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Shor D, Khoo V, Jayaprakash KT. Advancing the Paradigm: Oligometastatic Disease and the Impact of Stereotactic Ablative Body Radiotherapy. Clin Oncol (R Coll Radiol) 2024; 36:402-405. [PMID: 38631977 DOI: 10.1016/j.clon.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Affiliation(s)
- D Shor
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
| | - V Khoo
- The Royal Marsden Hospital NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - K T Jayaprakash
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Kings Lynn, UK
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2
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Yoon SM, Bazan JG. Navigating Breast Cancer Oligometastasis and Oligoprogression: Current Landscape and Future Directions. Curr Oncol Rep 2024; 26:647-664. [PMID: 38652425 PMCID: PMC11168988 DOI: 10.1007/s11912-024-01529-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE We examine the potential for curative approaches among metastatic breast cancer (MBC) patients by exploring the recent literature on local ablative therapies like surgery and stereotactic body radiation therapy (SBRT) in patients with oligometastatic (OM) breast cancer. We also cover therapies for MBC patients with oligoprogressive (OP) disease. KEY FINDINGS Surgery and SBRT have been studied for OM and OP breast cancer, mainly in retrospective or non-randomized trials. While many studies demonstrated favorable results, a cooperative study and single-institution trial found no support for surgery/SBRT in OM and OP cases, respectively. CONCLUSION While there is interest in applying local therapies to OM and OP breast cancer, the current randomized data does not back the routine use of surgery or SBRT, particularly when considering the potential for treatment-related toxicities. Future research should refine patient selection through advanced imaging and possibly explore these therapies specifically in patients with hormone receptor-positive or HER2-positive disease.
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Affiliation(s)
- Stephanie M Yoon
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Jose G Bazan
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
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Oka R, Utsumi T, Noro T, Suzuki Y, Iijima S, Sugizaki Y, Somoto T, Kato S, Endo T, Kamiya N, Suzuki H. Progress in Oligometastatic Prostate Cancer: Emerging Imaging Innovations and Therapeutic Approaches. Cancers (Basel) 2024; 16:507. [PMID: 38339259 PMCID: PMC10854639 DOI: 10.3390/cancers16030507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Prostate cancer (PCa) exhibits a spectrum of heterogeneity, from indolent to highly aggressive forms, with approximately 10-20% of patients experiencing metastatic PCa. Oligometastatic PCa, characterized by a limited number of metastatic lesions in specific anatomical locations, has gained attention due to advanced imaging modalities. Although patients with metastatic PCa typically receive systemic therapy, personalized treatment approaches for oligometastatic PCa are emerging, including surgical and radiotherapeutic interventions. This comprehensive review explores the latest developments in the field of oligometastatic PCa, including its biological mechanisms, advanced imaging techniques, and relevant clinical studies. Oligometastatic PCa is distinct from widespread metastases and presents challenges in patient classification. Imaging plays a crucial role in identifying and characterizing oligometastatic lesions, with new techniques such as prostate-specific membrane antigen positron emission tomography demonstrating a remarkable efficacy. The management strategies encompass cytoreductive surgery, radiotherapy targeting the primary tumor, and metastasis-directed therapy for recurrent lesions. Ongoing clinical trials are evaluating the effectiveness of these approaches. Oligometastatic PCa occupies a unique position between locally advanced and high-volume metastatic diseases. While a universally accepted definition and standardized diagnostic criteria are still evolving, emerging imaging technologies and therapeutic strategies hold promise for improving the patient outcomes in this intermediate stage of PCa.
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Affiliation(s)
| | - Takanobu Utsumi
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi 285-8741, Chiba, Japan; (R.O.); (T.N.); (Y.S.); (S.I.); (Y.S.); (T.S.); (S.K.); (T.E.); (N.K.); (H.S.)
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4
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Zerella MA, Zaffaroni M, Ronci G, Dicuonzo S, Rojas DP, Morra A, Gerardi MA, Fodor C, Rondi E, Vigorito S, Penco S, Sargenti M, Baratella P, Vicini E, Morigi C, Kahler-Ribeiro-Fontana S, Galimberti VE, Gandini S, De Camilli E, Renne G, Cattani F, Veronesi P, Orecchia R, Jereczek-Fossa BA, Leonardi MC. A narrative review for radiation oncologists to implement preoperative partial breast irradiation. LA RADIOLOGIA MEDICA 2023; 128:1553-1570. [PMID: 37650981 DOI: 10.1007/s11547-023-01706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
The strategy to anticipate radiotherapy (RT) before surgery, for breast cancer (BC) treatment, has recently generated a renewed interest. Historically, preoperative RT has remained confined either to highly selected patients, in the context of personalized therapy, or to clinical research protocols. Nevertheless, in the recent years, thanks to technological advances and increased tumor biology understanding, RT has undergone great changes that have also impacted the preoperative settings, embracing the modern approach to breast cancer. In particular, the reappraisal of preoperative RT can be viewed within the broader view of personalized and tailored medicine. In fact, preoperative accelerated partial breast irradiation (APBI) allows a more precise target delineation, with less variability in contouring among radiation oncologists, and a smaller treatment volume, possibly leading to lower toxicity and to dose escalation programs. The aim of the present review, which represents a benchmark study for the AIRC IG-23118, is to report available data on different technical aspects of preoperative RT including dosimetric studies, patient's selection and set-up, constraints, target delineation and clinical results. These data, along with the ones that will become available from ongoing studies, may inform the design of the future trials and representing a step toward a tailored APBI approach with the potential to challenge the current treatment paradigm in early-stage BC.Trial registration: The study is registered at clinicaltrials.gov (NCT04679454).
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Affiliation(s)
- Maria Alessia Zerella
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Mattia Zaffaroni
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Giuseppe Ronci
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Damaris Patricia Rojas
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Anna Morra
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | | | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sabrina Vigorito
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Silvia Penco
- Division of Breast Radiology, IRCSS, IEO European Institute of Oncology, Milan, Italy
| | - Manuela Sargenti
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Baratella
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa Vicini
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Consuelo Morigi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa De Camilli
- Department of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Renne
- Department of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Maria Cristina Leonardi
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy.
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Ahmadsei M, Thaler K, Gasser E, Pouymayou B, Dal Bello R, Christ SM, Willmann J, Kovacs B, Balermpas P, Tanadini-Lang S, Saguner AM, Mayinger M, Andratschke N, Guckenberger M. Dosimetric analysis of 17 cardiac Sub-structures, Toxicity, and survival in ultra central lung tumor patients treated with SBRT. Clin Transl Radiat Oncol 2023; 43:100675. [PMID: 37744054 PMCID: PMC10511337 DOI: 10.1016/j.ctro.2023.100675] [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: 05/22/2023] [Revised: 08/04/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
•Data on cardiac toxicity after SBRT for ultra-central lung tumors remains limited.•We analyzed the dose to 18 cardiac sub-structures and cardiovascular toxicity.•A SBRT regimen of 45 Gy in 8-10 fractions yields good local control and low toxicity.•The highest cardiac doses were observed in the pulmonary artery and left atrium.•Higher doses to the base of the heart seem to be associated with non-cancer deaths.
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Affiliation(s)
- Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Kai Thaler
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Elena Gasser
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Bertrand Pouymayou
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Sebastian M. Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Boldizsar Kovacs
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952 Schlieren, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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Nagpal SK, Khabra K, Ross G, Kirby AM. Ten-Year Outcomes of Stereotactic Body Radiotherapy for Oligometastatic Breast Cancer: Does Synchronous Oligometastatic Breast Cancer Benefit? Clin Oncol (R Coll Radiol) 2023; 35:736-743. [PMID: 37684189 DOI: 10.1016/j.clon.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
AIMS The benefit of stereotactic body radiotherapy (SBRT) in metachronous oligometastatic breast cancer (OMBC) has previously been described and its use in current clinical practice is established. The role of SBRT in the management of synchronous OMBC remains uncertain. The aim of this study was to compare outcomes of SBRT-treated synchronous OMBC with those of SBRT-treated metachronous OMBC. MATERIALS AND METHODS This was a retrospective analysis of consecutive extracranial OMBC patients treated with SBRT at a single institution between 2011 and 2022. Kaplan-Meier methods were used to calculate progression-free survival (PFS), overall survival, local control and distant control. Log-rank tests were used to test any differences. Cox regression was used for univariate and multivariate analyses to identify predictive factors. Toxicity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 5. RESULTS In total, 74 OMBC patients with 113 lesions were analysed. The median follow-up was 20 months (range 0-98). Seventy per cent of patients presented metachronously and 30% synchronously. 30 Gy in three fractions was most commonly prescribed, resulting in a median biologically effective dose (BED at α/β = 10) of 60 Gy (range 35.7-112.5 Gy). Forty-nine per cent of patients switched systemic therapy post-SBRT (median time to switch: 14 months, range 0-79). Two patients (2%) experienced grade 3 acute toxicities with no grade ≥4 toxicities. At 2 years overall survival was 92.4% and PFS 39.0%, local control 85.9% and distant control 37.0%. For metachronous and synchronous disease, respectively, 2-year local control rates were 86.5% and 85.8% and PFS rates were 35.3% and 48.3%. The median PFS of metachronous and synchronous disease were 18 months and 17 months, respectively (P = 0.86). Predictive factors on multivariate analysis were treated site for overall survival, change in systemic therapy post-SBRT for PFS and BED for local control. CONCLUSION Our data confirm SBRT as a well-tolerated treatment for OMBC with excellent local control rates regardless of metachronous or synchronous presentation. There is no suggestion that survival outcomes are inferior for synchronous disease. Further prospective studies are required to validate this finding.
