSION OMBC is a heterogeneous entity whose incidence is higher than has commonly been published. Not an indolent disease, each subgroup, with its biological and anatomical characteristics, merits specific management.
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Affiliation(s)
- Jean-Louis Lacaze
- Départment d'Oncologie Médicale, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France.
| | - Ciprian Chira
- Département de Radiothérapie, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Gauthier Glemarec
- Département de Radiothérapie, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Nils Monselet
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Thibaut Cassou-Mounat
- Département de Médecine Nucléaire, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Eleonora De Maio
- Départment d'Oncologie Médicale, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Eva Jouve
- Département de Chirurgie, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Carole Massabeau
- Département de Radiothérapie, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Clémence Brac de la Perrière
- Départment d'Oncologie Médicale, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Gabrielle Selmes
- Département de Chirurgie, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Mony Ung
- Départment d'Oncologie Médicale, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Vincent Nicolai
- Départment d'Oncologie Médicale, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Bastien Cabarrou
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), 1 Av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Florence Dalenc
- Département d'Oncologie Médicale, Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Université de Toulouse, UPS, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
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De B, Farooqi AS, Mitchell KG, Ludmir EB, Lewis J, Rinsurongkawong W, Rinsurongkawong V, Lee JJ, Swisher SG, Gibbons DL, Zhang J, Le X, Elamin YY, Gomez DR, Ning MS, Lin SH, Liao Z, Chang JY, Vaporciyan AA, Heymach JV, Antonoff MB, Gandhi SJ. Benchmarking Outcomes for Molecularly Characterized Synchronous Oligometastatic Non-Small-Cell Lung Cancer Reveals EGFR Mutations to Be Associated With Longer Overall Survival. JCO Precis Oncol 2023; 7:e2200540. [PMID: 36716413 PMCID: PMC9928880 DOI: 10.1200/po.22.00540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/03/2022] [Accepted: 12/12/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Local consolidative therapy (LCT) for patients with synchronous oligometastatic non-small-cell lung cancer is an evolving treatment strategy, but outcomes following LCT stratified by genetic mutations have not been reported. We sought to identify genomic associations with overall survival (OS) and progression-free survival (PFS) for these patients. METHODS We identified all patients presenting between 2000 and 2017 with stage IV non-small-cell lung cancer and ≤ 3 synchronous metastatic sites. Patients were grouped according to mutational statuses. Primary outcomes included OS and PFS following initial diagnosis. RESULTS Of 194 included patients, 121 received comprehensive LCT to all sites of disease with either surgery or radiation. TP53 mutations were identified in 40 of 78 (55%), KRAS in 32 of 95 (34%), EGFR in 24 of 109 (22%), and STK11 in nine of 77 (12%). At median follow-up of 96 months, median OS and PFS were 26 (95% CI, 23 to 31) months and 11 (95% CI, 9 to 13) months, respectively. On multivariable analysis, patients with EGFR mutations had lower mortality risk (hazard ratio [HR], 0.53; 95% CI, 0.29 to 0.98; P = .044) compared with wild-type patients, and patients with STK11 mutations had higher risk of progression or mortality (HR, 2.32; 95% CI, 1.12 to 4.79; P = .023) compared with wild-type patients. TP53 and KRAS mutations were not associated with OS or PFS. Among 71 patients with known EGFR mutational status who received comprehensive LCT, EGFR mutations were associated with lower mortality compared with wild-type (HR, 0.45; 95% CI, 0.22 to 0.94; P = .032). CONCLUSION When compared with wild-type patients, those with EGFR and STK11 mutations had longer OS and shorter PFS, respectively. EGFR mutations were associated with longer OS among oligometastatic patients treated with comprehensive LCT in addition to systemic therapy.
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Affiliation(s)
- Brian De
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahsan S. Farooqi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kyle G. Mitchell
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ethan B. Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeff Lewis
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Waree Rinsurongkawong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - J. Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen G. Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Don L. Gibbons
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jianjun Zhang
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiuning Le
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yasir Y. Elamin
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel R. Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew S. Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven H. Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joe Y. Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ara A. Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John V. Heymach
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Saumil J. Gandhi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
The hypothesis that ablative therapies (such as surgery or radiation) can be used to cure patients with a limited number of metastases was influential in changing practice. Early assertions of efficacy were based on observational studies, often without control groups, showing better-than-expected outcomes. However, in the past decade, new evidence from randomized trials has emerged, which in some cases have affirmed old hypotheses, but in other cases have raised new questions. In this review, we discuss the challenges in defining oligometastatic disease, summarize the randomized evidence evaluating metastasis-directed therapy in patients with oligometastatic disease, provide context for the difficulty in generating randomized evidence, and examine ongoing phase III studies.
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Affiliation(s)
- Wei Liu
- Division of Radiation Oncology, BC Cancer Vancouver, Vancouver, BC, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - David A Palma
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
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19
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van Ommen-Nijhof A, Steenbruggen TG, Capel L, Vergouwen M, Vrancken Peeters MJT, Wiersma TG, Sonke GS. Survival and prognostic factors in oligometastatic breast cancer. Breast 2022; 67:14-20. [PMID: 36549169 PMCID: PMC9795523 DOI: 10.1016/j.breast.2022.12.007] [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: 10/21/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Guidelines for oligometastatic breast cancer (OMBC) propagate multimodality treatment including polychemotherapy and local ablative treatment (LAT) of all lesions. The aim of this approach is prolonged disease remission, or even cure. Long-term outcomes in OMBC and factors associated with prognosis are largely unknown, due to the rarity of this condition. We report overall survival (OS), event-free survival (EFS), and prognostic factors in a large real-world cohort of patients with OMBC. METHODS Patients with breast cancer and 1-3 distant metastatic lesions, treated in the Netherlands Cancer Institute between 1997 and 2020, were identified via text mining of medical files. We collected patient, tumor and treatment characteristics. The Kaplan-Meier method was used to calculate OS and EFS estimates, and Cox regression analyses to assess prognostic factors. RESULTS The cohort included 239 patients, of whom 54% had ERpos/HER2neg, 20% HER2pos and 20% triple negative disease. Median follow-up was 88.0 months (95% confidence interval (CI) 82.9-93.1) during which 107 patients died and 139 developed disease progression/recurrence; median OS was 93.0 months (95%CI 66.2-119.8). Factors associated with OS in multivariable analysis were subtype, disease-free interval and radiologic response to first-line systemic therapy; LAT was associated with EFS, but not OS. CONCLUSIONS In this large real-world cohort of patients with OMBC, OS and EFS compare favorably to survival in the general MBC population. Radiologic complete response to first-line systemic therapy was associated with favorable OS and EFS, indicating the importance of early optimal systemic therapy. The value of LAT in OMBC requires further study.
