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Donovan EK, Lo SS, Beriwal S, Chen H, Cheung P, Keller A, Nwachukwu C, Mantz C, Pond GR, Schnarr K, Swaminath A, Albuquerque K, Leung E. Stereotactic Ablative Radiotherapy for Gynecological Oligometastatic and Oligoprogessive Tumors. JAMA Oncol 2024; 10:941-948. [PMID: 38869888 PMCID: PMC11177214 DOI: 10.1001/jamaoncol.2024.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/29/2023] [Indexed: 06/14/2024]
Abstract
Importance The role of stereotactic ablative radiotherapy (SABR) for gynecologic malignant tumors has yet to be clearly defined despite recent clinical uptake. Objective To evaluate the outcomes of SABR in patients with oligometastatic and oligoprogressive gynecologic cancers. Design, Setting, and Participants In this retrospective pooled analysis, patients with oligometastatic and oligoprogressive gynecologic cancers receiving SABR at 5 institutions from Canada and the US were studied. Data were collected from January 2011 to December 2020, and data were analyzed from January to December 2023. Exposure Stereotactic ablative radiotherapy. Main Outcomes and Measures Cumulative incidence of local and distant recurrence, chemotherapy-free survival (CFS), and overall survival (OS) probabilities after SABR were calculated using Kaplan-Meier methods. Univariable and multivariable analysis was conducted using Cox regression methods. Results A total of 215 patients with 320 lesions meeting criteria were included in the analysis; the median (range) age at primary diagnosis was 59 (23-86) years. The median (range) follow-up from SABR was 18.5 (0.1-124.5) months. The primary site included the endometrium (n = 107), ovary (n = 64), cervix (n = 30), and vulva or vagina (n = 14). Local cumulative incidence of recurrence was 13.7% (95% CI, 9.4-18.9) and 18.5% (95% CI, 13.2-24.5) at 1 and 5 years, respectively. Distant cumulative incidence of recurrence was 48.5% (95% CI, 41.4-55.1) and 73.1% (95% CI, 66.0-79.0) at 1 and 5 years, respectively. OS was 75.7% (95% CI, 69.2-81.1) and 33.1% (95% CI, 25.3-41.1) at 1 and 5 years, respectively. The median CFS was 21.7 months (95% CI, 15.4-29.9). On multivariable analysis, local recurrence was significantly associated with nodal metastasis, lesion size, biologically effective dose, treatment indication, institution, and primary disease type. Distant progression-free survival was associated with nodal targets and lesion size. OS and CFS were significantly associated with lesion size. Conclusions and Relevance In this study, SABR appeared to have excellent local control with minimal toxic effects in this large patient group, and certain patients may achieve durable distant control and OS as well. It may be possible to delay time to chemotherapy in select patient subtypes and therefore reduce associated toxic effects. Prospective multicenter trials will be critical to establish which characteristics procure the greatest benefit from SABR use and to define the ideal time to implement SABR with other oncologic treatments.
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Affiliation(s)
- Elysia K. Donovan
- Department of Oncology, Division of Radiation Oncology, Escarpment Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Simon S. Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle
| | - Sushil Beriwal
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Keller
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chika Nwachukwu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | | | - Gregory R. Pond
- Escarpment Cancer Research Institute, Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Kara Schnarr
- Department of Oncology, Division of Radiation Oncology, Escarpment Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Anand Swaminath
- Department of Oncology, Division of Radiation Oncology, Escarpment Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Eric Leung
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Escande A, Leblanc J, Hannoun-Levi JM, Renard S, Ducassou A, Hennequin C, Chargari C. Place of radiotherapy for treatment of metastatic cervical, vaginal and endometrial uterine cancer. Cancer Radiother 2024; 28:15-21. [PMID: 37507287 DOI: 10.1016/j.canrad.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/30/2023]
Abstract
Beyond classical palliative-intent irradiation schemes, there are increasing data suggesting a benefit for intensive locoregional treatments in metastatic gynecological cancers. Such approach aims at avoiding local symptoms related to tumor progression, but may also improve survival outcome by shrinking tumor burden to a microscopic state. This strategy is rarely considered upfront (in highly selected patients with very limited oligometastatic disease), but rather after systemic treatment. In case of tumor response (especially if complete response) of the metastatic sites, pelvic±para-aortic radiotherapy can be considered in combination with a brachytherapy boost to obtain long-term local control, in particular in cervical or vaginal cancer patients. Such approach seems particularly relevant when there is isolated persistence or progression of macroscopic disease within the pelvis. In parallel, there is also an increasing place for radiotherapy of oligo-metastatic sites. We review the literature on the place of radiotherapy in the management of cancers of the cervix and metastatic endometrial cancer.
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Affiliation(s)
- A Escande
- Radiotherapy department, Centre Léonard de Vinci, Dechy, France, CRIStAL lab, UMR9189, University of Lille, Villeneuve d'Ascq, France, H.Warembourg, School of medicine, University of Lille, Lille, France
| | - J Leblanc
- Service d'Oncologie Radiothérapie-Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - J-M Hannoun-Levi
- Département de radiothérapie, centre Antoine-Lacassagne, université de Nice-Sophia, Nice, France
| | - S Renard
- Département de radiothérapie, centre Alexis Vautrin, Vandœuvre-lès-Nancy, France
| | - A Ducassou
- Radiotherapy Department, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, Hôpital Saint-Louis, 75475 Paris, France
| | - C Chargari
- Service d'oncologie radiothérapie-centre hospitalier universitaire Pitié Salpêtrière-Assistance publique des Hôpitaux de Paris, Paris 75013, France.
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Xue Q, Enyang W, Tingting G, Xiaolin M, Qipeng M, Song G. Anti-tumour and radiosensitising effects of PARP inhibitor on cervical cancer xenografts. J OBSTET GYNAECOL 2023; 43:2171783. [PMID: 36786286 DOI: 10.1080/01443615.2023.2171783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This study evaluated the radiosensitising effect of niraparib; a poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitor on HeLa cervical cancer cells in nude mice and explored its possible mechanism. Twenty-four 3-5-week-old female BALB/c nude mice, inoculated with HeLa cells into the right hind leg, were randomly assigned into eight groups with three mice per group and treated. The tumour volume was significantly reduced under niraparib + radiotherapy combination as compared to monotherapy and untreated mice. The tumour growth was significantly delayed by 23.33-39 days when treated with combination therapy (p<.05). Further, univariate analysis revealed prolonged time for tumour growth when radiotherapy was followed by niraparib (I.G.) rather than niraparib (I.P.) (p=.003). Combination therapy reduced levels of PARP-1 precursor, PARP-1 splicer, PAR and RAD51 protein with high expression of γ-H2AX/CC3 and low expression of Ki-67. Niraparib in combination with radiotherapy can enhance the formation of DNA double strand breaks in HeLa cells and up regulate the expression of γ-H2AX/CC3.IMPACT STATEMENTWhat is already known on this subject? Asia has the highest incidence of cervical cancer (58.2%). Poly(adenosine diphosphate-ribose) polymerases (PARPs) are family of enzymes involved in single-strand break (SSB) and double-strand break (DSB) repair pathways. Niraparib is an effective inhibitor of both PARP-1 and PARP-2 and has the ability to cross the blood-brain barrier.What the results of this study add? Our study demonstrated that the combination of niraparib and radiotherapy can significantly enhance the cytotoxicity induced by radiotherapy. The inhibition effect of radiotherapy combined with niraparib on the tumour growth of mice was prominent, thereby establishing the radio-sensitisation activity of niraparib.What are the implications of these findings for clinical practice and/or further research? Niraparib can improve the cytotoxic effect of radiotherapy by increasing the formation of DSBs and up regulating the expression of apoptotic protein in HeLa cells.