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Affiliation(s)
- S K Nagpal
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
| | - K Khabra
- Research Data and Statistics Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - G Ross
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - A M Kirby
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
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van der Weijst L, Bultijnck R, Van Damme A, Huybrechts V, van Eijkeren M, Lievens Y. Patient-reported outcomes and functional exercise capacity in a real-life setting in non-small cell lung cancer patients undergoing stereotactic body radiotherapy: the Lung PLUS study. Front Oncol 2023; 13:1220248. [PMID: 37692843 PMCID: PMC10485838 DOI: 10.3389/fonc.2023.1220248] [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: 05/10/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction To better understand the impact of stereotactic body radiotherapy (SBRT) and its treatment-related toxicity on early-stage non-small cell lung cancer (ES-NSCLC) patients, we conducted the Lung PLUS study in a real-world setting. Methods This is a monocentric prospective longitudinal study up to 12 months post-treatment, evaluating clinician- and patient-reported toxicity (resp. CTCAE and PRO-CTCAE), health-related quality of life (HRQoL) (EORTC QLQ-C30 and LC-13), activities of daily living (HAQ-DI) and functional exercise capacity (6 Minute Walking Test (6MWT)). A mixed model approach was applied to analyze the data. Results At baseline, clinicians and patients (n=51) reported mostly fatigue (63% vs 79%), cough (49% vs 75%) and dyspnea (65% vs 73%) of any grade. Dyspnea (p=.041) increased over time. Meaningful clinical improvements were particularly seen in pain, fatigue, and cough. Clinician reported clinically meaningful improvements and deteriorations over time in fatigue, cough, and dyspnea. Almost at every timepoint, more people reported deterioration to the clinician than improvement in aforementioned toxicities. Overall HRQoL (p=.014), physical (p=.011) and emotional (p<.001) functioning improved over time. At baseline, patients had a moderate daily functioning score and walked an average distance of 360 meters. No statistically significant differences were found in daily functioning and exercise capacity over time. Conclusion Our study showed an increase in patient-reported toxicity and dyspnea, without impacting functional status, following SBRT. Overall HRQoL, physical and emotional functioning improved over time. Understanding the impact of treatment on patient-reported outcomes is crucial to identify the needs/problems of patients to enhance their HRQoL.
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Affiliation(s)
- Lotte van der Weijst
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Axel Van Damme
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Vincent Huybrechts
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Marc van Eijkeren
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Yolande Lievens
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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Zhao F, Yang D, Xu T, He J, Guo J, Li X. New treatment insights into pancreatic acinar cell carcinoma: case report and literature review. Front Oncol 2023; 13:1210064. [PMID: 37465113 PMCID: PMC10351044 DOI: 10.3389/fonc.2023.1210064] [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: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
Pancreatic acinar cell carcinoma (PACC) is a rare pancreatic malignancy with unique clinical, molecular, and morphologic features. The long-term survival of patients with PACC is substantially better than that of patients with ductal adenocarcinoma of the pancreas. Surgical resection is considered the first choice for treatment; however, there is no standard treatment option for patients with inoperable disease. The patient with metastatic PACC reported herein survived for more than 5 years with various treatments including chemotherapy, radiotherapy, antiangiogenic therapy and combined immunotherapy.
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Affiliation(s)
- Fangrui Zhao
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dashuai Yang
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Tangpeng Xu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jiahui He
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jin Guo
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiangpan Li
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Rodríguez Pérez A, Felip Font E, Chicas-Sett R, Montero-Luis Á, de Paz Arias L, González-Del-Alba A, López-Campos F, López López C, Hernando Requejo O, Conde-Moreno AJ, Arranz Arija JÁ, de Castro Carpeño J. Unravelling oligometastatic disease from the perspective of radiation and medical oncology. Part I: non-small cell lung cancer and breast cancer. Clin Transl Oncol 2023; 25:882-896. [PMID: 36525231 DOI: 10.1007/s12094-022-03011-6] [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: 07/29/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Abstract
Oligometastatic disease (OMD) defines a cancer status that is intermediate between localized and widely spread metastatic disease, and can be treated with curative intent. While diagnostic imaging tools have considerably improved in recent years, unidentified micrometastases can still evade current detection techniques, allowing the disease to progress. The various OMD scenarios are mainly defined by the number of metastases, the biological and molecular tumour profiles, and the timing of the development of metastases. Increasing knowledge has contributed to the earlier and improved detection of OMD, underlining the importance of early disease control. In view of increasing OMD detection rates in current real-world clinical practice and the lack of standardized evidence-based guidelines to treat this cancer status, a board of experts from the Spanish Societies of Radiation Oncology (SEOR) and Medical Oncology (SEOM) organized a series of sessions to update the current state-of-the-art on OMD from a multidisciplinary perspective, and to discuss how results from clinical studies might translate into promising treatment options. This expert review series summarizes what is known and what it is pending clarification in the context of OMD in the scenarios of non-small cell lung cancer and breast cancer (Part I), and prostate cancer and colorectal cancer (Part II), aiming to offer specialists a pragmatic framework to help improve patient management.
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Affiliation(s)
- Aurora Rodríguez Pérez
- Radiation Oncology Department, Hospital Ruber Internacional, C. de La Masó, 38, 28034, Madrid, Spain.
| | - Enriqueta Felip Font
- Medical Oncology Department, Hospital Universitario del Vall d'Hebron, Barcelona, Spain
| | | | - Ángel Montero-Luis
- Radiation Oncology Department, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Laura de Paz Arias
- Medical Oncology Department, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | | | | | - Carlos López López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
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[Translated article] Oligometastases in oncological orthopaedic surgery. Our experience. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T389-T396. [DOI: 10.1016/j.recot.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022] Open
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11
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Ortiz-Cruz EJ, García-Mauriño Peñín C, Moriel-Garceso DJ, Peleteiro Pensado M, Barrientos Ruiz I, Redondo Sánchez A, Pozo-Kreilinger JJ, Belinchón-Olmeda B, Tapia-Viñe M. Oligometástasis en la cirugía ortopédica oncológica. Nuestra experiencia. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:389-396. [DOI: 10.1016/j.recot.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022] Open
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Garde-Noguera J, Martín-Martín M, Obeso A, López-Mata M, Crespo IR, Pelari-Mici L, Juan Vidal O, Mielgo-Rubio X, Trujillo-Reyes JC, Couñago F. Current treatment landscape for oligometastatic non-small cell lung cancer. World J Clin Oncol 2022; 13:485-495. [PMID: 35949432 PMCID: PMC9244972 DOI: 10.5306/wjco.v13.i6.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/24/2021] [Accepted: 05/12/2022] [Indexed: 02/06/2023] Open
Abstract
The management of patients with advanced non-small cell lung carcinoma (NSCLC) has undergone major changes in recent years. On the one hand, improved sensitivity of diagnostic tests, both radiological and endoscopic, has altered the way patients are staged. On the other hand, the arrival of new drugs with antitumoral activity, such as targeted therapies or immunotherapy, has changed the prognosis of patients, improving disease control and prolonging survival. Finally, the development of radiotherapy and surgical and interventional radiology techniques means that radical ablative treatments can be performed on metastases in any location in the body. All of these advances have impacted the treatment of patients with advanced lung cancer, especially in a subgroup of these patients in which all of these treatment modalities converge. This poses a challenge for physicians who must decide upon the best treatment strategy for each patient, without solid evidence for one optimal mode of treatment in this patient population. The aim of this article is to review, from a practical and multidisciplinary perspective, published evidence on the management of oligometastatic NSCLC patients. We evaluate the different alternatives for radical ablative treatments, the role of primary tumor resection or radiation, the impact of systemic treatments, and the therapeutic sequence. In short, the present document aims to provide clinicians with a practical guide for the treatment of oligometastatic patients in routine clinical practice.
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Affiliation(s)
- Javier Garde-Noguera
- Department of Medical Oncology, Hospital Arnau de Vilanova, Valencia 46015, Spain
| | | | - Andres Obeso
- Department of Thoracic Surgery, Hospital Clínico Universitario de Santiago de Compostela, Vigo 15706, Spain
| | - Miriam López-Mata
- Department of Radiation Oncology, Hospital Clínico Universitario Lozano Blesa, Zaragoza 50009, Spain
| | - Inigo Royo Crespo
- Department of Thoracic Surgery, Hospital Universitari Vall d’ Hebron, Barcelona 08035, Spain
| | - Lira Pelari-Mici
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - O Juan Vidal
- Department of Medical Oncology, Hospital Universitario y Politécnico La Fe, Valencia 46026, Spain
| | - Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Alcorcón 28922, Madrid, Spain
| | - Juan Carlos Trujillo-Reyes
- Department of Thoracic Surgery, Hospital de la Santa Creu I Sant Pau, Barcelona 08029, Spain
- Department of Surgery, Universitat Autonoma de Barcelona, Barcelona 08029, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Medicine Department, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón 28670, Madrid, Spain
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13
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The role of medical physicists in clinical trials across Europe. Phys Med 2022; 100:31-38. [PMID: 35717777 DOI: 10.1016/j.ejmp.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/11/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The roles and responsibilities of medical physicists (MPs) are growing together with the evolving science and technology. The complexity of today's clinical trials requires the skills and knowledge of MPs for their safe and efficient implementation. However, it is unclear to what extent the skillsets offered by MPs are being exploited in clinical trials across Europe. METHODS The EFOMP Working Group on the role of Medical Physics Experts in Clinical Trials has designed a survey that targeted all 36 current National Member Organisations, receiving a response from 31 countries. The survey included both quantitative and qualitative queries regarding the involvement of MPs in trial design, setup, and coordination, either as trial team members or principal investigators. RESULTS The extent of MPs involvement in clinical trials greatly varies across European countries. The results showed disparities between the roles played by MPs in trial design, conduct or data processing. Similarly, differences among the 31 European countries that responded to the survey were found regarding the existence of national bodies responsible for trials or the available training offered to MPs. The role of principal investigator or co-investigator was reported by 12 countries (39%), a sign of efficient collaboration with medical doctors in designing and implementing clinical studies. CONCLUSION Organisation of specific training courses and guideline development for clinical trial design and conduct would encourage the involvement of a larger number of MPs in all stages of trials across Europe, leading to a better standardisation of clinical practice.