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Affiliation(s)
- Annemiek van Ommen-Nijhof
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE, Amsterdam, the Netherlands
| | - Tessa G. Steenbruggen
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE, Amsterdam, the Netherlands,Department of Internal Medicine, St Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, the Netherlands
| | - Laura Capel
- Department of Internal Medicine, St Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, the Netherlands
| | - Michel Vergouwen
- Department of Biometrics, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE, Amsterdam, the Netherlands
| | - Marie-Jeanne T. Vrancken Peeters
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE, Amsterdam, the Netherlands,Department of Surgery, Amsterdam University Medical Center, PO Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Terry G. Wiersma
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE, Amsterdam, the Netherlands
| | - Gabe S. Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE, Amsterdam, the Netherlands,Department of Medical Oncology, Amsterdam University Medical Center, PO Box 22660, 1100 DD, Amsterdam, the Netherlands,Corresponding author. Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE, Amsterdam, the Netherlands. @annemiekvon
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20
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Kim H, Yang DS, Kim SM. Consolidative high‐dose thoracic radiotherapy for limited metastatic nonsmall cell lung cancer: Focusing on oligo‐progressive disease. Asia Pac J Clin Oncol 2022; 19:385-391. [DOI: 10.1111/ajco.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Hakyoung Kim
- Department of Radiation Oncology Korea University Guro Hospital Korea University College of Medicine Seoul Republic of Korea
| | - Dae Sik Yang
- Department of Radiation Oncology Korea University Guro Hospital Korea University College of Medicine Seoul Republic of Korea
| | - Sun Myung Kim
- Department of Radiation Oncology Korea University Guro Hospital Korea University College of Medicine Seoul Republic of Korea
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21
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Dose-escalated radiotherapy with simultaneous integrated boost for bone metastases in selected patients with assumed favourable prognosis. Radiol Oncol 2022; 56:515-524. [PMID: 36503710 PMCID: PMC9784373 DOI: 10.2478/raon-2022-0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) concepts for dose escalation are increasingly used for bone metastases in patients with oligometastatic or oligoprogressive disease. For metastases that are not suitable for SBRT-regimens, a treatment with 30/40 Gy with simultaneous integrated boost (SIB) in 10 fractions represents a possible regimen. The aim of this study was to investigate the feasibility of this concept and the acute and subacute toxicities. PATIENTS AND METHODS Clinical records for dose-escalated radiotherapy of all consecutive patients treated with this regimen were evaluated retrospectively (24 patients with 28 target volumes for oncologic outcomes and 25 patients with 29 target volumes for treatment feasibility and dose parameters analysis). Analysis of radiotherapy plans included size of target volumes and dosimetric parameter for target volumes and organs at risk (OAR). Acute and subacute toxicities were evaluated according to Common Terminology Criteria for Adverse Events (CTCAE) V4.0. RESULTS The most common localization was the spine (71.4%). The most common histology was prostate cancer (45.8%). Oligometastatic or oligoprogressive disease was the indication for dose-escalated radiotherapy in 19/24 patients (79.2%). Treatment was feasible with all patients completing radiotherapy. Acute toxicity grade 1 was documented in 36.0% of the patients. During follow up, one patient underwent surgery due to bone instability. The 1-year local control and patient-related progression-free survival (PFS) were 90.0 ± 6.7% and 33.3 ± 11.6%, respectively. CONCLUSIONS Dose-escalated hypofractionated radiotherapy with simultaneous integrated boost for bone metastases resulted in good local control with limited acute toxicities. Only one patient required surgical intervention. The regimen represents an alternative to SBRT in selected patients.
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Oligometastases: Learning From the Past, Building for the Future. Int J Radiat Oncol Biol Phys 2022; 114:833-835. [DOI: 10.1016/j.ijrobp.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
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Local Therapy for Oligometastatic Disease—Cart Before the Horse? Int J Radiat Oncol Biol Phys 2022; 114:836-839. [DOI: 10.1016/j.ijrobp.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022]
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Tran PT, Sutera P, Phillips RM, Deek MP, Chmura S. From Idea to Clinical Practice: A Brief History of Oligometastatic Disease. Int J Radiat Oncol Biol Phys 2022; 114:576-580. [DOI: 10.1016/j.ijrobp.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/03/2022] [Indexed: 10/31/2022]
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25
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Recognition of and treatment recommendations for oligometastatic disease in multidisciplinary tumor boards. Clin Transl Radiat Oncol 2022; 38:123-129. [DOI: 10.1016/j.ctro.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
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Systemic Therapy Combined with Locoregional Therapy Improved Survival in Oligometastatic Breast Cancer: A Single-Center Retrospective Cohort Study. JOURNAL OF ONCOLOGY 2022; 2022:7839041. [PMID: 36245976 PMCID: PMC9553526 DOI: 10.1155/2022/7839041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022]
Abstract
The optimal therapeutic options, adding locoregional therapy (LRT) to systemic therapy (ST) or not, for patients with oligometastatic breast cancer (OMBC) have not been fully elucidated. Hence, we designed a retrospective observational study which enrolled patients with measurable extracranial OMBC having less than 5 metastatic lesions not necessarily in the same organ. We retrospectively reviewed a total of 199 patients diagnosed with extracranial OMBC, including 28 receiving ST followed by LRT (ST to LRT group), 44 receiving LRT followed by ST (LRT to ST group), and 127 receiving ST alone (ST alone group). After a median follow-up of 28.7 months, patients receiving both ST and LRT had a significantly better prognosis than those receiving ST alone: the median progression-free survival (PFS) was 16.3, 14.0, and 9.3 months (P < 0.001) and the median overall survival (OS) was 39.8, 70.5, and 26.7 months (P < 0.001) in the ST to LRT, LRT to ST, and ST alone groups, respectively. Sequence of ST and LRT had no significant impact on survival among patients receiving both. Further exploratory analysis identified ST plus LRT as an independent predictor for longer PFS. In conclusion, we demonstrated that adding LRT to ST was associated with survival benefits for patients with OMBC, and further prospective studies were warranted.
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Kim H, Kim SM, Yang DS, Lee KH, Kim YB. Clinical Outcomes of Stereotactic Ablative Radiotherapy for All Stages of Non-Small Cell Lung Cancer; Definitive versus Consolidative. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091304. [PMID: 36143981 PMCID: PMC9506516 DOI: 10.3390/medicina58091304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Stereotactic ablative radiotherapy (SABR) is not confined to early stage non-small cell lung cancer (NSCLC) and has a potential role in stage IV disease. We aimed to evaluate the effect of SABR on local control rates and survival outcomes in patients with all stages of NSCLC according to the treatment aim. Materials and Methods: We retrospectively reviewed the medical records of 88 patients with NSCLC who received SABR at the Korea University Guro Hospital between January 2015 and March 2021. Among these, 64 patients with stage I–II NSCLC ineligible for surgery were treated with a definitive aim. Twenty-four patients with stage IV limited metastatic NSCLC showing a favorable response to prior systemic therapy were treated with a consolidative aim. Results: The median follow-up time was 34 (range: 5–88) months. Thirty-one patients developed recurrence (35.2%), with distant metastasis being the most common (25/31, 80.6%). In-field local recurrence occurred in four patients (4/88 patients, 4.5%). For patients treated with definitive SABR, the 3-year overall survival (OS) and disease-free survival (DFS) rates were 91.8% and 58.6%, respectively. In patients treated with consolidative SABR, the 3-year OS and DFS rates were 86.7% and 53.8%, respectively. With respect to treatment-related pulmonary toxicity, grade 3 radiation pneumonitis incidence requiring hospitalization was 2.3% (2/88). Conclusions: Definitive SABR is appropriate for medically inoperable or high surgical risk patients with early stage NSCLC with acceptable treatment-related toxicities. Consolidative SABR improves local control rates and helps achieve long-term survival in patients with limited metastatic NSCLC.