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Affiliation(s)
- Qin Xue
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wang Enyang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Gong Tingting
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ma Xiaolin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ma Qipeng
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Gao Song
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Macchia G, Pezzulla D, Campitelli M, Laliscia C, Fodor A, Bonome P, Draghini L, Ippolito E, De Sanctis V, Ferioli M, Titone F, Balcet V, Di Cataldo V, Russo D, Vicenzi L, Cossa S, Lucci S, Cilla S, Deodato F, Gambacorta MA, Scambia G, Morganti AG, Ferrandina G. Efficacy and Safety of Stereotactic Body Radiation Therapy in Oligometastatic Uterine Cancer (MITO-RT2/RAD): A Large, Real-World Study in Collaboration With Italian Association of Radiation Oncology, Multicenter Italian Trials in Ovarian Cancer, and Mario Negri Gynecologic Oncology Group Groups. Int J Radiat Oncol Biol Phys 2023; 117:321-332. [PMID: 37150261 DOI: 10.1016/j.ijrobp.2023.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/04/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE This retrospective, multicenter study analyzes the efficacy and safety of stereotactic body radiation therapy in a large cohort of patients with oligometastatic/persistent/recurrent uterine cancer. METHODS AND MATERIALS Clinical and radiation therapy data from several radiation therapy centers treating patients by stereotactic body radiation therapy between March 2006 and October 2021 were collected. Objective response rate was defined as complete and partial response, and clinical benefit included objective response rate plus stable disease. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer and Common Terminology Criteria for Adverse Events scales were used to grade toxicities. Primary endpoints were the rate of complete response to stereotactic body radiation therapy, and the 2-year actuarial local control rate "per-lesion" basis. Secondary endpoints were progression-free survival and overall survival, as well as toxicity. RESULTS In the study, 157 patients with oligometastatic/persistent/recurrent uterine cancer bearing 272 lesions treated by stereotactic body radiation therapy at 14 centers were analyzed. Lymph node metastases (137, 50.4%) were prevalent, followed by parenchyma lesions (135, 49.6%). Median total dose was 35 Gy (10-75.2), in 5 fractions (range, 1-10). Complete and partial responses were 174 (64.0%), and 54 (19.9%), respectively. Stable disease was registered in 29 (10.6%), and 15 (5.5%) lesions progressed. Type of lesion (lymph node), volume (≤13.7 cc) and total dose (BED10 >59.5 Gy) were significantly associated with a higher probability of achieving complete response. Patients achieving complete response (CR) "per-lesion" basis experienced a 2-year actuarial local control rate of 92.4% versus 33.5% in lesions not achieving complete response (NCR; P < .001). Moreover, the 2-year actuarial progression-free survival rate in patients with CR was 45.4%, and patients with NCR had a 2-year rate of 17.6% (P < .001). Finally, patients who had a CR had a 2-year overall survival rate of 82.7%, compared with 56.5% for NCR patients (P <.001). Severe acute toxicity was around 2%, including one toxic death due to gastric perforation, and severe late toxicity around 4%. CONCLUSIONS The efficacy of stereotactic body radiation therapy in this setting was confirmed. The low toxicity profile and the high local control rate in complete responder patients encourage the wider use of this approach.
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Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy.
| | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Maura Campitelli
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Bonome
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | | | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Roma, Italy
| | - Vitaliana De Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Roma, Italy
| | - Martina Ferioli
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum. Bologna University, Bologna, Italy
| | - Francesca Titone
- Department of Radiation Oncology, University Hospital Udine, Udine, Italy
| | - Vittoria Balcet
- Radiation Oncology Department, Ospedale degli Infermi, Biella
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, University of Florence, Firenze, Italy
| | | | - Lisa Vicenzi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Sabrina Cossa
- UOC Radioterapia, Fondazione "Casa Sollievo della Sofferenza," IRCCS, S. Giovanni Rotondo, Foggia, Italy
| | - Simona Lucci
- Department of Radiation Oncology, University Hospital Udine, Udine, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise, Campobasso, Molise, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore Roma, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore Roma, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum. Bologna University, Bologna, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Gao H, Wu H, Zhang Y, Chen Z, Qi Z, Wang M, Cheng P. Locoregional therapy for oligometastatic cervical cancer: a single-center retrospective study. Int J Gynecol Cancer 2023; 33:198-207. [PMID: 36229079 DOI: 10.1136/ijgc-2022-003620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oligometastases are limited in number and extent, and therefore, are amenable to locoregional therapy. OBJECTIVE To analyze recurrence patterns, survival outcomes, and prognostic factors in patients with cervical cancer receiving locoregional therapy for oligometastases. METHODS The included patients had 1-3 extracranial oligometastases and received definitive radiotherapy, surgery, or ablation at a single institution between January 2007 and May 2022. Outcomes were evaluated using the Kaplan-Meier method. Prognostic factors were examined using the Cox proportional hazards model, and tumor growth rates were predicted by non-linear regression. RESULTS We identified 56 patients who presented with an oligometastatic disease to the supraclavicular fossa (n=19), lung (n=33), or other sites (n=4). Totals of 30 (53.6%), 41 (73.2%), 47 (83.9%), and 52 (92.9%) patients were diagnosed 1, 2, 3, and 4 years after cervical cancer diagnosis, respectively. Seven patients were simultaneously treated for para-aortic or pelvic recurrences. After a median follow-up of 24 months (range 1-86), the 3-year local recurrence-free rate in patients with supraclavicular versus non-supraclavicular oligometastases was 100% vs 93.5%. The 3-year overall survival rate was 40.1% vs 55.2% (p=0.04). Ten (17.9%) patients experienced new oligometastatic progression in a median of 8 months (range 4-14). Multivariate analysis showed that tumor size was the only prognostic factor for overall survival, with a 3-year overall survival rate of 91.7% vs 21.6% (≤15 mm vs >15 mm, p<0.001). Nineteen (86.4%) of 22 lesions diagnosed within 6 months of the last negative CT scan had a maximum diameter of ≤15 mm, and the predicted interval of tumor growth to 15 mm was 5.8 months. CONCLUSION Locoregional therapy for cervical cancer oligometastases can achieve long-term survival, especially in patients with small lesions (≤15 mm). Better follow-up mode after cervical cancer treatment and system therapy for oligometastases should be further explored.