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14
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Ito K, Nakajima Y, Ikuta S. Stereotactic body radiotherapy for spinal oligometastases: a review on patient selection and the optimal methodology. Jpn J Radiol 2022; 40:1017-1023. [PMID: 35396669 PMCID: PMC9529679 DOI: 10.1007/s11604-022-01277-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/25/2022] [Indexed: 12/24/2022]
Abstract
Stereotactic body radiotherapy (SBRT) has excellent local control and low toxicity for spinal metastases and is widely performed for spinal oligometastases. However, its additional survival benefit to standard of care, including systemic therapy, is unknown because the results of large-scale randomized controlled trials regarding SBRT for oligometastases have not been reported. Consequently, the optimal patient population among those with spinal oligometastases and the optimal methodology for spine SBRT remain unclear. The present review article discusses two topics: evidence-based optimal patient selection and methodology. The following have been reported to be good prognostic factors: young age, good performance status, slow-growing disease with a long disease-free interval, minimal disease burden, and mild fluorodeoxyglucose accumulation in positron emission tomography. In addition, we proposed four measures as the optimal SBRT method for achieving excellent local control: (i) required target delineation; (ii) recommended dose fraction schedule (20 or 24 Gy in a single fraction for spinal oligometastases and 35 Gy in five fractions for lesions located near the spinal cord); (iii) optimizing dose distribution for the target; (iv) dose constraint options for the spinal cord.
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Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677 Japan
| | - Yujiro Nakajima
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677 Japan
- Department of Radiological Sciences, Komazawa University, Tokyo, Japan
| | - Syuzo Ikuta
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677 Japan
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15
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de Sousa LG, Neto FL, Lin J, Ferrarotto R. Treatment of Recurrent or Metastatic Adenoid Cystic Carcinoma. Curr Oncol Rep 2022; 24:621-631. [PMID: 35212920 DOI: 10.1007/s11912-022-01233-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Adenoid cystic carcinoma (ACC) is a rare and heterogeneous malignancy of secretory glands. Recurrence after curative-intent treatment is common, and approximately 40% of patients develop metastatic disease, for which consensus is lacking regarding therapeutic approaches. Here, we review the available therapies for recurrent/metastatic (R/M) ACC and offer our perspectives on future treatment options. RECENT FINDINGS Proteogenomic studies of ACC revealed two molecular subtypes with therapeutic implications: ACC-I (37% of cases) and ACC-II (63%); each has distinct disease biology and prognosis. Molecular drivers, such as NOTCH1, have emerged as potential therapeutic targets for ACC-I and are being explored in clinical trials. Despite its biological heterogeneity, treatment for R/M ACC is not personalized and limited to cytotoxic agents and VEGFR inhibitors, which produce modest responses and significant toxicity. The increasing understanding of ACC's molecular biology might guide the development of biomarkers for patient selection and new therapies development.
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Affiliation(s)
- Luana Guimaraes de Sousa
- Departments of a Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, PO Box 432, Houston, TX, 77030, USA
| | - Felippe Lazar Neto
- Departments of a Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, PO Box 432, Houston, TX, 77030, USA
| | - Jessica Lin
- Departments of a Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, PO Box 432, Houston, TX, 77030, USA
| | - Renata Ferrarotto
- Departments of a Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, PO Box 432, Houston, TX, 77030, USA.
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16
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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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17
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Ariani R, Hwang L, Maliglig AM, Ragab O, Ye JC. Temporality and Patterns of Metastatic Recurrence in Node-Positive Breast Cancer Following Trimodality Therapy: Opportunity for Improved Oligometastases Detection and Salvage Local Therapy. Am J Clin Oncol 2022; 45:88-94. [PMID: 34991105 DOI: 10.1097/coc.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is evidence that detection and treatment of oligometastases (≤5 lesions) may improve survival in breast cancer patients. However, there are no current national guidelines for screening of early, asymptomatic metastases. This study examined the patterns and timing of recurrence with respect to survival in node-positive breast cancer (NPBC) patients at higher risk for developing metastases. METHODS A single-institution retrospective review of NPBC patients treated with trimodality therapy was performed to collect patient and disease characteristics, recurrence location, method of detection, and survival outcome. Univariate and multivariate analyses were done to identify factors associated with recurrence. RESULTS Ninety-four NPBC patients treated at a safety-net hospital between 2008 and 2019 were identified. Twenty-one developed recurrence and were divided into oligometastatic (OM) (n=10) or diffusely metastatic (DM) (n=11) subgroups. Median recurrence-free survival in OM and DM was 18 and 36 months, respectively. Median overall survival (OS) for OM was not reached. Median OS for DM was 57 months. Four patients with OM progressed to diffuse disease in a median period of 17 months; median survival thereafter was 57 months. All patients with recurrence had distant metastases on initial detection, with the most common site being bone (14). Recurrence was most frequently detected by computed tomography (CT) (13), with the majority of disease located within the thorax region. CONCLUSIONS All NPBC patients had distant metastasis at time of recurrence. Patients with OM had shorter interval to recurrence yet longer OS compared with DM. This study highlights improved surveillance imaging for timely detection of OM breast cancer that may yet be amenable to aggressive local salvage therapy to prevent progression to diffuse disease.
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Affiliation(s)
| | | | - Ana M Maliglig
- Radiology, Keck School of Medicine of University of Southern California, Los Angeles, CA
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18
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Sawayama H, Miyamoto Y, Hiyoshi Y, Ogawa K, Kato R, Akiyama T, Kiyozumi Y, Yoshida N, Baba H. Overall survival after recurrence in stage I-III colorectal cancer patients in accordance with the recurrence organ site and pattern. Ann Gastroenterol Surg 2021; 5:813-822. [PMID: 34755013 PMCID: PMC8560596 DOI: 10.1002/ags3.12483] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/24/2021] [Accepted: 06/06/2021] [Indexed: 11/10/2022] Open
Abstract
AIM This study aimed to investigate the prognosis after recurrence in patients with stage I-III colon cancer (CC) and rectal cancer (RC). METHODS Cancer recurred in 116 (15.2%) out of 763 patients with stage I-III colorectal cancer. The overall survival (OS) after recurrence was evaluated based on the recurrence organs and patterns. RESULTS The first recurrence occurred in the lungs, livers, lymph nodes, and other sites in 32, 22, 12, and 2 patients, respectively. It was localized, disseminated, and involved two or more organs in 14, 9, and 25 patients, respectively. Patients with CC had a shorter OS after recurrence as compared to those with RC (P = .0103). Compared to other organ metastasis, liver metastasis was associated with an earlier recurrence (P = .0026) and shorter OS after recurrence (hazard ratio [HR]: 2.216; 95% confidence interval [CI]: 1.052-4.459; P = .0370). Lung metastasis was associated with a more favorable prognosis as compared to other organ recurrences (HR: 0.338; 95% CI: 0.135-0.741; P = .0057). One-organ recurrence and oligometastasis were observed in 78.4% and 49.1% of the patients, respectively. The 5-y OS rates of patients with one-organ recurrence and oligometastasis were 47.5% and 71.7%, respectively. Invasive treatment was associated with a favorable prognosis (P < .0001). CONCLUSIONS Liver metastasis and dissemination were associated with a shorter OS after recurrence. Approximately 50% of the patients experienced oligometastasis, which was associated with a favorable prognosis. Hence, to improve patient prognosis it is better to perform invasive treatments when possible.
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Affiliation(s)
- Hiroshi Sawayama
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yuji Miyamoto
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological SurgeryCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Katsuhiro Ogawa
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Rikako Kato
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Takahiko Akiyama
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yuki Kiyozumi
- Department of Gastroenterological SurgeryCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Naoya Yoshida
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Hideo Baba
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
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19
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Facondo G, Vullo G, Valeriani M, Ascolese AM, De Sanctis V, Osti MF. Stereotactic body radiation therapy (SBRT) for patients with oligometastatic/oligoprogressive adrenal metastases: Outcomes and toxicities profile in a monoinstitutional study. Cancer Treat Res Commun 2021; 29:100481. [PMID: 34700142 DOI: 10.1016/j.ctarc.2021.100481] [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: 09/09/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
AIMS To evaluate survival outcomes and toxicology profiles in oligometastatic/oligoprogressive patients treated with SBRT for adrenal metastases. METHODS We retrospectively analyzed 25 metastatic adrenal lesions in 24 oligometastatic/oligoprogressive patients undergoing ablative Stereotactic Body Radiation Therapy (SBRT) between February 2010 and November 2019 in our department. The primary endpoint was overall survival (OS). Secondary endpoints were local overall response rate (ORR), acute and late toxicities. RESULTS The most common primary tumor was non-small cell lung cancer (54%). Twenty-one patients received chemo or immuno-therapy. The median planning target volume (PTV) was 41.7 cm3. Median SBRT dose was 36 Gy. Median dose per fraction was 15 Gy. Median survival was 35-months with OS outcomes ranging from 6-months (100%), 1-year (87.5%) and 2-years (66.7%). ORR based on RECIST criteria was 66.5%. 12 patients experienced acute toxicities, mostly grade 1-2 (8 patients, 32%). CONCLUSIONS SBRT for oligometastatic/oligoprogressive patients with adrenal metastases showed acceptable survival outcomes and a safe toxicity profile.