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Affiliation(s)
- Hakyoung Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
| | - Sun Myung Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
| | - Dae Sik Yang
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
| | - Kyung Hwa Lee
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
| | - Young Bum Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
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Local Consolidative Therapy for Oligometastatic Non-Small Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14163977. [PMID: 36010969 PMCID: PMC9406686 DOI: 10.3390/cancers14163977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Metastatic non-small cell lung cancer (NSCLC) classically portends a poor prognosis and worse overall survival. However, recent advances in modern systemic therapy and the increasing recognition of a distant clinical entity known as “oligometastatic disease”—i.e., a controlled primary tumor and a limited number of distant lesions (≤5 metastases)—have led to paradigm shifts in management. Findings from Phase II randomized clinical trials suggest that aggressive local consolidative therapy (LAT) in the form of surgery or highly conformal radiation, known as stereotactic ablative body radiotherapy (SABR), may help to significantly mitigate disease progression and prolong survival. In this review, we summarize clinical evidence from published and ongoing trials that support the use of LAT/SABR in the treatment of oligometastatic NSCLC. We discuss key findings and caveats to these studies, and we highlight potential considerations and avenues for further investigation in the oligometastatic disease space. Abstract In the last 20 years, significant strides have been made in our understanding of the biological mechanisms driving disease pathogenesis in metastatic non-small cell lung cancer (NSCLC). Notably, the development and application of predictive biomarkers as well as refined treatment regimens in the form of chemoimmunotherapy and novel targeted agents have led to substantial improvements in survival. Parallel to these remarkable advancements in modern systemic therapy has been a growing recognition of “oligometastatic disease” as a distinct clinical entity—defined by the presence of a controlled primary tumor and ≤5 sites of metastatic disease amenable to local consolidative therapy (LAT), with surgery or stereotactic ablative body radiotherapy (SABR). To date, three randomized studies have provided clinical evidence supporting the use of LAT/SABR in the treatment of oligometastatic NSCLC. In this review, we summarize clinical evidence from these landmark studies and highlight ongoing trials evaluating the use of LAT/SABR in a variety of clinical contexts along the oligometastatic disease spectrum. We discuss important implications and caveats of the available data, including considerations surrounding patient selection and application in routine clinical practice. We conclude by offering potential avenues for further investigation in the oligometastatic disease space.
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Motaghi M, England RW, Nejad NH, Sankaran N, Patel AM, Khan MA. Assessing long-term locoregional control of spinal osseous metastases after microwave ablation. J Clin Neurosci 2022; 104:48-55. [PMID: 35963064 DOI: 10.1016/j.jocn.2022.07.025] [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: 12/15/2021] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 11/18/2022]
Abstract
Osseous metastases to the spine result in significant pain and decreased quality of life. The purpose of this study was to evaluate the long-term efficacy of microwave ablation (MWA) for the treatment of spinal metastases regarding pain reduction and local control of disease progression. In this single center retrospective study, patients with osseous metastases to the spine undergoing MWA with vertebroplasty from 2013 to 2020 were included. Locoregional control of metabolic activity at the treated level was assessed using PET/CT scan both pre- and post-procedure. Pain reduction was measured using change in visual analog scale (VAS) pain score. Forty-eight spinal levels were treated with MWA in 28 patients (57 % male, mean age 68 ± 9 years). Median ablation time, energy, and temperature were 4 min and 13 s, 3.6 kJ, and 80 °C, respectively. Median pre-procedure maximum standard uptake value (SUVmax) was significantly reduced following ablation, from 4.55 (IQR 3.65-6.1) to 0 (IQR 0-1.8; p < 0.001), over an average of 29 ± 14.1 month follow up period. Pre-procedure VAS pain score was reduced from median (IQR) of 8 (6.5-9) to 1(1-2), 2(1-3) and 1(0.5-3) at 24 h, four weeks, and six months post-procedure, respectively (all p < 0.001 with respect to pre-procedure scores). In conclusion, this study supports microwave ablation as an effective technique for pain palliation and long-term locoregional tumor control of oligometastatic spinal disease as assessed by metabolic response.
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Affiliation(s)
- Mina Motaghi
- Department of Internal Medicine, Brookdale University Medical Center, Brooklyn, NY 11212, USA
| | - Ryan W England
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, the Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Nima Hafezi Nejad
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, the Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Nisha Sankaran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, the Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Akash M Patel
- Department of Radiology, Division of Interventional Radiology, The University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Majid A Khan
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, the Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Radiology. Division of Neuroradiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
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Berber T, Sakin A. Role of Consolidative Stereotactic Body Radiation Therapy in Oligoresistant/Oligoprogressive Pulmonary Parenchymal Metastases. Cancer Manag Res 2022; 14:2597-2607. [PMID: 36068821 PMCID: PMC9441141 DOI: 10.2147/cmar.s360766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Aim To extend the survival of patients by providing local control of metastases in oligoresistance/oligoprogressive disease. Methods We retrospectively evaluated the efficacy of stereotactic body radiotherapy (SBRT) applied to 30 lesions in the lungs of 19 patients who were considered inoperable by the tumor board upon the development of oligoresistance/oligoprogressive lung metastasis while undergoing chemotherapy between January 2016 and December 2017. Each patient had one to five metastases in their lungs. The median SBRT biologic effective dose at α/β of 10 (BED10) was 180.0 (IQR: 115.5–180.0) Gy. Results We obtained effective, low-toxicity results. The rates of local control were 89.4%, 84.2%, and 78.9% for the 1st, 2nd, and 3rd years, respectively. The median local control time was 4 (IQR: 3–6) months. The median overall survival (OS) was 36.3 (IQR: 29.7–42.9) months. The rates of OS for the 1st, 2nd, and 3rd years were 89.5%, 73.7%, and 61.4%, respectively. Despite the nonoccurrence of grade 4–5 toxicity in the lungs, six (31.6%) patients had grade 1–3 pulmonary pneumonia, one patient had a grade 4 skin ulceration, and two patients had increased chronic obstructive pulmonary disease in the follow-up period. Discussion In patients with oligometastatic lung tumors, SBRT is very effective in terms of progression-free survival and OS.