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Affiliation(s)
- Hui Gao
- Department of Oncology, General Hospital of Western Theatre Command, Chengdu, Sichuan, China
| | - Haijing Wu
- Department of Gynecological Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, Sichuan, China
| | - Yue Zhang
- Department of Oncology, General Hospital of Western Theatre Command, Chengdu, Sichuan, China
| | - Zhiming Chen
- Department of Nuclear Medicine, General Hospital of Western Theatre Command, Chengdu, Sichuan, China
| | - Zhongchun Qi
- Department of Oncology, General Hospital of Western Theatre Command, Chengdu, Sichuan, China
| | - Mingyi Wang
- Department of Obstetrics and Gynecology, General Hospital of Western Theatre Command, Chengdu, Sichuan, China
| | - Peng Cheng
- Department of Oncology, General Hospital of Western Theatre Command, Chengdu, Sichuan, China
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Facondo G, Vullo G, De Sanctis V, Rotondi M, Sigillo RC, Valeriani M, Osti MF. Clinical Outcomes of Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Patients with Lymph Node Metastases from Gynecological Cancers. J Pers Med 2023; 13:jpm13020229. [PMID: 36836463 PMCID: PMC9965700 DOI: 10.3390/jpm13020229] [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: 01/02/2023] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND To evaluate clinical outcomes of stereotactic body radiation therapy (SBRT) as a local treatment for lymph node metastases from gynecological cancers. METHODS Between November 2007 and October 2021, we retrospectively analyzed 29 lymph node metastases in 22 oligometastatic/oligoprogressive patients treated with SBRT. The Kaplan-Meier method was used to estimate the rates survival. Univariate analysis for prognostic factors were performed with the log-rank test, and Cox proportional hazards regression was used to estimate hazard ratios (HR). RESULTS Median age was 62 years (IQR, 50-80 years). Median follow-up was 17 months (IQR 10.5-31 months). The median survival was 22 months (CI 95%: 4.2-39.7, IQR: 12.5-34.5 months). Six months, one year and two year overall survival (OS) were 96.6%, 85.2%, and 48.7%, respectively. Median local control (LC) was not reached. Six months, 1one year and 2 year were 93.1%, 87.9%, and 79.9%, respectively. Distant metastasis free survival (DMFS) at one year, and two year was 53% and 37.1%, respectively Four patients (18%) experienced acute G1-G2 toxicities. No G3-4 acute toxicity was reported, and no late toxicity was observed. CONCLUSIONS SBRT for lymph node recurrence offers excellent in-field tumor control with safe profile and low toxicities. Size, number of oligometastases, and time primary tumor to RT seem to be significant prognostic factors.
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Shenker R, Stephens SJ, Davidson B, Chino J. Role of stereotactic body radiotherapy in gynecologic radiation oncology. Int J Gynecol Cancer 2022; 32:372-379. [DOI: 10.1136/ijgc-2021-002466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/15/2021] [Indexed: 12/25/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT, also referred to as stereotactic ablative radiotherapy (SABR)) has been used in the treatment of primary and metastatic solid tumors, and increasingly so in gynecologic oncology. This review article aims to summarize the current literature describing the utility of SBRT in the primary, recurrent, and limited metastatic settings for gynecologic malignancies. The use of SBRT in both retrospective and prospective reports has been associated with adequate control of the treated site, particularly in the setting of oligometastatic disease. It is not, however, recommended as an alternative to brachytherapy for intact disease unless all efforts to use brachytherapy are exhausted. While phase I and II trials have established the relative safety and potential toxicities of SBRT, there remains a dearth of phase III randomized evidence, including the use of immunotherapy, in order to better establish the role of this technique as a method of improving more global outcomes for our patients with gynecologic cancers.
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Kataria T, Naga P, Banerjee S, Gupta D, Narang K, Tayal M, Bisht SS. CyberKnife Stereotactic Ablative Radiotherapy for Recurrent or Oligometastatic Gynecological Cancers. South Asian J Cancer 2021; 10:107-111. [PMID: 34568224 PMCID: PMC8460339 DOI: 10.1055/s-0041-1731576] [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] [Indexed: 10/26/2022] Open
Abstract
Purpose Use of stereotactic ablative radiotherapy (SABR) in the treatment of recurrent or metastatic lesions from a primary gynecologic cancer is a relatively new concept. The present study aims to assess the safety, efficacy, and possible toxicity profile of CyberKnife SABR, recurrent or metastatic disease. Materials/Methods CyberKnife VSI-based SABR was offered to 20 oligometastatic/recurrent gynecological cancer patients between 2013 and 2019. Patient, tumor, and treatment characteristics including radiotherapy details, clinical outcome in terms of local control rates, and toxicities are reported in this study. Results Twenty-five recurrent or oligometastatic lesions for 20 primary gynecologic cancer patients including cervical ( n = 8), ovarian ( n = 6), endometrial ( n = 5), and vulvar ( n = 1) cancers were analyzed. Of these, 4 (16%) were intracranial lesions and remaining 21 (84%) were extracranial, consisting of 14 (67%) extrapelvic and 7 (33%) pelvic lesions. The median SABR dose delivered was 60 Gy biologically effective dose (range 42-133 Gy) in an average of four fractions (range 1-6). The mean follow-up was 18 (range 2-70) months. Local tumor control was achieved in 82% of patients. There was no grade ≥ 3 toxicity recorded. Conclusion Our study results suggest that CyberKnife SABR is an effective treatment modality with no major morbidity in patients with recurrent or oligometastatic gynecological cancers.
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Affiliation(s)
- Tejinder Kataria
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Pushpa Naga
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Susovan Banerjee
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Kushal Narang
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Manoj Tayal
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India
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Portelance L, Corradini S, Erickson B, Lalondrelle S, Padgett K, van der Leij F, van Lier A, Jürgenliemk-Schulz I. Online Magnetic Resonance-Guided Radiotherapy (oMRgRT) for Gynecological Cancers. Front Oncol 2021; 11:628131. [PMID: 34513656 PMCID: PMC8429611 DOI: 10.3389/fonc.2021.628131] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 07/12/2021] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy (RT) is increasingly being used in gynecological cancer management. RT delivered with curative or palliative intent can be administered alone or combined with chemotherapy or surgery. Advanced treatment planning and delivery techniques such as intensity-modulated radiation therapy, including volumetric modulated arc therapy, and image-guided adaptive brachytherapy allow for highly conformal radiation dose delivery leading to improved tumor control rates and less treatment toxicity. Quality on-board imaging that provides accurate visualization of target and surrounding organs at risk is a critical feature of these advanced techniques. As soft tissue contrast resolution is superior with magnetic resonance imaging (MRI) compared to other imaging modalities, MRI has been used increasingly to delineate tumor from adjacent soft tissues and organs at risk from initial diagnosis to tumor response evaluation. Gynecological cancers often have poor contrast resolution compared to the surrounding tissues on computed tomography scan, and consequently the benefit of MRI is high. One example is in management of locally advanced cervix cancer where adaptive MRI guidance has been broadly implemented for adaptive brachytherapy. The role of MRI for external beam RT is also steadily increasing. MRI information is being used for treatment planning, predicting, and monitoring position shifts and accounting for tissue deformation and target regression during treatment. The recent clinical introduction of online MRI-guided radiation therapy (oMRgRT) could be the next step in high-precision RT. This technology provides a tool to take full advantage of MRI not only at the time of initial treatment planning but as well as for daily position verification and online plan adaptation. Cervical, endometrial, vaginal, and oligometastatic ovarian cancers are being treated on MRI linear accelerator systems throughout the world. This review summarizes the current state, early experience, ongoing trials, and future directions of oMRgRT in the management of gynecological cancers.