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Affiliation(s)
- Giuseppe Facondo
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy.
| | - Maurizio Valeriani
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy
| | - Anna Maria Ascolese
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy
| | - Vitaliana De Sanctis
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy
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20
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Shin IS, Rim CH. Stepwise-Hierarchical Pooled Analysis for Synergistic Interpretation of Meta-analyses Involving Randomized and Observational Studies: Methodology Development. J Med Internet Res 2021; 23:e29642. [PMID: 34315697 PMCID: PMC8446840 DOI: 10.2196/29642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/09/2021] [Accepted: 07/27/2021] [Indexed: 12/28/2022] Open
Abstract
Background The necessity of including observational studies in meta-analyses has been discussed in the literature, but a synergistic analysis method for combining randomized and observational studies has not been reported. Observational studies differ in validity depending on the degree of the confounders’ influence. Combining interpretations may be challenging, especially if the statistical directions are similar but the magnitude of the pooled results are different between randomized and observational studies (the ”gray zone”). Objective To overcome these hindrances, in this study, we aim to introduce a logical method for clinical interpretation of randomized and observational studies. Methods We designed a stepwise-hierarchical pooled analysis method to analyze both distribution trends and individual pooled results by dividing the included studies into at least three stages (eg, all studies, balanced studies, and randomized studies). Results According to the model, the validity of a hypothesis is mostly based on the pooled results of randomized studies (the highest stage). Ascending patterns in which effect size and statistical significance increase gradually with stage strengthen the validity of the hypothesis; in this case, the effect size of the observational studies is lower than that of the true effect (eg, because of the uncontrolled effect of negative confounders). Descending patterns in which decreasing effect size and statistical significance gradually weaken the validity of the hypothesis suggest that the effect size and statistical significance of the observational studies is larger than the true effect (eg, because of researchers’ bias). Conclusions We recommend using the stepwise-hierarchical pooled analysis approach for meta-analyses involving randomized and observational studies.
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Affiliation(s)
- In-Soo Shin
- Graduate School of Education, Dongguk University, Seoul, Republic of Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Ansan Hospital, Korea University, Gyeonggido, Republic of Korea
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21
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Tjong MC, Louie AV, Iyengar P, Solomon BJ, Palma DA, Siva S. Local ablative therapies in oligometastatic NSCLC-upfront or outback?-a narrative review. Transl Lung Cancer Res 2021; 10:3446-3456. [PMID: 34430379 PMCID: PMC8350079 DOI: 10.21037/tlcr-20-994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/17/2021] [Indexed: 12/14/2022]
Abstract
Patients with oligometastatic (OM) non-small cell lung cancer (NSCLC) have favorable outcomes compared to patients presenting with diffuse metastatic disease. Recent randomized trials have demonstrated safety and efficacy signals for local ablative therapies with radiotherapy, surgery, or radiofrequency ablation for OM-NSCLC patients alongside systemic therapies. However, it remains unclear whether local ablative therapy (LAT) should be offered either upfront preceding systemic therapies or following initial systemic therapies as local consolidative therapy (LCT). Establishing optimal timing of RT and systemic therapy combinations is essential to maximize efficacy while maintaining safety. Most published randomized trial evidence surrounding the benefits of LAT and systemic therapies were generated from OM-NSCLC patients receiving cytotoxic chemotherapy agents. With increasing use of novel agents such as targeted therapies (i.e., tyrosine kinase inhibitors) and immune checkpoint inhibitors in management of metastatic NSCLC patients, LAT timing may need to be modulated based on the use of specific agents. This narrative review will discuss the current evidence on either upfront LAT or LCT for OM-NSCLC based on published trials and cohort studies. We briefly explored the possible biological mechanisms of the potential clinical advantages of either approach. This review also summarized the ongoing trials incorporating both upfront LAT and LCT, and considerations for future LAT strategies.
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Affiliation(s)
- Michael C Tjong
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Puneeth Iyengar
- Department of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin J Solomon
- Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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22
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Chen X, Chen H, Poon I, Erler D, Badellino S, Biswas T, Dagan R, Foote M, Louie AV, Ricardi U, Sahgal A, Redmond KJ. Late metastatic presentation is associated with improved survival and delayed wide-spread progression after ablative stereotactic body radiotherapy for oligometastasis. Cancer Med 2021; 10:6189-6198. [PMID: 34432390 PMCID: PMC8446561 DOI: 10.1002/cam4.4133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/25/2022] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is increasingly used to treat oligometastatic disease (OMD), but the effect of metastasis timing on patient outcomes remains uncertain. Methods An international database of patients with OMD treated with SBRT was assembled with rigorous quality assurance. Early versus late metastases were defined as those diagnosed ≤24 versus >24 months from the primary tumor. Overall survival (OS), progression‐free survival (PFS), and incidences of wide‐spread progression (WSP) were estimated using multivariable Cox proportional hazard models stratified by primary tumor types. Results The database consists of 1033 patients with median follow‐up of 24.1 months (0.3–104.7). Late metastatic presentation (N = 427) was associated with improved OS compared to early metastasis (median survival 53.6 vs. 33.0 months, hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.47–0.72, p < 0.0001). Patients with non‐small cell lung cancer (NSCLC, N = 255, HR 0.49, 95% CI: 0.33–0.74, p = 0.0005) and colorectal cancer (N = 235, HR 0.50, 95% CI: 0.30–0.84, p = 0.008) had better OS if presenting with late metastasis. Late metastasis correlated with longer PFS (median 17.1 vs. 9.0 months, HR 0.71, 95% CI: 0.61–0.83, p < 0.0001) and lower 2‐year incidence of WSP (26.1% vs. 43.6%, HR 0.60, 95% CI: 0.49–0.74, p < 0.0001). Fewer WSP were observed in patients with NSCLC (HR 0.52, 95% CI: 0.33–0.83, p = 0.006) and kidney cancer (N = 63, HR 0.37, 95% CI: 0.14–0.97, p = 0.044) with late metastases. Across cancer types, greater SBRT target size was a significant predictor for worse OS. Conclusion Late metastatic presentation is associated with improved survival and delayed progression in patients with OMD treated with SBRT.
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Affiliation(s)
- Xuguang Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Darby Erler
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | | | - Tithi Biswas
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA
| | - Matthew Foote
- Department of Radiation Oncology, University of Queensland, Princess Alexandra Hospital, Queensland, Australia
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | | | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
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23
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Boström JP, Jetschke K, Schmieder K, Adamietz IUA. [Surgical treatment and radiation therapy of brain metastases]. Radiologe 2021; 61:767-778. [PMID: 34272570 DOI: 10.1007/s00117-021-00894-4] [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: 11/28/2022]
Abstract
The aim of this work is to outline the principles of interdisciplinary treatment of brain metastases. Interdisciplinary treatment is determined by the clinical situation, anatomical conditions and tumor entity and has the goal of reducing toxicity. Magnetic resonance imaging, computed tomography (CT) and positron emission tomography-CT are used to diagnose brain metastases. Neurosurgery is used for accessible, symptomatic metastases. For localized metastases, including multiple metastases, that are surgically inaccessible, radiosurgery is used. If possible, partial brain irradiation is preferred to whole-brain irradiation. Protection of the hippocampus during whole-brain radiotherapy reduces therapy toxicity. In emergency situations, steroids provide effective support and a neurosurgical intervention may be life-saving. The options for systemic drug therapy are increasing.
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Affiliation(s)
- Jan P Boström
- Klinik für Strahlentherapie und Radio-Onkologie, Marien Hospital Herne, Universitätsklinikum, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.,Gamma Knife Zentrum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Kathleen Jetschke
- Klinik für Neurochirurgie, Knappschaftskrankenhaus Langendreer, Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Kirsten Schmieder
- Klinik für Neurochirurgie, Knappschaftskrankenhaus Langendreer, Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Irenä Us A Adamietz
- Klinik für Strahlentherapie und Radio-Onkologie, Marien Hospital Herne, Universitätsklinikum, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland. .,Gamma Knife Zentrum, Ruhr-Universität Bochum, Bochum, Deutschland. .,Klinik für Strahlentherapie und Radioonkologie, St. Josef-Hospital Bochum, Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Deutschland.
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24
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Voglhuber T, Eitz KA, Oechsner M, Vogel MME, Combs SE. Analysis of using high-precision radiotherapy in the treatment of liver metastases regarding toxicity and survival. BMC Cancer 2021; 21:780. [PMID: 34229642 PMCID: PMC8259027 DOI: 10.1186/s12885-021-08488-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Hepatic metastases occur frequently in the context of many tumor entities. Patients with colorectal carcinoma have already developed liver metastases in 20% at the time of diagnosis, and 25–50% develop metastases in the further course of the disease and therapy. The frequent manifestation and the variable appearance of liver metastases result in an interdisciplinary challenge, regarding treatment management. The aim of this study was to evaluate high-precision stereotactic body radiotherapy (SBRT) for liver metastases. Methods A cohort of 115 patients with 150 irradiated liver metastases was analyzed. All metastases were treated between May 2004 and January 2020 using SBRT. A contrast-enhanced computed tomography (CT) was performed in all patients for treatment planning, followed by image-guided high-precision radiotherapy using cone-beam CT. A median cumulative dose of 35 Gy and a median single dose of 7 Gy was applied. Results Median OS was 20.4 months and median LC was 35.1 months with a 1-year probability of local failure of 18% (95%-CI: 12.0–24.3%). In this cohort, 18 patients were still alive at the time of evaluation. The median FU-time in total was 11.4 months and for living patients 26.6 months. 70.4% of patients suffered from acute toxicities. There were several cases of grade 1 and 2 toxicities, such as constipation (13.9%), nausea (24.4%), loss of appetite (7.8%), vomiting (10.4%), diarrhea (7.8%), and abdominal pain (16.5%). 10 patients (8.7%) suffered from grade 3 toxicities. Late toxicities affected 42.6% of patients, the majority of these affected the gastrointestinal system. Conclusion SBRT is becoming increasingly important in the field of radiation oncology. It has evolved to be a highly effective treatment for primary and metastasized tumors, and offers a semi-curative treatment option also in the case of oligometastatic patients. Overall, it represents a very effective and well-tolerated therapy option to treat hepatic metastases. Based on the results of this work and the studies already available, high-precision radiotherapy should be considered as a valid and promising treatment alternative in the interdisciplinary discussion.