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Affiliation(s)
- Tanju Berber
- Department of Radiation Oncology, Okmeydani Training and Research Hospital, Istanbul, Turkey
- Correspondence: Tanju Berber, Department of Radiation Oncology, Okmeydani Training and Research Hospital, Istanbul, 34307, Turkey, Tel +0905324111202, Email
| | - Abdullah Sakin
- Department of Medical Oncology, Medipol University, Bahçelievler Medipol Hospital, Istanbul, Turkey
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Christ SM, Pohl K, Muehlematter UJ, Heesen P, Kühnis A, Willmann J, Ahmadsei M, Badra EV, Kroeze SGC, Mayinger M, Andratschke N, Huellner M, Guckenberger M. Imaging-based prevalence of oligometastatic disease: A single-center cross-sectional study. Int J Radiat Oncol Biol Phys 2022; 114:596-602. [PMID: 35908582 DOI: 10.1016/j.ijrobp.2022.06.100] [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: 03/11/2022] [Revised: 05/25/2022] [Accepted: 06/26/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION AND BACKGROUND Oligometastatic disease refers to a distinct state in cancer patients characterized by a low metastatic burden, with diagnosis being defined by a limited number of distant metastases in radiological imaging. However, oligometastasis remains poorly understood in terms of its biology and prevalence in the metastatic cascade. In the absence of clinically viable molecular biomarkers, this study examined the prevalence of oligometastasis using oncological imaging. MATERIALS AND METHODS This study is based on all consecutive FDG- and PSMA-PET scans conducted at our cancer center between January and December 2020. We identified and analyzed all PET scans from patients with maximum five distant metastases from a solid malignancy and also reviewed concurrent cMRI imaging in all candidate patients. Data on number and site of metastases were extracted from the imaging reports and verified on imaging studies in case of uncertainties. RESULTS In total, 7,000 PET scans were analyzed, 1,155 of which were performed in unique metastatic patients, and 637 patients showed extra-cranial oligometastatic disease (55%). Concurrent cMRI scans were available for 20% (130/637) of extracranial oligometastatic patients, 36 of which proved to be polymetastatic after combined PET and cMRI analysis. Prevalence of oligometastatic disease was influenced by primary tumor histology and most frequent in pancreatic, liver and gallbladders cancers (59%), and least frequent in cancer of unknown primary (26%). In 72% of oligometastatic cases, only one or two metastases were detected. Bone/soft tissue metastases were the most common sites of distant metastasis (41%). About three quarters of patients had metachronous oligometastatic disease. DISCUSSION AND CONCLUSION Our analysis suggests that about half of metastatic cancer patients are characterized by a limited tumor burden detectable on PET and cMRI imaging. This finding warrants intensified research efforts to better understand the biology of oligometastatic disease and to optimize multidisciplinary treatment strategies.
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Affiliation(s)
- Sebastian M Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | | | - Urs J Muehlematter
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Anja Kühnis
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eugenia Vlaskou Badra
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephanie G C Kroeze
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Huellner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Dhaliwal I, Kassirian S, Mitchell MA, Qiabi M, Warner A, Louie AV, Wong HH, McDonald CM, Rajchgot J, Palma DA. Endoscopic nodal staging in oligometastatic non-small cell lung cancer (NSCLC) being treated with stereotactic ablative radiotherapy (ENDO-SABR). BMC Cancer 2022; 22:468. [PMID: 35484614 PMCID: PMC9047351 DOI: 10.1186/s12885-022-09563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Research in treatment of non-small cell lung cancer (NSCLC) has shown promising results with stereotactic ablative radiotherapy (SABR) of oligometastatic disease, wherein distant disease may be limited to one or a few distant organs by host factors. Traditionally, PET/CT has been used in detecting metastatic disease and avoiding futile surgical intervention, however, sensitivity and specificity is limited to only 81 and 79%, respectively. Mediastinal staging still identifies occult nodal disease in up to 20% of NSCLC patients initially thought to be operative candidates. Endobronchial ultrasound and transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive tool for the staging and diagnosis of thoracic malignancy. When EBUS is combined with endoscopic ultrasound using the same bronchoscope (EUS-B), the diagnostic sensitivity and negative predictive value increase to 84 and 97%, respectively. Endoscopic staging in patients with advanced disease has never been studied, but may inform treatment if a curative SABR approach is being taken. Methods This is a multi-centre, prospective, cohort study with two-stage design. In the first stage, 10 patients with oligometastatic NSCLC (lung tumour ± hilar/mediastinal lymphadenopathy) with up to 5 synchronous metastases will be enrolled An additional 19 patients will be enrolled in the second stage if rate of treatment change is greater than 10% in the first stage. Patients will be subject to EBUS or combined modality EBUS/EUS-B to assess bilateral lymph node stations using a N3 to N2 to N1 progression. Primary endpoint is defined as the rate of change to treatment plan including change from SABR to conventional dose radiation, change in mediastinal radiation field, and change from curative to palliative intent treatment. Discussion If a curative approach with SABR for oligometastatic disease is being explored, invasive mediastinal staging may guide treatment and prognosis. This study will provide insight into the use of endoscopic mediastinal staging in determining changes in treatment plan of NSCLC. Results will inform the design of future phase II trials. Trial registration Clinicaltrials.gov identifier NCT04852588. Date of registration: April 19, 2021. Protocol version: 1.1 on December 9, 2021.
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Affiliation(s)
- Inderdeep Dhaliwal
- Division of Respirology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Shayan Kassirian
- Division of Respirology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael A Mitchell
- Division of Respirology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mehdi Qiabi
- Division of Thoracic Surgery, Department of Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Andrew Warner
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Alexander V Louie
- Division of Radiation Oncology, Department of Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Harvey H Wong
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christine M McDonald
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jason Rajchgot
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
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Filippini Velázquez G, Schiele S, Gerken M, Neumaier S, Hackl C, Mayr P, Klinkhammer-Schalke M, Illerhaus G, Schlitt HJ, Anthuber M, Kröncke T, Messmann H, Märkl B, Schmid C, Trepel M, Müller G, Claus R, Hackanson B. Predictive preoperative clinical score for patients with liver-only oligometastatic colorectal cancer. ESMO Open 2022; 7:100470. [PMID: 35461024 PMCID: PMC9271475 DOI: 10.1016/j.esmoop.2022.100470] [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: 11/16/2021] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Resection of liver metastases from colorectal cancer (CRC) in the oligometastatic stage improves survival and is a potentially curative treatment. Thus, predictive scores that reliably identify those patients who especially benefit from surgery are essential. Patients and methods In this multicenter analysis, 512 patients had undergone surgery for liver metastases from CRC. We investigated distinct cancer-specific risk factors that are routinely available in clinical practice and developed a predictive preoperative score using a training cohort (TC), which was thereafter tested in a validation cohort (VC). Results Inflammatory response to the tumor, a right-sided primary tumor, multiple liver metastases, and node-positive primary tumor were significant adverse variables for overall survival (OS). Patients were stratified in five groups according to the cumulative score given by the presence of these risk factors. Median OS for patients without risk factors was 133.8 months [95% confidence interval (CI) 81.2-not reached (nr)] in the TC and was not reached in the VC. OS decreased significantly for each subsequent group with increasing number of risk factors. Median OS was significantly shorter (P < 0.0001) for patients presenting all four risk factors: 14.3 months (95% CI 10.5 months-nr) in the TC and 16.6 months (95% CI 14.6 months-nr) in the VC. Conclusions Including easily obtainable variables, this preoperative score identifies oligometastatic CRC patients with prolonged survival rates that may be cured, and harbors potential to be implemented in daily clinical practice. We identified four variables of adverse outcome for patients treated with surgical resection of liver metastases from CRC. Adverse variables were inflammatory response to the tumor, multiple metastases, right-sided primary tumor, node-positive primary tumor. We developed a preoperative clinical score according to the number of risk factors present. Using easily obtainable variables, this score identified patients with oligometastatic CRC with good prognosis. Patients without risk factors should strongly be considered for surgical resection of their metastases.