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Affiliation(s)
- Lorraine Portelance
- Sylvester Comprehensive Cancer Center, Radiation Oncology Department, University of Miami, Miami, FL, United States
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Susan Lalondrelle
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research London, London, United Kingdom
| | - Kyle Padgett
- Sylvester Comprehensive Cancer Center, Radiation Oncology Department, University of Miami, Miami, FL, United States
| | - Femke van der Leij
- Department of Radiation Oncology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Astrid van Lier
- Department of Radiation Oncology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Ina Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
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Stereotactic body radiotherapy for the treatment of gynecologic malignancies: Passing fancy or here to stay? Gynecol Oncol 2021; 161:642-644. [PMID: 33867142 DOI: 10.1016/j.ygyno.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Ingle M, Lalondrelle S. Current Status of Anatomical Magnetic Resonance Imaging in Brachytherapy and External Beam Radiotherapy Planning and Delivery. Clin Oncol (R Coll Radiol) 2020; 32:817-827. [PMID: 33169690 DOI: 10.1016/j.clon.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
Radiotherapy planning and delivery have dramatically improved in recent times. Imaging is key to a successful three-dimensional and increasingly four-dimensional based pathway with computed tomography embedded as the backbone modality. Computed tomography has significant limitations for many tumour sites where soft-tissue discrimination is suboptimal, and where magnetic resonance imaging (MRI) has largely superseded in the diagnostic arena. MRI is increasingly used together with computed tomography in the radiotherapy planning pathway and is now established as a prerequisite for several tumours. With the advent of combined MRI and linear accelerator (MR-linac) systems, a transition to MRI-based radiotherapy planning is becoming reality, with increasing experience and research involving these new platforms. In this overview, we aim to highlight how magnetic resonance-guided imaging has improved radiotherapy, using gynaecological malignancies to illustrate, in both external beam radiotherapy and image-guided brachytherapy, and will assess the early evidence for magnetic resonance-guided radiotherapy using combined MR-linac systems.
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Affiliation(s)
- M Ingle
- Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK
| | - S Lalondrelle
- Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK.
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12
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Chopra S, Mangaj A, Sharma A, Tan LT, Sturdza A, Jürgenliemk-Schulz I, Han K, Huang F, Schmid MP, Fokdal L, Chargari C, Diendorfer T, Tanderup K, Potter R, Nout RA. Management of oligo-metastatic and oligo-recurrent cervical cancer: A pattern of care survey within the EMBRACE research network. Radiother Oncol 2020; 155:151-159. [PMID: 33144247 DOI: 10.1016/j.radonc.2020.10.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the metastatic or recurrent cervical cancer, systemic chemotherapy constitutes the main treatment. Though there is an increasing use of high dose external radiation and brachytherapy in the metastatic setting, no consensus exists. METHODS A 17-item survey was designed with additional case-based questions to explore present management of oligo-metastatic and oligo-recurrent cervix cancer within EMBRACE research group participating sites. The questions were designed to elicit prevailing practices in the management of de-novo oligo-metastasis and oligo-recurrent setting after completing the primary treatment of cervix cancer. The survey was sent electronically with two rounds of email reminders to respond over a 2-week survey period. The online survey was designed such that it was mandatory to complete all questions. The responses were recorded and results were summarized as proportions and summary statistics were generated. RESULTS Twenty-two centers responded to this survey. A majority (90%) of respondents reported a low incidence of de-novo oligo-metastatic cervical cancer in their practice (<5%), with a higher proportion of patients with oligo-recurrence after completing primary treatment (5-10%). All responding sites preferred to treat pelvic disease in the de-novo oligo-metastatic setting albeit with different fractionation regimens. While 68.2% of respondents recommended chemo-radiation and brachytherapy, 31.8% considered additional systemic therapy. Overall 77.3% centers recommended the use of stereotactic ablative radiation therapy to oligo-metastasis. For out-of-field nodal recurrences, 63.7% of respondents considered treating with curative intent, while 59% preferred treating in-field recurrence with palliative intent. A vast majority of the participating centers (90%) have stereotactic radiation therapy capacity and would consider a clinical trial addressing oligo-metastatic and oligo-recurrent cervical cancer. CONCLUSION Although contemporary practice is variable, a substantial proportion of EMBRACE centers consider high dose radiation in de-novo metastatic and oligo-recurrence settings. However, there is clear need for a joint clinical protocol and prospective studies to address the role of high dose radiation within oligo-recurrent and oligo-metastatic scenarios.
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Affiliation(s)
- Supriya Chopra
- Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India.
| | - Akshay Mangaj
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Alisha Sharma
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Li Tee Tan
- Cambridge University Addenbrooke's Hospital, United Kingdom
| | - Alina Sturdza
- Medical University/General Hospital of Vienna, Comprehensive Cancer Center, Austria
| | | | - Kathy Han
- University of Toronto Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Canada
| | - Fleur Huang
- Cross Cancer Institute and University of Alberta, Department of Oncology, Edmonton, Canada
| | - Maximilian P Schmid
- Medical University/General Hospital of Vienna, Comprehensive Cancer Center, Austria
| | - Lars Fokdal
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | | | - Tamara Diendorfer
- Medical University/General Hospital of Vienna, Comprehensive Cancer Center, Austria
| | - Kari Tanderup
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | - Richard Potter
- Medical University/General Hospital of Vienna, Comprehensive Cancer Center, Austria
| | - Remi A Nout
- Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, the Netherlands.
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13
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Yegya-Raman N, Cao CD, Hathout L, Girda E, Richard SD, Rosenblum NG, Taunk NK, Jabbour SK. Stereotactic body radiation therapy for oligometastatic gynecologic malignancies: A systematic review. Gynecol Oncol 2020; 159:573-580. [PMID: 32917412 DOI: 10.1016/j.ygyno.2020.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/08/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) for oligometastatic gynecologic malignancies. METHOD A comprehensive search of the PubMed, Medline, and EMBASE databases was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. "Oligometastatic" was defined as a limited number of uncontrolled/untreated metastatic lesions (typically ≤ 5), including regional nodal metastases. Primary outcomes were response rate (complete response or partial response), local control of oligometastatic lesions, and toxicity. RESULTS Of 716 screened records, 17 studies (13 full length articles, 4 conference abstracts) were selected and analyzed as 16 unique studies. A total of 667 patients were treated with ~1071 metastatic lesions identified. Primary sites included ovarian (57.6%), cervical (27.1%), uterine (11.1%), vaginal (0.4%), vulvar (0.3%), and other/unspecified (3.4%). Most patients (65.4%) presented with a single metastatic lesion. Metastatic lesion sites included the abdomen (44.2%), pelvis (18.8%), thorax (15.5%), neck (4.6%), central nervous system (4.3%), bone (1.6%), and other/unspecified (11%). Of the lesions, 64% were nodal. Response rate (among 8 studies) ranged from 49% to 97%, with 7/8 studies reporting > 75% response rate. Local control ranged from 71% to 100%, with 14/16 studies reporting ≥ 80% local control. No grade ≥ 3 toxicities were observed in 9/16 (56%) studies. Median progression-free survival (PFS) (among 10 studies) ranged from 3.3 months to 21.7 months. Disease progression most commonly occurred outside of the SBRT radiation field (79% to 100% of failures). CONCLUSIONS SBRT for oligometastatic gynecologic malignancies is associated with favorable response and local control rates but a high rate of out-of-field progression and heterogeneous PFS. Additional study into rational combinations of SBRT and systemic therapy appears warranted to further improve patient outcomes.