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Affiliation(s)
- Theresa Voglhuber
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.
| | - Kerstin A Eitz
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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25
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Barberi V, Pietragalla A, Franceschini G, Marazzi F, Paris I, Cognetti F, Masetti R, Scambia G, Fabi A. Oligometastatic Breast Cancer: How to Manage It? J Pers Med 2021; 11:532. [PMID: 34207648 PMCID: PMC8227505 DOI: 10.3390/jpm11060532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022] Open
Abstract
Breast cancer (BC) is the most frequent cancer among women and represents the second leading cause of cancer-specific death. A subset of patients with metastatic breast cancer (MBC) presents limited disease, termed 'oligometastatic' breast cancer (OMBC). The oligometastatic disease can be managed with different treatment strategies to achieve long-term remission and eventually cure. Several approaches are possible to cure the oligometastatic disease: locoregional treatments of the primary tumor and of all the metastatic sites, such as surgery and radiotherapy; systemic treatment, including target-therapy or immunotherapy, according to the biological status of the primary tumor and/or of the metastases; or the combination of these approaches. Encouraging results involve local ablative options, but these trials are limited by being retrospective and affected by selection bias. Systemic therapy, e.g., the use of CDK4/6 inhibitors for hormone receptor-positive (HR+)/HER-2 negative BC, leads to an increase of progression-free survival (PFS) and overall survival (OS) in all the subgroups, with favorable toxicity. Regardless of the lack of substantial data, this subset of patients could be treated with curative intent; the appropriate candidates could be mostly young women, for whom a multidisciplinary aggressive approach appears suitable. We provide a global perspective on the current treatment paradigms of OMBC.
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Affiliation(s)
- Vittoria Barberi
- Medical Oncology 1, Regina Elena National Cancer Institute, IRCCS, 00144 Rome, Italy; (V.B.); (F.C.)
| | - Antonella Pietragalla
- Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.P.); (G.S.)
| | - Gianluca Franceschini
- Comprehensive Cancer Center, Multidisciplinary Breast Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.F.); (R.M.)
| | - Fabio Marazzi
- UOC Radiotherapy, Department of Imaging Diagnostic, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Cognetti
- Medical Oncology 1, Regina Elena National Cancer Institute, IRCCS, 00144 Rome, Italy; (V.B.); (F.C.)
| | - Riccardo Masetti
- Comprehensive Cancer Center, Multidisciplinary Breast Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.F.); (R.M.)
| | - Giovanni Scambia
- Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.P.); (G.S.)
| | - Alessandra Fabi
- Unit of Precision Medicine in Breast Cancer, Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
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26
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Mihai AM, Armstrong PJ, Hickey D, Milano MT, Dunne M, Healy K, Thirion P, Heron DE, ElBeltagi N, Armstrong JG. Late Toxicity and Long-Term Local Control in Patients With Ultra-Central Lung Tumours Treated by Intensity-Modulated Radiotherapy-Based Stereotactic Ablative Body Radiotherapy With Homogenous Dose Prescription. Clin Oncol (R Coll Radiol) 2021; 33:627-637. [PMID: 34092462 DOI: 10.1016/j.clon.2021.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/21/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022]
Abstract
AIMS To report late toxicity and long-term outcomes of intensity-modulated radiotherapy (IMRT)-based stereotactic ablative body radiotherapy (SABR) in patients with ultra-central lung tumours. MATERIALS AND METHODS This is a single-institution retrospective analysis of patients treated with SABR for ultra-central tumours between May 2008 and April 2016. Ultra-central location was defined as tumour (GTV) abutting or involving trachea, main or lobar bronchi. Respiratory motion management and static-field dynamic-IMRT were used, with dose prescribed homogeneously (maximum <120%). Descriptive analysis, Kaplan-Meier method, log-rank test and Cox regression were used to assess outcomes. RESULTS Sixty-five per cent of patients had inoperable primary non-small cell lung cancer and 35% had lung oligometastases. The median age was 72 (range 34-85) years. The median gross tumour volume and planning target volume (PTV) were 19.6 (range 1.7-203.3) cm3 and 57.4 (range 7.7-426.6) cm3, respectively. The most commonly used dose fractionation was 60 Gy in eight fractions (n = 51, 87.8%). Median BED10 for D98%PTV and D2%PTV were 102.6 Gy and 115.06 Gy, respectively. With a median follow-up of 26.5 (range 3.2-100.5) months, fatal haemoptysis occurred in five patients (8.7%), of which two were directly attributable to SABR. A statistically significant difference was identified between median BED3 for 4 cm3 of airway, for patients who developed haemoptysis versus those who did not (147.4 versus 47.2 Gy, P = 0.005). At the last known follow-up, 50 patients (87.7%) were without local recurrence. Freedom from local progression at 2 and 4 years was 92 and 79.8%, respectively. The median overall survival was 34.3 (95% confidence interval 6.1-61.6) months. Overall survival at 2 and 4 years was 55.1 and 41.2%, respectively. CONCLUSION In patients with high-risk ultra-central lung tumours, IMRT-based SABR with homogenous dose prescription achieves high local control, similar to that reported for peripheral tumours. Although fatal haemoptysis occurred in 8.7% of patients, a direct causality with SABR was evident in only 3%. Larger studies are warranted to ascertain factors associated with outcomes, especially toxicity, and identify patients who would probably benefit from this treatment.
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Affiliation(s)
- A M Mihai
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland.
| | - P J Armstrong
- University College Dublin School of Medicine, Dublin, Ireland
| | - D Hickey
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland
| | - M T Milano
- University of Rochester, Rochester, NY, USA
| | - M Dunne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - K Healy
- University College Dublin School of Medicine, Dublin, Ireland
| | - P Thirion
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - D E Heron
- Bon Secours Mercy Health, Cincinnati, OH, USA
| | - N ElBeltagi
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - J G Armstrong
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland
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27
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Abstract
Oligometastasis represents an intermediate disease stage between localized and widely metastatic cancer. Efficient identification of patients with oligometastasis remains a barrier for accrual on clinical trials of oligometastasis-directed therapy. Here we review the prospect of circulating tumor DNA-based monitoring to promote sensitive, specific, and cost-efficient detection of cancer recurrence during posttreatment surveillance. Thus, an impetus for the development and implementation of clinical-grade circulating tumor DNA assays should be for the positive impact they will have on clinical investigations of oligometastasis-directed therapy.
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Affiliation(s)
- David Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Bhishamjit S. Chera
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Gaorav P. Gupta
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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28
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Radiation in the Treatment of Oligometastatic and Oligoprogressive Disease: Rationale, Recent Data, and Research Questions. ACTA ACUST UNITED AC 2021; 26:156-165. [PMID: 32205541 DOI: 10.1097/ppo.0000000000000436] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The use of local ablative therapy or metastasis-directed therapy is an emerging management paradigm in oligometastatic and oligoprogressive cancer. Recent randomized evidence has demonstrated that stereotactic ablative radiotherapy (SABR) targeting all metastatic deposits is tolerable and can improve progression-free and overall survival. While SABR is noninvasive, minimally toxic, and generally safe, rare grade 5 events have been reported. Given this and recognizing the often-uncertain prognosis of patients with metastatic disease, equipoise persists regarding the therapeutic window within which to deploy SABR for this indication. Ongoing phase III trials are aimed at validating the demonstrated safety, tolerability, and survival benefits while also refining patient selection, possibly with the aid of novel biomarkers. This narrative review of the role of SABR in oligometastatic and oligoprogressive disease summarizes recent randomized evidence and ongoing clinical trials, discusses our rationale for treatment and key management principles, and posits that SABR should be considered the preferred modality for multisite, metastasis-directed ablative therapy.
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29
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Ohguri T, Kakinouchi S, Imada H, Matsuyama A, Yahara K, Nakahara S, Hohchi N, Suzuki H, Korogi Y. Pediatric nasopharyngeal cancer with repeated oligometastases involving the bone, liver and distant lymph nodes who achieved cure after radiotherapy. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:135-141. [PMID: 32273642 PMCID: PMC7103869 DOI: 10.18999/nagjms.82.1.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Systemic chemotherapy is a standard treatment for Stage IVc nasopharyngeal carcinoma (NPC). Stage IVc NPC patients with oligometastases have a better prognosis, and local therapy has an important role in further development of the disease. However, the efficacy of local therapy to the metastases in patients with multiple-site and/or multiple-organ metastases is limited due to the aggressive behavior of the tumor. We report a NPC case in a pediatric patient with repeated oligometastases involving the bone, liver and distant lymph nodes who achieved 10-year disease free status after initial chemotherapy and radiotherapy to all the metastases. This very rare case demonstrated that radiotherapy to oligometastatic lesions have a potential to cure repeated oligometastases which involved multiple-organ metastases in a pediatric NPC with stage IVc.
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Affiliation(s)
- Takayuki Ohguri
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Sho Kakinouchi
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hajime Imada
- Department of Cancer Therapy Center, Tobata Kyoritsu Hospital, Kitakyushu, Japan
| | - Atsuji Matsuyama
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Katsuya Yahara
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Sota Nakahara
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Nobusuke Hohchi
- Department of Otorhinolaryngology Head and Neck Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hideaki Suzuki
- Department of Otorhinolaryngology Head and Neck Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
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30
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Hagiwara K, Harimoto N, Araki K, Watanabe A, Kubo N, Nakazawa S, Yajima T, Uchida N, Shirabe K. Long-term survival of two patients with pancreatic cancer after resection of liver and lung oligometastases: a case report. Surg Case Rep 2020; 6:309. [PMID: 33284401 PMCID: PMC7721952 DOI: 10.1186/s40792-020-01029-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background The efficacy of resection of pancreatic cancer metastases has not been established. We here report two patients with long-term survival after resection of lung and liver metastases. Case presentation The first patient underwent distal pancreatectomy for pancreatic cancer. One year later, she underwent partial hepatectomy for a single liver metastasis. She subsequently underwent pulmonary resections 7, 7.5, 9, and 10 years later for pulmonary metastases from pancreatic cancer. Thus, this patient underwent five surgeries for metastases, one for a liver metastasis and four for lung metastases. All of the tumors were pathologically diagnosed as metastatic pancreatic cancer. She is currently alive without new recurrence 10 years after the initial diagnosis. The second patient underwent pancreaticoduodenectomy for pancreatic cancer. Four years later, she underwent a thoracoscopic partial resection for lung metastasis. The tumor was similar to the pancreatic cancer on pathological examination. She is currently alive without new recurrences 6 years after the initial diagnosis. Conclusion Long-term survival can be achieved in some patients with pancreatic cancer by resection of metachronous liver or lung metastases.