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Affiliation(s)
- G Filippini Velázquez
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - S Schiele
- Faculty of Applied Mathematics and Statistics, University of Augsburg, Augsburg, Germany
| | - M Gerken
- Tumor Center Regensburg, Institute for Quality Assurance and Health Service Research, University of Regensburg, Regensburg, Germany
| | - S Neumaier
- Department of Haematology and Oncology, Katharinen Hospital Stuttgart, Stuttgart, Germany
| | - C Hackl
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - P Mayr
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - M Klinkhammer-Schalke
- Tumor Center Regensburg, Institute for Quality Assurance and Health Service Research, University of Regensburg, Regensburg, Germany
| | - G Illerhaus
- Department of Haematology and Oncology, Katharinen Hospital Stuttgart, Stuttgart, Germany
| | - H J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - M Anthuber
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - T Kröncke
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - H Messmann
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - B Märkl
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - C Schmid
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - M Trepel
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - G Müller
- Faculty of Applied Mathematics and Statistics, University of Augsburg, Augsburg, Germany
| | - R Claus
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany; General Pathology and Molecular Diagnostics, Faculty of Medicine, University of Augsburg, Augsburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - B Hackanson
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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The Road to Dissemination: The Concept of Oligometastases and the Barriers for Widespread Disease. Cancers (Basel) 2022; 14:cancers14082046. [PMID: 35454951 PMCID: PMC9033015 DOI: 10.3390/cancers14082046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/02/2022] [Accepted: 04/13/2022] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Oligometastatic disease is an intermediate state of metastatic dissemination with a limited number of metastatic sites and extent of disease. Tumor cells need multiple capabilities in order to migrate, survive and evolve to macroscopic metastases. These capabilities are acquired by evolutionary mechanisms and are associated with several clinical factors and biomarkers. Better understanding of these properties and biomarkers may help to select patients that can benefit from local ablative therapies, which have shown to be a promising approach in recent clinical evidence. Abstract Over the last years, the oligometastatic disease state has gained more and more interest, and randomized trials are now suggesting an added value of stereotactic radiotherapy on all macroscopic disease in oligometastatic patients; but what barriers could impede widespread disease in some patients? In this review, we first discuss the concept of oligometastatic disease and some examples of clinical evidence. We then explore the route to dissemination: the hurdles a tumoral clone has to overtake before it can produce efficient and widespread dissemination. The spectrum theory argues that the range of metastatic patterns encountered in the clinic is the consequence of gradually obtained metastatic abilities of the tumor cells. Tumor clones can obtain these capabilities by Darwinian evolution, hence early in their genetic progression tumors might produce only a limited number of metastases. We illustrate selective dissemination by discussing organ tropism, the preference of different cancer (sub)types to metastasize to certain organs. Finally we discuss biomarkers that may help to distinguish the oligometastatic state.
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Diplas BH, Santos PMG, Shahrokni A, Warner A, Iyengar P, Yang JT, Gomez DR, Palma DA, Tsai CJ. The Role of Ablative Radiotherapy in Older Adults With Limited Metastatic Disease. Semin Radiat Oncol 2022; 32:135-141. [PMID: 35307115 PMCID: PMC10898514 DOI: 10.1016/j.semradonc.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For patients with oligometastatic cancer, radiotherapy presents a promising avenue for achieving meaningful symptom relief and durable disease control. Data from recently published and ongoing randomized studies are helping to define the appropriate contexts for effective intervention with stereotactic ablative body radiotherapy (SABR) in the oligometastatic setting. Importantly, older adults represent a significant portion of patients with oligometastatic disease, yet often comprise a minority of patients in clinical trials. Moreover, older adults of the same chronologic age may have variable degrees of fitness and frailty. In this review, we highlight the specific challenges and considerations for the use of radiotherapy for older adults with oligometastatic disease-noting the importance of geriatric assessments in clinical decision-making about the appropriateness of SABR and other metastasis-directed therapies in this population. We then review data from existing trials, including a subset analysis of adverse events and survival estimates among older adults enrolled in the landmark SABR-COMET trial. Finally, we discuss future directions for research, including the need for focused clinical trials in older adult cohorts. Ultimately, a multidisciplinary approach is critical when carefully balancing the potential risks and benefits of this emerging treatment paradigm in the older adult population.
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Affiliation(s)
- Bill H Diplas
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patricia Mae G Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Armin Shahrokni
- Department of Medicine, Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Puneeth Iyengar
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Jonathan T Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Milic M, Mondini M, Deutsch E. How to Improve SBRT Outcomes in NSCLC: From Pre-Clinical Modeling to Successful Clinical Translation. Cancers (Basel) 2022; 14:cancers14071705. [PMID: 35406477 PMCID: PMC8997119 DOI: 10.3390/cancers14071705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Despite major research and clinical efforts, lung cancer remains the leading cause of cancer-related death. Stereotactic body radiotherapy (SBRT) has emerged as a major treatment modality for lung cancer in the last decade. Additional research is needed to elucidate underlying mechanisms of resistance and to develop improved therapeutic strategies. Clinical progress relies on accurate preclinical modelling of human disease in order to yield clinically meaningful results; however, successful translation of pre-clinical research is still lagging behind. In this review, we summarize the major clinical developments of radiation therapy for non-small-cell lung cancer (NSCLC), and we discuss the pre-clinical research models at our disposal, highlighting ongoing translational challenges and future perspectives. Abstract Despite major research and clinical efforts, lung cancer remains the leading cause of cancer-related death. While the delivery of conformal radiotherapy and image guidance of stereotactic body radiotherapy (SBRT) have revolutionized the treatment of early-stage non-small-cell lung cancer (NSCLC), additional research is needed to elucidate underlying mechanisms of resistance and identify novel therapeutic combinations. Clinical progress relies on the successful translation of pre-clinical work, which so far has not always yielded expected results. Improved clinical modelling involves characterizing the preclinical models and selecting appropriate experimental designs that faithfully mimic precise clinical scenarios. Here, we review the current role of SBRT and the scope of pre-clinical armamentarium at our disposal to improve successful clinical translation of pre-clinical research in the radiation oncology of NSCLC.
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Affiliation(s)
- Marina Milic
- Gustave Roussy, Université Paris-Saclay, INSERM U1030, F-94805 Villejuif, France;
| | - Michele Mondini
- Gustave Roussy, Université Paris-Saclay, INSERM U1030, F-94805 Villejuif, France;
- Correspondence: (M.M.); (E.D.)
| | - Eric Deutsch
- Gustave Roussy, Université Paris-Saclay, INSERM U1030, F-94805 Villejuif, France;
- Gustave Roussy, Département d’Oncologie-Radiothérapie, F-94805 Villejuif, France
- Correspondence: (M.M.); (E.D.)