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Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Connie D Cao
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Eugenia Girda
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Scott D Richard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Norman G Rosenblum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Neil K Taunk
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA.
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Reddy AV, Mills MN, Reshko LB, Martin Richardson K, Kersh CR. Stereotactic Body Radiation Therapy in Oligometastatic Uterine Cancer: Clinical Outcomes and Toxicity. Cancer Invest 2020; 38:522-530. [PMID: 32870714 DOI: 10.1080/07357907.2020.1817483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report on clinical outcomes in patients with oligometastatic uterine cancer treated with stereotactic body radiation therapy (SBRT). Twenty-seven patients with 61 lesions were treated with SBRT. Median follow-up was 16.9 months. Local control was achieved in 49/61 (80.3%) lesions. One-year local-progression-free survival and overall survival were 75.9% and 65.4%. Lesions with favorable response were smaller than lesions with unfavorable response (p = .007). Liver lesions were less likely to achieve favorable response (p = .0128). There were no grade 3 or 4 events. Treatment with SBRT can provide excellent local control in oligometastatic uterine cancer with minimal toxicity.
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Affiliation(s)
- Abhinav V Reddy
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Leonid B Reshko
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky, USA
| | - K Martin Richardson
- Riverside and University of Virginia Radiosurgery Center, Newport News, Virginia, USA
| | - Charles R Kersh
- Riverside and University of Virginia Radiosurgery Center, Newport News, Virginia, USA.,Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
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15
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Zhang TW, Palma D, D'Souza D, Velker V, Mendez LC. Stereotactic Ablative Radiotherapy for Recurrent or Metastatic Gynecological Cancer: Extending Lives? Curr Treat Options Oncol 2020; 21:58. [PMID: 32533272 DOI: 10.1007/s11864-020-00748-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OPINION STATEMENT Recent phase II clinical trials suggest that stereotactic ablative radiation therapy (SABR) can potentially improve survival for patients with oligometastatic cancer. However, these studies have mostly enrolled primaries other than gynecologic malignancies. While level I evidence is limited, recent publications exploring the use of SABR for oligometastatic gynecologic cancers have indicated a potential role for this treatment in para-aortic lymph node recurrences, and in visceral and brain metastases. The use of SABR for recurrences in the pelvis presents a number of challenges as these patients have often received previous radiation treatment. In these settings, care must be taken to avoid trespassing normal tissue tolerance with SABR leading to toxicity, especially as the potential benefit of SABR in this setting is not based on high-level evidence. Although SABR is feasible and in general safe for oligometastatic gynecologic malignancies, insufficient data are available to indicate whether it is associated with improved survival. Clinical judgment that incorporates patient and tumor factors is needed to determine if SABR is appropriate for selecting patients. Future directions include combining SABR with novel systemic therapies, determining optimal sequencing of treatments, and generating more robust randomized data pertaining to the use of SABR for oligometastatic gynecologic cancers.
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Affiliation(s)
- Tina W Zhang
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada
| | - David Palma
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada
| | - David D'Souza
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada
| | - Vikram Velker
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada
| | - Lucas C Mendez
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada.
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16
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Onal C, Gultekin M, Oymak E, Guler OC, Yilmaz MT, Yuce Sari S, Akkus Yildirim B, Yildiz F. Stereotactic radiotherapy in patients with oligometastatic or oligoprogressive gynecological malignancies: a multi-institutional analysis. Int J Gynecol Cancer 2020; 30:865-872. [PMID: 32273293 DOI: 10.1136/ijgc-2019-001115] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Data supporting stereotactic body radiotherapy for oligometastatic patients are increasing; however, the outcomes for gynecological cancer patients have yet to be fully explored. Our aim is to analyze the clinical outcomes of stereotactic body radiotherapy in the treatment of patients with recurrent or oligometastatic ovarian cancer or cervical cancer. METHODS The clinical data of 29 patients (35 lesions) with oligometastatic cervical cancer (21 patients, 72%) and ovarian carcinoma (8 patients, 28%) who were treated with stereotactic body radiotherapy for metastatic sites were retrospectively evaluated. All patients had <5 metastases at diagnosis or during progression, and were treated with stereotactic body radiotherapy for oligometastatic disease. Patients with ≥5 metastases or with brain metastases and those who underwent re-irradiation for primary site were excluded. Age, progression time, mean biologically effective dose, and treatment response were compared for overall survival and progression-free survival. RESULTS A total of 29 patients were included in the study. De novo oligometastatic disease was observed in 7 patients (24%), and 22 patients (76%) had oligoprogression. The median follow-up was 15.3 months (range 1.9-95.2). The 1 and 2 year overall survival rates were 85% and 62%, respectively, and the 1 and 2 year progression-free survival rates were 27% and 18%, respectively. The 1 and 2 year local control rates for all patients were 84% and 84%, respectively. All disease progressions were observed at a median time of 7.7 months (range 1.0-16.0) after the completion of stereotactic body radiotherapy. Patients with a complete response after stereotactic body radiotherapy for oligometastasis had a significantly higher 2 year overall survival and progression-free survival compared with their counterparts. In multivariate analysis, early progression (≤12 months) and complete response after stereotactic body radiotherapy for oligometastasis were the significant prognostic factors for improved overall survival. However, no significant factor was found for progression-free survival in the multivariable analysis. No patients experienced grade 3 or higher acute or late toxicities. CONCLUSIONS Patients with early detection of oligometastasis (≤12 months) and with complete response observed at the stereotactic body radiotherapy site had a better survival compared with their counterparts. Stereotactic body radiotherapy at the oligometastatic site resulted in excellent local control rates with minimal toxicity, and can potentially contribute to long-term survival.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Baskent Universitesi Tip Fakultesi, Adana, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Ezgi Oymak
- 3Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent Universitesi Tip Fakultesi, Adana, Turkey
| | - Melek Tugce Yilmaz
- Department of Radiation Oncology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent Universitesi Tip Fakultesi, Adana, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
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17
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[Radiotherapy for ovarian carcinoma management: Literature review]. Cancer Radiother 2020; 24:159-165. [PMID: 32151544 DOI: 10.1016/j.canrad.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 11/24/2022]
Abstract
Ovarian cancer is the fifth most common cancer in women in France with 4714 new cases in 2017. More than 70% of patients whose disease is initially locally advanced will present locoregional or distant recurrence. Therapeutic options in this situation are not consensual. They are based on chemotherapy possibly associated with an iterative cytoreductive surgery when it is bearable by the patient. The place of radiotherapy in the management of the disease is hidden in the vast majority of national or international standards. We conducted a general review of the literature to clarify the role of irradiation in the global management of ovarian cancers, particularly in recurrence.