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Affiliation(s)
- Kei Hagiwara
- Gunma University Graduate School of Medicine, Hepatobiliary and Pancreatic Surgery, 3-39-22 Showa-machi, Maebashi, Japan
| | - Norifumi Harimoto
- Gunma University Graduate School of Medicine, Hepatobiliary and Pancreatic Surgery, 3-39-22 Showa-machi, Maebashi, Japan. .,Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Kenichiro Araki
- Gunma University Graduate School of Medicine, Hepatobiliary and Pancreatic Surgery, 3-39-22 Showa-machi, Maebashi, Japan
| | - Akira Watanabe
- Gunma University Graduate School of Medicine, Hepatobiliary and Pancreatic Surgery, 3-39-22 Showa-machi, Maebashi, Japan
| | - Norio Kubo
- Gunma University Graduate School of Medicine, Hepatobiliary and Pancreatic Surgery, 3-39-22 Showa-machi, Maebashi, Japan
| | - Seshiru Nakazawa
- Division of General Thoracic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Japan
| | - Toshiki Yajima
- Division of General Thoracic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Japan
| | - Nobuyuki Uchida
- Haramachi Red Cross Hospital, 698 Haramachi, Agatsuma, Gunma, Japan
| | - Ken Shirabe
- Gunma University Graduate School of Medicine, Hepatobiliary and Pancreatic Surgery, 3-39-22 Showa-machi, Maebashi, Japan
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Peyraga G, Ducassou A, Arnaud FX, Lizée T, Pouédras J, Moyal É. [Radiotherapy and spinal toxicity: News and perspectives]. Cancer Radiother 2020; 25:55-61. [PMID: 33303351 DOI: 10.1016/j.canrad.2020.05.017] [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: 04/04/2020] [Revised: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 01/21/2023]
Abstract
Radiation-induced myelopathy is a devastating late effect of radiotherapy. Fortunately, this late effect is exceptional. The clinical presentation of radiation myelopathy is aspecific, typically occurring between 6 to 24 months after radiotherapy, and radiation-induced myelopathy remains a diagnosis of exclusion. Magnetic resonance imaging is the most commonly used imaging tool. Radiation oncologists must be extremely cautious to the spinal cord dose, particularly in stereotactic radiotherapy and reirradiation. Conventionally, a maximum dose of 50Gy is tolerated in normofractionated radiotherapy (1.8 to 2Gy per fraction). Repeat radiotherapies lead to consider cumulative doses above this recommendation to offer individualized reirradiation. Several factors increase the risk of radiation-induced myelopathy, such as concomitant or neurotoxic chemotherapy. The development of predictive algorithms to prevent the risk of radiation-induced myelopathy is promising. However, radiotherapy prescription should be cautious, regarding to ALARA principle (as low as reasonably achievable). As the advent of immunotherapy has improved patient survival data and the concept of oligometastatic cancer is increasing in daily practice, stereotactic treatments and reirradiations will be increasingly frequent indications. Predict the risk of radiation-induced myelopathy is therefore a major issue in the following years, and remains a daily challenge for radiation oncologists.
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Affiliation(s)
- G Peyraga
- Service de radiothérapie, groupe de radiothérapie et d'oncologie des Pyrénées (Grop), chemin de l'Ormeau, 65000 Tarbes, France.
| | - A Ducassou
- Service de radiothérapie, Institut universitaire du cancer de Toulouse (Oncopole), 1, avenue Irène-Joliot-Curie, 31000 Toulouse, France
| | - F-X Arnaud
- Service de radiothérapie, Institut universitaire du cancer de Toulouse (Oncopole), 1, avenue Irène-Joliot-Curie, 31000 Toulouse, France
| | - T Lizée
- Service de radiothérapie, Institut cancérologique de l'ouest, centre Paul-Papin, 15, rue André-Bocquel, 49055 Angers, France
| | - J Pouédras
- Service de radiothérapie, Institut universitaire du cancer de Toulouse (Oncopole), 1, avenue Irène-Joliot-Curie, 31000 Toulouse, France
| | - É Moyal
- Service de radiothérapie, Institut universitaire du cancer de Toulouse (Oncopole), 1, avenue Irène-Joliot-Curie, 31000 Toulouse, France
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32
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Role of Surgical Intervention in Unresectable Non-Small Cell Lung Cancer. J Clin Med 2020; 9:jcm9123881. [PMID: 33260352 PMCID: PMC7760873 DOI: 10.3390/jcm9123881] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 12/25/2022] Open
Abstract
With the development of systemic treatments with high response rates, including tyrosine kinase inhibitors and immune checkpoint inhibitors, some patients with unresectable lung cancer now have a chance to undergo radical resection after primary treatment. Although there is no general consensus regarding the definition of “unresectable” in lung cancer, the term “resectable” refers to technically resectable and indicates that resection can provide a favorable prognosis to some extent. Unresectable lung cancer is typically represented by stage III and IV disease. Stage III lung cancer is a heterogeneous disease, and in some patients with technically resectable non-small cell lung cancer (NSCLC), multimodality treatments, including induction chemoradiotherapy followed by surgery, are the treatments of choice. The representative surgical intervention for unresectable stage III/IV NSCLC is salvage surgery, which refers to surgical treatment for local residual/recurrent lesions after definitive non-surgical treatment. Surgical intervention is also used for an oligometastatic stage IV NSCLC. In this review, we highlight the role of surgical intervention in patients with unresectable NSCLC, for whom an initial complete resection is technically difficult. We further describe the history of and new findings on salvage surgery for unresectable NSCLC and surgery for oligometastatic NSCLC.
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33
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Zhao X, Kong Y, Zhang L. Anti-PD-1 Immunotherapy Combined With Stereotactic Body Radiation Therapy and GM-CSF as Salvage Therapy in a PD-L1-Negative Patient With Refractory Metastatic Esophageal Squamous Cell Carcinoma: A Case Report and Literature Review. Front Oncol 2020; 10:1625. [PMID: 33014817 PMCID: PMC7493754 DOI: 10.3389/fonc.2020.01625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is a malignancy with poor prognosis, which is often diagnosed at a late stage. Effective treatment options are limited when patients fail standard systemic therapy. The application of PD-1 inhibitors have led to a paradigm shift in the treatment of ESCC, but its efficacy as monotherapy is limited. Previous studies have shown that the antitumor effects may be reinforced when a PD-1 inhibitor is combined with radiotherapy or GM-CSF. This study aimed to report a case of a patient about advanced unresectable ESCC negative expression of PD-L1, who experienced tumor progression after chemoradiotherapy and targeted therapy.A significant systemic effect was seen after PD-1 inhibitor combined with GM-CSF and stereotactic body radiotherapy (SBRT) for metastatic lesions, however, severe pneumonia occurred after the triple-combination therapy. This study also reviewed several reports about the efficacy and safety of combination therapy.
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Affiliation(s)
- Xiangrong Zhao
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Radiotherapy & Oncology, Soochow University, Suzhou, China
| | - Yuehong Kong
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Radiotherapy & Oncology, Soochow University, Suzhou, China
| | - Liyuan Zhang
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Radiotherapy & Oncology, Soochow University, Suzhou, China
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34
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Yan M, Moideen N, Bratti VF, Moraes FYD. Stereotactic body radiotherapy (SBRT) in metachronous oligometastatic prostate cancer: a systematic review and meta-analysis on the current prospective evidence. Br J Radiol 2020; 93:20200496. [PMID: 32822547 DOI: 10.1259/bjr.20200496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE In contrast to traditional views of incurability, patients with oligometastatic disease present with an opportunity for disease eradication with aggressive treatment. There is mounting evidence in support of the role of stereotactic body radiotherapy (SBRT) in oligometastatic prostate cancer (OMPC). METHODS MEDLINE and EMBASE were queried for prospective cohort studies reporting the outcomes of metachronous OMPC treated with SBRT. The primary outcome was overall local control. Secondary outcomes included androgen deprivation therapy-free survival (ADTFS), biochemical recurrence free survival (BCFS), and progression-free survival (PFS). When appropriate, these endpoints were combined in a meta-analysis. RESULTS We screened 356 abstracts and identified 10 studies to include in our analysis, with a total of 653 patients and 1,111 lesions. The maximum number of lesions included in any single study ranged from 3 to 5. PET-CT staging occurred in 92.4% of all patients. SBRT dose varied, with BED1.5 ranging from 152 to 408. Only one Grade 3 bone toxicity was observed. Meta-analysis reported an overall local control rate of 97% (95% CI, 94-100). Median ADTFS was 24.7 months (95% CI, 20.1-29.2 months). Two-year BCFS, PFS, and ADTFS were 33% (95% CI, 11-55), 39% (95% CI, 24-54), and 52% (95%CI, 41-62), respectively. Patients treated with SBRT were half as likely to experience PSA progression than those on observation when looking at randomized control trial data alone. CONCLUSION SBRT appears to be effective in controlling overall disease burden in metachronous OMPC patients and is associated with minimal significant toxicity. The current prospective literature is scarce, and further prospective data are needed to guide treatment recommendations. ADVANCES IN KNOWLEDGE This study provides a comprehensive summary of the prospective evidence reporting the outcomes of SBRT in the management of OMPC patients. We quantify the rates of local control, biochemical-free recurrence, progression-free survival, and ADT-free survival through meta-analysis.