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Heterogeneity of Synchronous Lung Metastasis Calls for Risk Stratification and Prognostic Classification: Evidence from a Population-Based Database. Cancers (Basel) 2022; 14:cancers14071608. [PMID: 35406378 PMCID: PMC8996888 DOI: 10.3390/cancers14071608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 12/30/2022] Open
Abstract
The epidemiology and associated potential heterogeneity of synchronous lung metastasis (sLM) have not been reported at a population-based level. Cancer patients with valid information about sLM status in the Surveillance, Epidemiology, and End Results database were enrolled. The prevalence of sLM, with a 95% confidential interval, and median survival of sLM, with interquartile range, were calculated and compared by Chi-square analyses and log-rank tests by primary cancer type and clinicopathological factors. Furthermore, the risk factors of sLM development were identified by multivariate logistic regression. Among 1,672,265 enrolled cases, 3.3% cases were identified with sLM, with a median survival of 7 months. Heterogeneity in prevalence and prognosis in sLM was observed among different primary cancers, with the highest prevalence in main bronchus cancer and best survival in testis cancer. Higher prevalence and poorer prognosis were observed in the older population, male population, African American, patients with lower socioeconomic status, and cases with advanced T stage, N stage, or more malignant pathological characteristics. Race, age, T stage, N stage, metastasis to other sites, insurance status and marital status were associated with sLM development (p < 0.001). The current study highlights the heterogeneity of the prevalence and prognosis in patients with sLM.
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Chen L, Zhu GY, Jin ZC, Zhong BY, Wang Y, Lu J, Pan T, Teng GJ, Guo JH. Efficacy and Safety of Radioactive 125I Seed Implantation for Patients with Oligo-Recurrence Soft Tissue Sarcomas. Cardiovasc Intervent Radiol 2022; 45:808-813. [PMID: 35316381 DOI: 10.1007/s00270-022-03077-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of computed tomography-guided radioactive iodine-125 (125I) seed implantation for oligo-recurrence soft tissue sarcomas following surgical resection. MATERIALS AND METHODS Patients with oligo-recurrence soft tissue sarcomas after curative surgical resection between June 2013 and December 2020 were included. The primary outcome measure was objective response rate according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1). The secondary outcomes included progression-free survival, overall survival, and safety profiles. RESULTS Twenty-nine patients receiving computed tomography-guided 125I seed implantation were included in the study. The objective response rates at 2-, 6- and 12-month follow-up were 48.3%, 65.5% and 40.9%, respectively. The median progression-free survival was 11.3 months. The median overall survival was 25.1 months, with a 1- and 2-year overall survival rate of 81.5% and 50.0%, respectively. No severe treatment-related adverse effects occured. CONCLUSION 125I seed implantation has the potential to be an effective and safe treatment for oligo-recurrence soft tissue sarcomas after surgical resection.
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Affiliation(s)
- Li Chen
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Guang-Yu Zhu
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Zhi-Cheng Jin
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Bin-Yan Zhong
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yong Wang
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Jian Lu
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Tao Pan
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Gao-Jun Teng
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Jin-He Guo
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
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Repeated Multimodality Ablative Therapies for Oligorecurrent Pulmonary Metastatic Disease. Curr Oncol 2022; 29:1683-1694. [PMID: 35323340 PMCID: PMC8947282 DOI: 10.3390/curroncol29030140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/03/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) and percutaneous thermal ablation (TA) are alternatives to surgery for the management of pulmonary oligometastases. In this collaborative work, we retrospectively analyzed patients who had undergone iterative focal ablative treatments of pulmonary oligometastases. We hypothesized that repeated ablative therapies could benefit patients with consecutive oligometastatic relapses. Patients treated with SBRT and/or TA for pulmonary oligometastases in two French academic centers between October 2011 and November 2016 were included. A total of 102 patients with 198 lesions were included; 45 patients (44.1%) received repeated focal treatments at the pulmonary site for an oligorecurrent disease (the “multiple courses” group). Median follow-up was 22.5 months. The 3-year overall survival rates of patients who had a single treatment sequence (the “single course” group) versus the “multiple courses” were 73.9% and 78.8%, respectively, which was not a statistically significant difference (p = 0.860). The 3-year systemic therapy-free survival tended to be longer in the “multiple courses” group (50.4%) than in the “single course” group (44.7%) (p = 0.081). Tolerance of repeated treatments was excellent with only one grade 4 toxicity. Thereby, multimodality repeated ablative therapy is effective in patients with pulmonary oligorecurrent metastases. This strategy may delay the use of more toxic systemic therapy.
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Baydoun A, Chen H, Poon I, Badellino S, Dagan R, Erler D, Foote M, Louie A, Redmond K, Ricardi U, Sahgal A, Biswas T. Outcomes and toxicities in oligometastatic patients treated with stereotactic body radiotherapy for adrenal gland metastases: A multi-institutional retrospective study. Clin Transl Radiat Oncol 2022; 33:159-164. [PMID: 35243027 PMCID: PMC8885400 DOI: 10.1016/j.ctro.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
SBRT to adrenal gland oligometastases achieves a satisfactory local control and OS. A minimum PTV dose BED10 > 46 Gy was associated with an improved OS and LRFS. A prescribed BED10 > 70 Gy was correlated with improved local control. High adrenal metastases volume should not preclude the delivery of SBRT.
Background Studies reporting SBRT outcomes in oligometastatic patients with adrenal gland metastases (AGM) are limited. Herein, we present a multi-institutional analysis of oligometastatic patients treated with SBRT for AGM. Material/methods The Consortium for Oligometastases Research (CORE) is among the largest retrospective series of patients with oligometastases. Among CORE patients, those treated with SBRT for AGM were included. Clinical and dosimetric data were collected. Adrenal metastatic burden (AMB) was defined as the sum of all adrenal GTV if more than one oligometastases is present. Competing risk analysis was used to estimate actuarial cumulative local recurrence (LR) and widespread progression (WP). Kaplan-Meier method was used to report overall survival (OS), local recurrence-free survival (LRFS), and progression-free survival (PFS). Treatment related toxicities were also reported. Results The analysis included 47 patients with 57 adrenal lesions. Median follow-up was 18.2 months. Median LRFS, PFS, and OS were 15.3, 5.3, and 19.1 months, respectively. A minimum PTV dose BED10 > 46 Gy was associated with an improved OS and LRFS. A prescribed BED10 > 70 Gy was an independent predictor of a lower LR probability. AMB>10 cc was an independent predictor of a lower risk for WP. Only one patient developed an acute Grade 3 toxicity consisting of abdominal pain. Conclusion SBRT to AGM achieved a satisfactory local control and OS in oligometastatic patients. High minimum PTV dose and BED10 prescription doses were predictive of improved LR and OS, respectively. Prospective studies are needed to determine comprehensive criteria for patients SBRT eligibility and dosimetric planning.
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Affiliation(s)
- A. Baydoun
- Department of Radiation Oncology, University Hospitals of Cleveland, Cleveland, OH 44106, USA
| | - H. Chen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - I. Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - S. Badellino
- Radiation Oncology Unit, Department of Oncology, University of Turin and Città della Salute e della Scienza Hospital, Via Genova 3, Turin 10126, Italy
| | - R. Dagan
- Department of Radiation Oncology, University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, United States
| | - D. Erler
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - M.C. Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD 4120, Australia
| | - A.V. Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - K.J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD 21218, United States
| | - U. Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Turin and Città della Salute e della Scienza Hospital, Via Genova 3, Turin 10126, Italy
| | - A. Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - T. Biswas
- Department of Radiation Oncology, University Hospitals of Cleveland, Cleveland, OH 44106, USA
- Corresponding author at: Department of Radiation Oncology, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Cleveland OH 44106, United States.