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18
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Mukai Y, Koike I, Matsunaga T, Yokota NR, Takano S, Sugiura M, Sato M, Miyagi E, Hata M. Radiation Therapy for Uterine Cervical Cancer With Lung Metastases Including Oligometastases. In Vivo 2020; 33:1677-1684. [PMID: 31471423 DOI: 10.21873/invivo.11655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIM To investigate the role and outcomes of radiation therapy (RT) for stage IVB uterine cervical cancer (UCC) patients with lung (oligo) metastases due to the lack of recent reports on the subject. PATIENTS AND METHODS The cohort for this retrospective study comprised 23 consecutive patients with UCC (squamous cell carcinoma, n=13) and lung metastases who had received pelvic RT. Ten had lung metastases only, including 7 with oligometastases (≤4 lung metastases); the remaining 13 also had other distant metastases. RESULTS Nine (39.1%) of the 22 patients (95.7%) completed RT without interruption. The 1-year primary progression-free rate was 95.2%. The 1-year overall survival rate was 47.2 % (estimated median survival: 9 months). Significant prognostic factors for survival included: i) ≤4 lung metastases (p=0.035), ii) unilateral lung metastases (p=0.039), iii) primary tumor diameter <100 mm (p<0.001), and iv) ECOG performance status <1 (p=0.015). CONCLUSION RT is safe and effective for stage IVB UCC patients with lung metastases.
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Affiliation(s)
- Yuki Mukai
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Izumi Koike
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tatsuya Matsunaga
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naho Ruiz Yokota
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Syoko Takano
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Madoka Sugiura
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mizuki Sato
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaharu Hata
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Kissel M, Rambeau A, Achkar S, Lecuru F, Mathevet P. Challenges and advances in cervix cancer treatment in elder women. Cancer Treat Rev 2020; 84:101976. [PMID: 32006796 DOI: 10.1016/j.ctrv.2020.101976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 01/18/2023]
Abstract
With population ageing, cancer treatments in elder patients is becoming a true public health care issue. There is an authentic dilemma between patient's frailty, residual life expectancy and the toll that take anticancer treatments. Since elder patients are almost always excluded from clinical trials, it is hard to get robust scientific data on the tolerability of oncologic treatments and to set in place recommendations. Cervix cancer is traditionally diagnosed in younger women but it has a 2nd incidence peak between 60 and 70 years old. Cervix cancer in elder patients is a subject to many questions in terms of screening and is a therapeutic challenge. This article reviews literature data on these different aspects, from screening to surgery, from radiotherapy to brachytherapy, from chemotherapy to supportive care, from immunotherapy to geriatric assessment. We tried to show how modern therapeutic innovations may benefit elder patients. Expected benefits in terms of efficacy and toxicity may overcome the long-lasting tendency to undertreatment in elder patients and improve their quality of life after cancer treatment. In 2020, there seems to be less and less reasons justifying that elder women with cervix cancer may not receive the appropriate treatment.
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Affiliation(s)
- M Kissel
- Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France.
| | - A Rambeau
- Department of Medical Oncology, Centre François Baclesse, ARCHADE, Caen, France
| | - S Achkar
- Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - F Lecuru
- Department of Gynecologic Oncology, Georges Pompidou European Hospital, Paris, France
| | - P Mathevet
- Gynecology Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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20
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Stereotactic Body Radiation Therapy in Oligometastatic Ovarian Cancer: A Promising Therapeutic Approach. Int J Gynecol Cancer 2019; 28:1507-1513. [PMID: 30036231 DOI: 10.1097/igc.0000000000001324] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Stereotactic body radiation therapy (SBRT) has been successfully used to treat oligometastases of several primary tumors, but few experiences have been described in patients with gynecological oligometastatic cancer, particularly in ovarian neoplasm. The aim of this study was to evaluate the role of this new radiotherapy modality in a series of oligometastatic ovarian cancer patients. MATERIALS AND METHODS Clinical records of patients affected by oligometastatic ovarian carcinoma treated with SBRT were reviewed. RESULTS Twenty-six patients with 44 metastatic lesions (lymph nodes, 63.6%; liver, 31.8%; and lung, 4.5%) treated with SBRT between January 2011 and May 2017 were analyzed. After a median follow-up period of 28.5 months (range, 6-86 months), 17 patients (65.4%) were still alive at time of analysis: 6 are without evidence of disease, 11 experienced a disease progression. Eight patients died of disease, 1 died because of an heart attack while being disease free. The median local control (LC) was not reached. One-, 2-, and 5-year LCs were 92.9%. Median progression-free survival was 19 months, with 1-year progression-free survival of 69.3% and 38% at 2 years, 19% at 5 years. Median overall survival was 64.5 months, with all patients alive after 1 year, 92.7% at 2 years, and 61.7% at 5 years. Five (11.3%) cases experienced G2 toxicity; most common adverse effect was nausea and vomiting (3 cases [6.8%]) followed by abdominal pain (2 cases [4.5%]). None of the patients had grade 3 or grade 4 acute or late toxicity. CONCLUSIONS In conclusion, SBRT is a feasible and safe approach for selected cases of oligometastatic ovarian cancer, with satisfactory results in terms of LC and disease free survival.
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21
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Ling DC, Vargo JA, Burton SA, Heron DE, Beriwal S. Salvage Curative-Intent Reirradiation Stereotactic Body Radiation Therapy for Isolated Pelvic and/or Paraortic Recurrences of Gynecologic Malignancies. Pract Radiat Oncol 2019; 9:418-425. [PMID: 31150869 DOI: 10.1016/j.prro.2019.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the feasibility of stereotactic body radiation therapy (SBRT) for isolated nodal recurrences of gynecologic malignancies within a previously irradiated area. METHODS AND MATERIALS A retrospective review was performed on 20 patients who underwent 21 curative-intent reirradiation SBRT treatments for locoregional recurrences of gynecologic malignancies. Disease control and survival outcomes were analyzed with the Kaplan-Meier method and log-rank test. Treatment toxicities were graded according to Common Terminology Criteria for Adverse Events version 4.03. RESULTS All patients had an isolated pelvic, paraortic, or intra-abdominal nodal recurrence, with the exception of 1 patient who had a concurrent paraortic and right acetabulum metastasis, both of which were irradiated with SBRT. Primary sites included cervix (30.0%), uterus (55.0%), vulva (5.0%), vagina (5.0%), and ovary (5.0%). Median prior external beam radiation therapy dose was 45 Gy. Recurrences were in field in 14 (66.7%) and marginal in 7 (33.3%). SBRT was directed to the pelvis in 13 cases (61.9%) and to paraortic or celiac nodes in 8 (38.1%). The most common SBRT regimen was 40 to 45 Gy in 5 fractions (n = 12). At a median follow-up of 31.2 months, 3-year actuarial in-field local control, distant progression-free survival, and overall survival were 61.4%, 44.0%, and 51.9%, respectively. At the time of last follow-up, 9 (45.0%) patients remained alive without evidence of disease. Actuarial 3-year risk of grade ≥2 and grade ≥3 late toxicities was 38.1% and 14.3%, respectively. CONCLUSIONS SBRT for isolated pelvic or intra-abdominal recurrences of gynecologic malignancies within a previously irradiated field is feasible with an acceptable toxicity rate. With this approach, about half of patients achieved durable disease-free survival.