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Affiliation(s)
- Michael Yan
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Canada
| | - Nikitha Moideen
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Canada
| | | | - Fabio Ynoe de Moraes
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Canada
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35
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Couñago F, Navarro-Martin A, Luna J, Rodríguez de Dios N, Rodríguez A, Casas F, García R, Gómez-Caamaño A, Contreras J, Serrano J. GOECP/SEOR clinical recommendations for lung cancer radiotherapy during the COVID-19 pandemic. World J Clin Oncol 2020; 11:510-527. [PMID: 32879841 PMCID: PMC7443829 DOI: 10.5306/wjco.v11.i8.510] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/07/2020] [Accepted: 08/01/2020] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 crisis has had a major and highly complex impact on the clinical practice of radiation oncology worldwide. Spain is one of the countries hardest hit by the virus, with devastating consequences. There is an urgent need to share experiences and offer guidance on decision-making with regard to the indications and standards for radiation therapy in the treatment of lung cancer. In the present article, the Oncological Group for the Study of Lung Cancer of the Spanish Society of Radiation Oncology reviews the literature and establishes a series of consensus-based recommendations for the treatment of patients with lung cancer in different clinical scenarios during the present pandemic.
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Affiliation(s)
- Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Clinical Department, Hospital La Luz, Madrid, Faculty of Biomedicine, Universidad Europea, Madrid 28223, Spain
| | - Arturo Navarro-Martin
- Department of Radiation Oncology, Institut Catalá d’Oncologia, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Javier Luna
- Department of Radiation Oncology, Hospital Fundación Jiménez Díaz, Madrid 28040, Spain
| | | | - Aurora Rodríguez
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | - Francesc Casas
- Department of Radiation Oncology, Thoracic Unit, Hospital Clínic, Barcelona 08036, Spain
| | - Rafael García
- Department of Radiaiton Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, A Coruña 15706, Spain
| | - Jorge Contreras
- Department of Radiation Oncology, Hospital Regional Universitario de Málaga, 29010, Spain
| | - Javier Serrano
- Department of Radiation Oncology, Clínica Universidad de Navarra, Madrid 28027, Spain
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36
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Voglhuber T, Kessel KA, Oechsner M, Vogel MME, Gschwend JE, Combs SE. Single-institutional outcome-analysis of low-dose stereotactic body radiation therapy (SBRT) of adrenal gland metastases. BMC Cancer 2020; 20:536. [PMID: 32513136 PMCID: PMC7282163 DOI: 10.1186/s12885-020-07030-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adrenal gland metastases are a common diagnostic finding in various tumor diseases. Due to the increased use of imaging methods, they are diagnosed more frequently, especially in asymptomatic patients. SBRT has emerged as a new, alternative treatment option in the field of radiation oncology. In the past, it was often used for treating inoperable lung, liver, prostate, and brain tumors. Meanwhile, it is also an established keystone in the treatment of oligometastatic diseases. This retrospective study aims to evaluate the effect of low-dose SBRT in patients with adrenal metastases. METHODS We analyzed a group of 31 patients with 34 adrenal gland lesions treated with low-dose SBRT between July 2006 and July 2019. Treatment-planning was performed through contrast-enhanced CT, followed by image-guided stereotactic radiotherapy using cone-beam CT. The applied cumulative median dose was 35 Gy; the median single dose was 7 Gy. We focused on local control (LC), progression-free survival (PFS), overall survival (OS), as well as acute and late toxicity. RESULTS Seven adrenal gland metastases (20.6%) experienced local failure, 80.6% of the patients faced a distant progression. Fourteen patients were still alive. Median follow-up for all patients was 9.8 months and for patients alive 14.4 months. No treatment-related side-effects >grade 2 occurred. Of all, 48.4% suffered from acute gastrointestinal disorders; 32.3% reported acute fatigue, throbbing pain in the renal area, and mild adrenal insufficiency. Altogether, 19.4% of the patients faced late-toxicities, which were as follows: Grade 1: 12.9% gastrointestinal disorders, 3.2% fatigue, Grade 2: 9.7% fatigue, 6.5% headache, 3.2% loss of weight. The 1-year OS and probability of LF were 64 and 25.9%, respectively. CONCLUSION Low-dose SBRT has proven as an effective and safe method with promising outcomes for treating adrenal metastases. There appeared no high-grade toxicities >grade 2, and 79.4% of treated metastases were progression-free. Thus, SBRT should be considered as a therapy option for adrenal metastases as an individual therapeutic concept in the interdisciplinary discussion as an alternative to surgical or systemic treatment.
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Affiliation(s)
- Theresa Voglhuber
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.
| | - Kerstin A Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Heidelberg, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Heidelberg, Germany
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Tjong MC, Malik NH, Chen H, Boldt RG, Li G, Cheung P, Poon I, Ung YC, Tsao M, Louie AV. Stereotactic ablative radiotherapy for malignant mediastinal and hilar lymphadenopathy: a systematic review. J Thorac Dis 2020; 12:2280-2287. [PMID: 32642133 PMCID: PMC7330368 DOI: 10.21037/jtd.2020.03.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Stereotactic ablative radiotherapy (SABR) safety and efficacy for mediastinal and hilar lymphadenopathy (MHL) is not yet established, given its potential for toxicity due to the proximity to esophagus and proximal bronchial tree (PBT). This review summarized current reported outcomes of MHL SABR. Methods This systematic review, based on the PRISMA guidelines, was performed using MEDLINE® (PubMed®), EMBASE and Cochrane Library databases from inception until December 2018. Studies reporting outcomes from SABR specifically for MHL from all primary malignancies were included. Non- English studies, guidelines, reviews, non-peer reviewed correspondences were excluded. Only the most recent publication and/or largest cohort from a single institution would be included for analysis. Results From the 222 studies identified, 4 retrospective studies totaling 196 patients were included in the analysis. One study included a small number of patients receiving non-ablative doses of stereotactic radiotherapy (RT). Non-small cell lung cancer (NSCLC) was the most common primary (65%), followed by breast (8%). Median follow-up ranged between 12 and 32 months. Reported dose and fractionation ranged from 21 to 60 Gy in 3–11 fractions, with median BED10 ranged from 46–106 Gy10. Three studies reported local control (LC) rates: study 1, 97% (1-year) and 77% (5-year); study 4, 88% (2-year); and study 2, 69% (6-month) and 66% (16-month). Pooled grade 3–5 toxicity rate according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0 was 6% (n=11). Pooled SABR-related mortality (grade 5 toxicity) rate was 2% (n=4). Three SABR-related deaths from esophageal fistulae (2 to trachea, 1 to mediastinum) were reported, with all 3 having prior RT to the subcarinal nodes. Conclusions Our review suggested SABR for MHL to be feasible and effective, though there is a potential for serious toxicity especially in the re-irradiation scenario. Multi-institutional and/or prospective studies will help determine the therapeutic benefit of SABR in this high-risk treatment scenario.
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Affiliation(s)
- Michael C Tjong
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Nauman H Malik
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.,Department of Radiation Oncology, London Health Sciences Centre, London, ON N6A 4L6, Canada
| | - R Gabriel Boldt
- Department of Radiation Oncology, London Health Sciences Centre, London, ON N6A 4L6, Canada
| | - George Li
- Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON M5S 1A8, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Yee C Ung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - May Tsao
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
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Chandy E, Taylor H, Gaito S, Wells E, Jones C, Meehan C, Burland H, Stone J, Snowball C, Mashru J, Riddell C, Hon Y, Welsh L, Saran F, Mandeville H. Hypofractionated Stereotactic Ablative Radiotherapy for Recurrent or Oligometastatic Tumours in Children and Young Adults. Clin Oncol (R Coll Radiol) 2020; 32:316-326. [DOI: 10.1016/j.clon.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/09/2019] [Accepted: 10/20/2019] [Indexed: 12/13/2022]
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Vengaloor Thomas T, Packianathan S, Bhanat E, Albert A, Abraham A, Gordy X, Kanakamedala M, Mehta D, Vijayakumar S. Oligometastatic head and neck cancer: Comprehensive review. Head Neck 2020; 42:2194-2201. [DOI: 10.1002/hed.26144] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/10/2020] [Accepted: 03/05/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | - Eldrin Bhanat
- University of Mississippi Medical Center Jackson Mississippi USA
| | - Ashley Albert
- University of Mississippi Medical Center Jackson Mississippi USA
| | - Anu Abraham
- University of Mississippi Medical Center Jackson Mississippi USA
| | - Xiaoshan Gordy
- University of Mississippi Medical Center Jackson Mississippi USA
| | | | - Divyang Mehta
- University of Mississippi Medical Center Jackson Mississippi USA
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Nieder C, Mannsåker B, Yobuta R. Late Brain Oligometastases Diagnosed at Least 36 Months after Cancer Detection are Associated with Favorable Survival Outcome. Cureus 2020; 12:e6553. [PMID: 32042526 PMCID: PMC6996465 DOI: 10.7759/cureus.6553] [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: 11/05/2022] Open
Abstract
Objective The aim of this study was to investigate the impact of a long disease-free interval (at least 36 months from the first diagnosis of cancer) on survival in patients with brain oligometastases (maximum four lesions, no extracranial metastases). Methods This study involves a retrospective analysis in a group of 89 patients treated with different brain-directed approaches. Results We identified seven patients (8%) with an interval from cancer diagnosis to the development of brain metastases of at least 36 months. The median time interval was five months. The one-year survival rates were 80% (interval of at least 36 months) and 43% (shorter interval), respectively (p = 0.049). Correspondingly, a large difference in actuarial median survival was observed (39.9 months [95% confidence interval, 16.8-63.0 months] versus 9.7 months (95% confidence interval, 6.1-13.3 months). However, the two Kaplan-Meier curves were not statistically significantly different, p = 0.13. In addition to treatment-related differences, the two groups also differed with regard to the type of primary tumor (high versus low rates of non-small cell lung cancer) and gender. Conclusion Late dissemination was uncommon. The often applied strategy of effective local treatment for patients with brain-only oligometastases is warranted, especially if the disease-free interval had been at least 36 months. Larger studies are needed to fully understand the impact of confounding factors, such as gender and tumor biology.