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Alite F, Shaikh PM, Mahadevan A. Influence of Dexamethasone Premedication on Acute Lung Toxicity in Lung SBRT. Front Oncol 2022; 12:837577. [PMID: 35311107 PMCID: PMC8928771 DOI: 10.3389/fonc.2022.837577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The cooperative group experience of thoracic sterotactic body radiation therapy (SBRT) in medically inoperable patients with early stage non-small cell lung cancer (NSCLC) historically utilized corticosteroid premedication. Patterns of care have been mixed as to whether premedication adds benefit in terms of improved lung toxicity and treatment tolerance. Methods Patients treated for NSCLC from 2014 to 2017 with definitive thoracic SBRT (BED10≥100) at a single institution, in a prospectively collected database were evaluated. Pretreatment clinicopathologic characteristics, including Eastern Cooperative Oncology Group (ECOG) performance status, PFT parameters of FEV1, and diffusing capacity for carbon monoxide (DLCO) were collected. Treatment and dosimetric characteristics were collected, and patients were scored as to whether dexamethasone was prescribed and utilized with each fraction. Toxicity was graded on multiple domains including lung as during and 30 days after completion of treatment using Common Terminology Criteria for Adverse Events Version 4. Univariate analysis was performed with Fisher’s exact test for categorical variables and two-tailed Student’s t-test for continuous variables. Multivariate analysis was performed with Cox proportional hazards model to adjust for age, pretreatment DLCO, ECOG, tumor size, central versus peripheral location, and biological effective dose. Results A total of 86 patients treated with thoracic SBRT with 54–60 Gy in 3–8 fractions met inclusion criteria, with the majority (70%) receiving 5 fractions. Of these patients, 45 (52%) received 4 mg dexamethasone premedication prior to each fraction of SBRT and 41 (48%) were treated without dexamethasone premedication. Overall acute lung toxicity was low in both groups. Between the two groups of patients, 5/45 (11%) developed grade 2 or higher lung toxicity including hospital admission in the dexamethasone premedication arm vs. 2/41 (5%) without premedication (p = 0.4370, Fisher’s exact test). Freedom from acute SBRT lung toxicity was no different between dexamethasone premedication arm and no premedication (Log rank, p = 0.45). On multivariate Cox proportional hazard modeling adjusting for age, ECOG, tumor size, central vs. peripheral location, pretreatment DLCO, and BED, there was no difference in freedom from acute lung toxicity without dexamethasone premedication (HR: 0.305; 95% CI: 0.033, 2.792; p = 0.293). Conclusions In this retrospective analysis, pretreatment steroid prophylaxis with dexamethasone confers a similar acute toxicity profile and no added clinical benefit to treatment without pretreatment steroid prophylaxis.
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Affiliation(s)
- Fiori Alite
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
- *Correspondence: Fiori Alite,
| | - Parvez M. Shaikh
- Department of Radiation Oncology, West Virginia University, Morgantown, WV, United States
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
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Stereotactic Ablative Radiotherapy for Oligometastatic Disease: A Tale of Emperor's New Clothes or New Standard of Care? Clin Oncol (R Coll Radiol) 2022; 34:318-324. [DOI: 10.1016/j.clon.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/24/2022] [Accepted: 02/10/2022] [Indexed: 12/19/2022]
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Treatment patterns for adrenal metastases using surgery and SABR during a 10-year period. Radiother Oncol 2022; 170:165-168. [DOI: 10.1016/j.radonc.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/04/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
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Macbeth F, Treasure T. Stereotactic Ablative Radiotherapy for Oligometastatic Disease: Great Enthusiasm but Scant Evidence. Clin Oncol (R Coll Radiol) 2022; 34:313-317. [DOI: 10.1016/j.clon.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 12/25/2022]
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PSMA PET/CT and radiotherapy in prostate cancer: a winning team. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-021-00478-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Metser U, Zukotynski K, Mak V, Langer D, MacCrostie P, Finelli A, Kapoor A, Chin J, Lavallée L, Klotz LH, Hagerty M, Hildebrand C, Bauman G. Effect of 18F-DCFPyL PET/CT on the Management of Patients with Recurrent Prostate Cancer: Results of a Prospective Multicenter Registry Trial. Radiology 2022; 303:414-422. [PMID: 35076300 DOI: 10.1148/radiol.211824] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The high positivity rate of prostate-specific membrane antigen (PSMA) PET in the setting of biochemical failure (BCF), even when conventional imaging is negative, is promising. Purpose To assess the disease detection rate of PSMA-based PET/CT with fluorine 18-DCFPyL as a radiotracer and the PET-directed management change in men with suspected limited recurrent prostate cancer. Materials and Methods This prospective multicenter registry (Ontario PSMA-PET Registry for Recurrent Prostate Cancer, or PREP) enrolled men with BCF after primary therapy (radical prostatectomy plus or minus salvage radiation therapy or primary radiation therapy) and zero to four disease sites at conventional imaging (CT and bone scintigraphy). The positivity rate of PSMA PET according to serum prostate-specific antigen (PSA) level; frequency of local-egional, oligometastatic, and extensive metastatic recurrence; and rate of change in management after PET findings were recorded. The nonparametric Mood median test was used to assess the association between serum PSA level and change in management. Results A total of 1289 men (median age, 71 years [interquartile range, 65-75 years]) were evaluated. PSMA PET helped detect disease in 841 of 1289 men (65%) and in 615 of 999 men (62%) with negative conventional imaging. The recurrence detection rates according to serum PSA level at enrollment were 38% (160 of 424 men), 63% (107 of 171 men), and 83% (573 of 692 men) for PSA under 0.5 ng/mL, 0.5-1.0 ng/mL, and above 1.0 ng/mL, respectively. At PSMA PET, 399 of 1289 men (31%) had local-regional recurrence, 314 (24%) had oligometastatic disease, and 128 (10%) had extensive metastases. Following PET examination, a change in planned management was recorded in 748 of 1289 men (58%), and in 371 of 1250 men (30%), there was a change in management intent, more commonly from palliative to potentially curative intent (255 of 1289 men [20%]). Conclusion Prostate-specific membrane antigen PET helped detect additional sites of disease compared with conventional imaging in approximately 60% of men with biochemical failure and suspected low-volume metastatic disease, resulting in frequent change in management, including a change from palliative to curative or radical intent therapy in 20% of men. Long-term follow-up is needed to determine whether this impacts disease control. Clinical trial registration no. NCT03718260 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Civelek in this issue.
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Affiliation(s)
- Ur Metser
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Katherine Zukotynski
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Victor Mak
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Deanna Langer
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Pamela MacCrostie
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Antonio Finelli
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Anil Kapoor
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Joseph Chin
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Luke Lavallée
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Laurence H Klotz
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Marlon Hagerty
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Catherine Hildebrand
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
| | - Glenn Bauman
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Ste 3-920, Toronto, ON, Canada M5G 2M9 (U.M.); Departments of Radiology and Medicine (K.Z.) and Division of Urology, Department of Surgery (A.K.), McMaster University, Hamilton, ON, Canada; Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, ON, Canada (V.M., D.L., P.M.); Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada (A.F., L.H.K.); Division of Urology, Department of Surgery (J.C.) and Department of Oncology (C.H., G.B.), Western University, London, ON, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (L.L.); and Department of Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (M.H.)