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Affiliation(s)
- Diane C Ling
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John A Vargo
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven A Burton
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dwight E Heron
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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Abstract
PURPOSE OF REVIEW Radiation has long been a primary treatment modality in locally advanced gynecologic carcinomas and a tool for palliation of metastatic disease. Here we review advances in imaging and radiation technologies and the corresponding clinical evolution of the role for radiation oncology in the treatment of gynecologic malignancies. RECENT FINDINGS Advances in MRI are impacting diagnosis, radiation target delineation, planning, treatment delivery, and response assessment. The combination of MRI and PET-computed tomography (PET-CT) has the potential to significantly change treatment recommendations as compared with a single imaging modality. Advances in radiation delivery including intensity modulated radiation therapy (IMRT) and stereotactic ablative radiotherapy (SABR) have expanded the role for radiation in the definitive treatment of high risk and oligometastatic ovarian cancer. Finally, global disparities in oncology resources has led to the development of resource stratified treatment guidelines for gynecologic malignancies. The use of ultrasound for brachytherapy planning may help improve access to this critical treatment modality. SUMMARY As imaging and radiation technologies advance, the indications for radiation in the treatment of gynecologic malignancies continues to evolve. Here we review the changing landscape of radiation oncology in the multidisciplinary management of gynecologic cancers.
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Bi Y, Verginadis II, Dey S, Lin L, Guo L, Zheng Y, Koumenis C. Radiosensitization by the PARP inhibitor olaparib in BRCA1-proficient and deficient high-grade serous ovarian carcinomas. Gynecol Oncol 2018; 150:534-544. [PMID: 30025822 DOI: 10.1016/j.ygyno.2018.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/27/2018] [Accepted: 07/01/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Approximately 15-25% of high-grade serous ovarian carcinomas (HGSOC) harbor BRCA1/2 mutations. Inhibition of Poly (ADP-ribose) polymerase (PARP) is synthetically lethal to cells and tumors with BRCA1/2 mutation. Our goal was to investigate the radiosensitizing effects of PARP inhibitor olaparib in HGSOC with different BRCA1 status. METHODS The radiosensitizing effects of olaparib were tested on BRCA1-proficient and deficient HGSOC by clonogenic survival and tumor growth assays. The effects of olaparib and radiation on DNA damage, PARP activity, and apoptosis were determined. RESULTS BRCA1-deficient HGSOC cells were more sensitive to RT alone and exhibited significantly higher levels of olaparib-mediated radiosensitization compared to BRCA1-proficient cells. Furthermore, when combined with RT, olaparib inhibited DNA damage repair and PARP1 activity, increased apoptosis, decreased growth of HGSOC xenografts and increased overall host survival. The growth-inhibitory effects of the combined olaparib and RT treatment were more pronounced in mice bearing BRCA1-deficient tumors compared to BRCA1-proficient tumors. CONCLUSIONS These results provide a preclinical rationale for improved treatment modalities using olaparib as an effective radiosensitizer in HGSOC, particularly in tumors with BRCA1-deficiencies.
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Affiliation(s)
- Yue Bi
- Oncology Center, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, China; Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ioannis I Verginadis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Souvik Dey
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lilie Lin
- MD Anderson Cancer Center, Division of Radiation Oncology, Houston, TX 77054, USA
| | - Linlang Guo
- Oncology Center, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Yanfang Zheng
- Oncology Center, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, China.
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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24
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Lazzari R, Ronchi S, Gandini S, Surgo A, Volpe S, Piperno G, Comi S, Pansini F, Fodor C, Orecchia R, Tomao F, Parma G, Colombo N, Jereczek-Fossa BA. Stereotactic Body Radiation Therapy for Oligometastatic Ovarian Cancer: A Step Toward a Drug Holiday. Int J Radiat Oncol Biol Phys 2018; 101:650-660. [PMID: 29893277 DOI: 10.1016/j.ijrobp.2018.03.058] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/18/2018] [Accepted: 03/28/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate stereotactic body radiation therapy (SBRT) for metachronous oligometastatic ovarian cancer patients in terms of local control, delay of systemic treatment, survival outcomes, and toxicity. METHODS AND MATERIALS Retrospective data collection from a single institution was performed. The inclusion criteria were as follows: (1) oligorecurrent or oligoprogressive disease in ovarian cancer patients during or after systemic therapy; (2) surgery or other local therapies not feasible; and (3) relative contraindication to systemic therapy for reasons such as unavailability of additional chemotherapy lines or refusal of the patient. Tumor response and toxicity were evaluated using the Response Evaluation Criteria in Solid Tumors and the Common Terminology Criteria for Adverse Events version 4.03, respectively. A new systemic therapy regimen was started after an SBRT treatment course in 57 of 109 cases (52.3%). Local progression-free survival, progression-free survival, and overall survival were calculated via the Kaplan-Meier method. The systemic treatment-free interval was calculated in cases without concomitant systemic therapy. RESULTS Between May 2012 and December 2016, 82 patients (156 lesions) underwent SBRT with a median dose of 24 Gy in 3 fractions. The median follow-up period was 17.4 months. Patients received a median of 3 systemic therapy regimens prior to SBRT. Concomitant systemic therapy was performed for 29 lesions (18.6%). Among 152 evaluable lesions, a complete radiologic response, partial response, stabilization, and progressive disease were observed in 91 (60%), 26 (17%), 24 (16%), and 11 (7%), respectively. No grade 3 or 4 acute or late toxicities were observed. The median systemic treatment-free interval after SBRT was 7.4 months, and 1 of 3 patients was disease free at 1 year after SBRT. The actuarial 2-year local progression-free survival, progression-free survival, and overall survival rates were 68%, 18%, and 71%, respectively. The pattern of failure was predominantly out of field. CONCLUSIONS SBRT for oligometastatic ovarian cancer showed good local control and a good toxicity profile. It might be an appealing alternative to other invasive local therapies to delay systemic therapy in the case of chemorefractory disease or intolerance to systemic agents.