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Willmann J, Badra EV, Adilovic S, Ahmadsei M, Christ SM, van Timmeren JE, Kroeze SG, Mayinger M, Guckenberger M, Andratschke N. Evaluation of the prognostic value of the ESTRO EORTC classification of oligometastatic disease in patients treated with stereotactic body radiotherapy: A retrospective single center study. Radiother Oncol 2022; 168:256-264. [DOI: 10.1016/j.radonc.2022.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/25/2022]
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Hu X, Li H, Kang X, Wang X, Pang H, Liu C, Zhang J, Wang Y. Efficacy and Safety of Local Radiotherapy to All Oligometastatic Sites in Elderly Patients with Metachronous Oligometastatic Cancers After Initial Treatment for the Primary Tumor. Cancer Manag Res 2021; 13:9247-9259. [PMID: 34955655 PMCID: PMC8694577 DOI: 10.2147/cmar.s345871] [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: 10/29/2021] [Accepted: 12/06/2021] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose This study aimed to investigate the efficacy and safety of maintenance therapy combined with local radiotherapy at all oligometastatic sites (LRTOS) in elderly patients with metachronous oligometastatic cancers (MOC). Patients and Methods A total of 242 elderly patients with MOC (≤5 metastases) and primary tumor well controlled after definitive treatment was retrospectively analyzed between August 2014 and February 2020 at Beijing Geriatric Hospital and Air Force General Hospital. Patients were divided into maintenance therapy group (maintenance therapy alone) and local radiotherapy group (maintenance therapy combined with LRTOS). Results There were 86 patients in the local radiotherapy group and 156 patients in the maintenance therapy group. The median length of follow-up was 36 months (range, 8.0–62 months). Median overall survival (mOS) was 25 months (95% CI: 21.1–28.9) in the local radiotherapy group and 16 months (95% CI: 14.5–17.6) in the maintenance therapy group (p < 0.001). Multivariate analyses demonstrated that LRTOS (hazard ratio (HR) = 0.49, 95% confidence interval (CI): 0.35–0.67, p < 0.001), good Eastern Cooperative Oncology Group Performance Status (ECOG PS, HR = 0.69, 95% CI: 0.49–0.97, p = 0.032), longer duration between diagnosis of primary tumor and occurrence of progression (HR = 0.87, 95% CI: 0.78–0.97, p = 0.015), and subsequent systemic treatment (HR = 0.52, 95% CI: 0.38–0.72, p < 0.001) were independent predictors of good OS. In patients who did not receive subsequent systemic treatment, their mOS was 21 months (95% CI: 12.8–29.2) for those treated with LRTOS and 14 months (95% CI: 11.4–16.6) for those who did not receive local radiotherapy (p = 0.001). Further multivariate analysis showed that LRTOS was the only independent factor for predicting good OS (HR = 0.47, 95% CI: 0.26–0.83, p = 0.010). Patients with metachronous oligometastatic lung cancer, colorectal cancer, prostate cancer, and breast cancer had higher survival benefits following LRTOS. Most patients suffered from grade 1–2 toxicities, but no treatment-related death was recorded. Conclusion This retrospective study shows that elderly patients with MOC treated with LRTOS may have better survival outcomes.
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Affiliation(s)
- Xiaolong Hu
- Department of Radiation Oncology, Beijing Geriatric Hospital, Beijing, People's Republic of China
| | - Hongqi Li
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
| | - Xiaoli Kang
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
| | - Xuan Wang
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
| | - Haifeng Pang
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
| | - Chen Liu
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
| | - Jianchun Zhang
- Department of Radiation Oncology, Beijing Geriatric Hospital, Beijing, People's Republic of China
| | - Yingjie Wang
- Department of Radiation Oncology, Air Force General Hospital, Beijing, People's Republic of China
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49
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Koerber SA, Fink CA, Dendl K, Schmitt D, Niegisch G, Mamlins E, Giesel FL. [Imaging of oligometastatic disease in selected urologic cancers]. Urologe A 2021; 60:1561-1569. [PMID: 34850260 DOI: 10.1007/s00120-021-01708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Local treatment of the primary or metastatic sites in urologic malignancies is promising when compared to systemic therapy alone, leading to the definition of a potentially curative oligometastatic state. OBJECTIVES Comparison of imaging modalities regarding local and metastatic tumor sites in urologic cancers. METHODS Review of comparative trials addressing quality criteria of imaging modalities. RESULTS Depending on primary tumor and metastatic site, conventional imaging modalities such as computer tomography (CT) and bone scintigraphy still represent the standard of care in Germany. Due to superior quality criteria, hybrid-imaging techniques were widely adopted for oncological staging and particular due to the new PSMA-ligand (PSMA-PET/CT) in prostate cancer imaging. The development of new radioisotopes as well as their clinical application remains a focus of current research. CONCLUSIONS High-quality diagnostic imaging modalities lay the groundwork for a precise definition of an oligometastatic state. By enabling treatment of the entire tumor burden, a delay of systemic therapy, longer progression-free survival, or even curative treatment may become achievable.
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Affiliation(s)
- S A Koerber
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C A Fink
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - K Dendl
- Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland.,Klinik für Nuklearmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - D Schmitt
- Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - G Niegisch
- Klinik für Urologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - E Mamlins
- Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - F L Giesel
- Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
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Mantovani C, Gastino A, Cerrato M, Badellino S, Ricardi U, Levis M. Modern Radiation Therapy for the Management of Brain Metastases From Non-Small Cell Lung Cancer: Current Approaches and Future Directions. Front Oncol 2021; 11:772789. [PMID: 34796118 PMCID: PMC8593461 DOI: 10.3389/fonc.2021.772789] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022] Open
Abstract
Brain metastases (BMs) represent the most frequent event during the course of Non-Small Cell Lung Cancer (NSCLC) disease. Recent advancements in the diagnostic and therapeutic procedures result in increased incidence and earlier diagnosis of BMs, with an emerging need to optimize the prognosis of these patients through the adoption of tailored treatment solutions. Nowadays a personalized and multidisciplinary approach should rely on several clinical and molecular factors like patient’s performance status, extent and location of brain involvement, extracranial disease control and the presence of any “druggable” molecular target. Radiation therapy (RT), in all its focal (radiosurgery and fractionated stereotactic radiotherapy) or extended (whole brain radiotherapy) declinations, is a cornerstone of BMs management, either alone or combined with surgery and systemic therapies. Our review aims to provide an overview of the many modern RT solutions available for the treatment of BMs from NSCLC in the different clinical scenarios (single lesion, oligo and poly-metastasis, leptomeningeal carcinomatosis). This includes a detailed review of the current standard of care in each setting, with a presentation of the literature data and of the possible technical solutions to offer a “state-of-art” treatment to these patients. In addition to the validated treatment options, we will also discuss the future perspectives on emerging RT technical strategies (e.g., hippocampal avoidance whole brain RT, simultaneous integrated boost, radiosurgery for multiple lesions), and present the innovative and promising findings regarding the combination of novel targeted agents such as tyrosine kinase inhibitors and immune checkpoint inhibitors with brain irradiation.
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Affiliation(s)
| | | | - Marzia Cerrato
- Department of Oncology, University of Torino, Torino, Italy
| | | | | | - Mario Levis
- Department of Oncology, University of Torino, Torino, Italy
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