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Affiliation(s)
- Roberta Lazzari
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Sara Ronchi
- Department of Radiation Oncology and Medical Physics, Centro Nazionale Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Sara Gandini
- Division of Epidemiology and Biostatistics Unit, European Institute of Oncology, Milan, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Stefania Volpe
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Gaia Piperno
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Floriana Pansini
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Scientific Directorate, European Institute of Oncology, Milan, Italy
| | - Federica Tomao
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University, Rome, Italy
| | - Gabriella Parma
- Department of Gynecology, European Institute of Oncology, Milan, Italy
| | - Nicoletta Colombo
- Department of Gynecology, European Institute of Oncology, Milan, Italy; University of Milano-Bicocca, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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25
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Ning MS, Ahobila V, Jhingran A, Stecklein SR, Frumovitz M, Schmeler KM, Eifel PJ, Klopp AH. Outcomes and patterns of relapse after definitive radiation therapy for oligometastatic cervical cancer. Gynecol Oncol 2018; 148:132-138. [DOI: 10.1016/j.ygyno.2017.10.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
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26
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Matsushita H, Jingu K, Umezawa R, Yamamoto T, Ishikawa Y, Takahashi N, Katagiri Y, Kadoya N. Stereotactic Radiotherapy for Oligometastases in Lymph Nodes-A Review. Technol Cancer Res Treat 2018; 17:1533033818803597. [PMID: 30352542 PMCID: PMC6201169 DOI: 10.1177/1533033818803597] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 01/26/2023] Open
Abstract
In recent years, the concept of oligometastases has become accepted and reports on stereotactic body radiotherapy as a treatment method have been published. Lesions in the brain, lung, and liver have been reported as target lesions. However, lymph node oligometastases could be a good candidate for stereotactic body radiotherapy as well. In this study, the usability of stereotactic body radiotherapy for oligometastases to lymph nodes is assessed by researching for each primary site. As a result, we could consider that stereotactic body radiotherapy could be almost well applied for lymph node oligometastases from the breast, gynecological organs, and prostate. However, doubts remain concerning the usefulness of stereotactic body radiotherapy for cervical node metastases from head and neck cancer or for mediastinal node metastases from lung or esophageal cancer since late toxicities have occurred with a large radiation dose at hypofractionation to major vessels or the central respiratory tract, especially in patients with irradiation histories. In addition, high-dose irradiation is required to control lymph node metastases from colorectal cancer due to its radioresistance, and severe late adverse events would therefore occur in adjacent organs such as the gastrointestinal tract. In cases of lymph node oligometastases with a primary tumor in the stomach or esophagus, stereotactic body radiotherapy should be used limitedly at present because this patient population is not so large and these metastases are often located close to organs at risk. Because of the varied status of recurrence and varied conditions of patients, it is difficult to determine the optimal dose for tumor control. It might be reasonable to determine the treatment dose individually based on dose constraints of adjacent organs. The oligometastatic state is becoming more frequently identified with more sensitive methods of detecting such oligometastases. In addition, there seems to be another type of oligometastases, so-called induced oligometastases, following successful systemic treatment. To determine the optimal indication of stereotactic body radiotherapy for lymph node oligometastases, further investigation about the mechanisms of oligometastases and further clinical studies including a phase III study are needed.
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Affiliation(s)
- Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Yu Katagiri
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
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27
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Nair R, Lamb BW, Geurts N, Alghazo O, Lam W, Lawrentschuk N, Murphy DG. The Role of Local Therapy for Oligometastatic Prostate Cancer: Should We Expect a Cure? Urol Clin North Am 2017; 44:623-633. [PMID: 29107278 DOI: 10.1016/j.ucl.2017.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The role of local treatment in oligometastatic prostate cancer remains contentious. Treatment of the prostate in metastatic disease may confer benefit, but prospective data are lacking. With improvements in treatments, aggressive strategies directed at metastases have increasingly become of clinical interest. Current evidence suggests good local control can be achieved; however, further data are required to determine overall cancer outcomes. This article evaluates the evidence available and consider whether local treatment of oligometastatic disease is a feasible, safe, and a positive strategy in this disease cohort. Cure should not be expected, although prolonged disease and treatment-free survival may be observed.
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Affiliation(s)
- Rajesh Nair
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Benjamin W Lamb
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Nicolas Geurts
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Omar Alghazo
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Wayne Lam
- Department of Urology, The University of Hong Kong, 9/F, Knowles Building Pok Fu Lam Road, Pok Fu Lam, Hong Kong SAR, China
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia; Department of Surgery, Austin Health, University of Melbourne, Parkville, 145 Studley Rd, Heidelberg Victoria 3084, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Cancer centre, Department of Oncology, University of Melbourne, 305 Grattan Street, Melbourne VIC 3000, Australia.
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28
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Fields EC, McGuire WP, Lin L, Temkin SM. Radiation Treatment in Women with Ovarian Cancer: Past, Present, and Future. Front Oncol 2017; 7:177. [PMID: 28871275 PMCID: PMC5566993 DOI: 10.3389/fonc.2017.00177] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/02/2017] [Indexed: 01/31/2023] Open
Abstract
Ovarian cancer is the most lethal of the gynecologic cancers, with 5-year survival rates less than 50%. Most women present with advanced stage disease as the pattern of spread is typically with dissemination of malignancy throughout the peritoneal cavity prior to development of any symptoms. Prior to the advent of platinum-based chemotherapy, radiotherapy was used as adjuvant therapy to sterilize micrometastatic disease. The evolution of radiotherapy is detailed in this review, which establishes radiotherapy as an effective therapy for women with micrometastatic disease in the peritoneal cavity after surgery, ovarian clear cell carcinoma, focal metastatic disease, and for palliation of advanced disease. However, with older techniques, the toxicity of whole abdominal radiotherapy and the advancement of systemic therapies have limited the use of radiotherapy in this disease. With newer radiotherapy techniques, including intensity-modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT), and low-dose hyperfractionation in combination with targeted agents, radiotherapy could be reconsidered as part of the standard management for this deadly disease.
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Affiliation(s)
- Emma C Fields
- Division of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, United States
| | - William P McGuire
- Internal Medicine, Virginia Commonwealth University, Richmond VA, United States
| | - Lilie Lin
- Division of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Sarah M Temkin
- Division of Gynecologic Oncology, Virginia Commonwealth University, Main Hospital, Richmond, VA, United States
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29
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Choi N, Chang JH, Kim S, Kim HJ. Radiation for persistent or recurrent epithelial ovarian cancer: a need for reassessment. Radiat Oncol J 2017; 35:144-152. [PMID: 28712280 PMCID: PMC5518454 DOI: 10.3857/roj.2017.00213] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/08/2017] [Accepted: 05/26/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose The role of radiotherapy (RT) was largely deserted after the introduction of platinum-based chemotherapy, but still survival rates are disappointingly low. This study focuses on assessing the clinical efficacy of RT in relation to chemotherapy resistance. Materials and Methods From October 2002 to January 2015, 44 patients were diagnosed with epithelial ovarian cancer (EOC) and treated with palliative RT for persistent or recurrent EOC. All patients received initial treatment with optimal debulking surgery and adjuvant platinum-based chemotherapy. The biologically effective dose (BED) was calculated with α/β set at 10. Ninety-four sites were treated with RT with a median BED of 50.7 Gy (range 28.0 to 79.2 Gy). The primary end-point was the in-field local control (LC) interval, defined as the time interval from the date RT was completed to the date any progressive or newly recurring disease within the RT field was detected on radiographic imaging. Results The median follow-up duration was 52.3 months (range 7.7 to 179.0 months). The 1-year and 2-year in-field LC rates were 66.0% and 55.0%, respectively. Comparisons of percent change of in-field tumor response showed similar distribution of responses among chemoresistant and chemosensitive tumors. On multivariate analysis of predictive factors for in-field LC analyzed by sites treated, BED ≥ 50 Gy (hazard ratio, 0.4; confidence interval, 0.2–0.9; p = 0.025) showed better outcomes. Conclusion Regardless of resistance to platinum-based chemotherapy, RT can be a feasible treatment modality for patients with persistent of recurrent EOC. The specific role of RT using updated approaches needs to be reassessed.
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Affiliation(s)
- Noorie Choi
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Suzy Kim
- Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
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