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Goto T. Is local consolidative therapy adequate for the treatment of oligometastatic non-small cell lung cancer? J Thorac Dis 2019; 11:E154-E157. [PMID: 31737327 DOI: 10.21037/jtd.2019.09.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
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Macchia G, Lazzari R, Colombo N, Laliscia C, Capelli G, D'Agostino GR, Deodato F, Maranzano E, Ippolito E, Ronchi S, Paiar F, Scorsetti M, Cilla S, Ingargiola R, Huscher A, Cerrotta AM, Fodor A, Vicenzi L, Russo D, Borghesi S, Perrucci E, Pignata S, Aristei C, Morganti AG, Scambia G, Valentini V, Jereczek-Fossa BA, Ferrandina G. A Large, Multicenter, Retrospective Study on Efficacy and Safety of Stereotactic Body Radiotherapy (SBRT) in Oligometastatic Ovarian Cancer (MITO RT1 Study): A Collaboration of MITO, AIRO GYN, and MaNGO Groups. Oncologist 2019; 25:e311-e320. [PMID: 32043791 DOI: 10.1634/theoncologist.2019-0309] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/23/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Recent studies have reported improvement of outcomes (progression-free survival, overall survival, and prolongation of androgen deprivation treatment-free survival) with stereotactic body radiotherapy (SBRT) in non-small cell lung cancer and prostate cancer. The aim of this retrospective, multicenter study (MITO RT-01) was to define activity and safety of SBRT in a very large, real-world data set of patients with metastatic, persistent, and recurrent ovarian cancer (MPR-OC). MATERIALS AND METHODS The endpoints of the study were the rate of complete response (CR) to SBRT and the 24-month actuarial local control (LC) rate on "per-lesion" basis. The secondary endpoints were acute and late toxicities and the 24-month actuarial late toxicity-free survival. Objective response rate (ORR) included CR and partial response (PR). Clinical benefit (CB) included ORR and stable disease (SD). Toxicity was evaluated by the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) and Common Terminology Criteria for Adverse Events (CTCAE) scales, according to center policy. Logistic and Cox regression were used for the uni- and multivariate analysis of factors predicting clinical CR and actuarial outcomes. RESULTS CR, PR, and SD were observed in 291 (65.2%), 106 (23.8%), and 33 (7.4%) lesions, giving a rate of CB of 96.4%. Patient aged ≤60 years, planning target volume (PTV) ≤18 cm3 , lymph node disease, and biologically effective dose α/β10 > 70 Gy were associated with higher chance of CR in the multivariate analysis. With a median follow-up of 22 months (range, 3-120), the 24-month actuarial LC rate was 81.9%. Achievement of CR and total dose >25 Gy were associated with better LC rate in the multivariate analysis. Mild toxicity was experienced in 54 (20.7%) patients; of 63 side effects, 48 were grade 1, and 15 were grade 2. The 24-month late toxicity-free survival rate was 95.1%. CONCLUSIONS This study confirms the activity and safety of SBRT in patients with MPR-OC and identifies clinical and treatment parameters able to predict CR and LC rate. IMPLICATIONS FOR PRACTICE This study aimed to define activity and safety of stereotactic body radiotherapy (SBRT) in a very large, real life data set of patients with metastatic, persistent, recurrent ovarian cancer (MPR-OC). Patient age <60 years, PTV <18 cm3 , lymph node disease, and biologically effective dose α/β10 >70 Gy were associated with higher chance of complete response (CR). Achievement of CR and total dose >25 Gy were associated with better local control (LC) rate. Mild toxicity was experienced in 20.7% of patients. In conclusion, this study confirms the activity and safety of SBRT in MPR-OC patients and identifies clinical and treatment parameters able to predict CR and LC rate.
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Affiliation(s)
- Gabriella Macchia
- Fondazione "Giovanni Paolo II," Unità Operativa di Radioterapia, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Roberta Lazzari
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicoletta Colombo
- Division of Medical Gynecologic Oncology, IEO European Institute of Oncology, IRCCS and University of Milan-Bicocca, Milan, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Giovanni Capelli
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Giuseppe Roberto D'Agostino
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital, IRCSS, Rozzano, Milan, Italy
| | - Francesco Deodato
- Fondazione "Giovanni Paolo II," Unità Operativa di Radioterapia, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | | | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Sara Ronchi
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Fabiola Paiar
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital, IRCSS, Rozzano, Milan, Italy
- Humanitas University, Department of Biomedical Sciences, Rozzano, Milano, Italy
| | - Savino Cilla
- Fondazione "Giovanni Paolo II," Unità Operativa di Fisica Medica, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Rossana Ingargiola
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Alessandra Huscher
- U.O. di Radioterapia Oncologica "Guido Berlucchi," Fondazione Poliambulanza, Brescia, Italy
| | - Anna Maria Cerrotta
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Lisa Vicenzi
- Department of Oncology and Radiotherapy, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Simona Borghesi
- Radiotherapy Department, Azienda USL Toscana sud est, San Donato Hospital-Arezzo, Italy
| | - Elisabetta Perrucci
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Sandro Pignata
- Istituto Nazionale Tumori di Napoli, Fondazione Pascale IRCCS, Naples, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità Operativa Complessa Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Vincenzo Valentini
- Fondazione "Giovanni Paolo II," Unità Operativa di Radioterapia, Università Cattolica del Sacro Cuore, Campobasso, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità Operativa Complessa di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Gabriella Ferrandina
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità Operativa Complessa Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
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Palma DA, Olson R, Harrow S, Correa RJM, Schneiders F, Haasbeek CJA, Rodrigues GB, Lock M, Yaremko BP, Bauman GS, Ahmad B, Schellenberg D, Liu M, Gaede S, Laba J, Mulroy L, Senthi S, Louie AV, Swaminath A, Chalmers A, Warner A, Slotman BJ, de Gruijl TD, Allan A, Senan S. Stereotactic ablative radiotherapy for the comprehensive treatment of 4-10 oligometastatic tumors (SABR-COMET-10): study protocol for a randomized phase III trial. BMC Cancer 2019; 19:816. [PMID: 31426760 PMCID: PMC6699121 DOI: 10.1186/s12885-019-5977-6] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 07/24/2019] [Indexed: 12/19/2022] Open
Abstract
Background Stereotactic ablative radiotherapy (SABR) has emerged as a new treatment option for patients with oligometastatic disease. SABR delivers precise, high-dose, hypofractionated radiotherapy, and achieves excellent rates of local control for primary tumors or metastases. A recent randomized phase II trial evaluated SABR in a group of patients with a small burden of oligometastatic disease (mostly with 1–3 metastatic lesions), and found that SABR was associated with benefits in progression-free survival and overall survival. The goal of this phase III trial is to assess the impact of SABR in patients with 4–10 metastatic cancer lesions. Methods One hundred and fifty-nine patients will be randomized in a 1:2 ratio between the control arm (consisting of standard of care palliative-intent treatments), and the SABR arm (consisting of standard of care treatment + SABR to all sites of known disease). Randomization will be stratified by two factors: histology (Group 1: prostate, breast, or renal; Group 2: all others), and type of pre-specified systemic therapy (Group 1: immunotherapy/targeted; Group 2: cytotoxic; Group 3: observation). SABR is to be completed within 2 weeks, allowing for rapid initiation of systemic therapy. Recommended SABR doses are 20 Gy in 1 fraction, 30 Gy in 3 fractions, or 35 Gy in 5 fractions, chosen to minimize risks of toxicity. The primary endpoint is overall survival, and secondary endpoints include progression-free survival, time to development of new metastatic lesions, quality of life, and toxicity. Translational endpoints include assessment of circulating tumor cells, cell-free DNA, and tumor tissue as prognostic and predictive markers, including assessment of immunological predictors of response and long-term survival. Discussion This study will provide an assessment of the impact of SABR on clinical outcomes and quality of life, to determine if long-term survival can be achieved for selected patients with 4–10 oligometastatic lesions. Trial registration Clinicaltrials.gov identifier: NCT03721341. Date of registration: October 26, 2018. Electronic supplementary material The online version of this article (10.1186/s12885-019-5977-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David A Palma
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada.
| | - Robert Olson
- Department of Radiation Oncology, British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | | | - Rohann J M Correa
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Famke Schneiders
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J A Haasbeek
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - George B Rodrigues
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Michael Lock
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Brian P Yaremko
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Glenn S Bauman
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Belal Ahmad
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Devin Schellenberg
- Department of Radiation Oncology, British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | - Mitchell Liu
- Department of Radiation Oncology, British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | - Stewart Gaede
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Joanna Laba
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Liam Mulroy
- Nova Scotia Cancer Centre, Halifax, NS, Canada
| | | | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Cancer Centre, Toronto, Canada
| | | | - Anthony Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Warner
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Tanja D de Gruijl
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Alison Allan
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Al-Shafa F, Arifin AJ, Rodrigues GB, Palma DA, Louie AV. A Review of Ongoing Trials of Stereotactic Ablative Radiotherapy for Oligometastatic Cancers: Where Will the Evidence Lead? Front Oncol 2019; 9:543. [PMID: 31293976 PMCID: PMC6598429 DOI: 10.3389/fonc.2019.00543] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/04/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose: The oligometastatic state is a proposed entity between localized cancer and widely metastatic disease, comprising an intermediate subset of metastatic cancer patients. Most data to support locally-directed treatment, such as stereotactic ablative radiotherapy (SABR), for oligometastases are from retrospective institutional reports. Following the success of a recently completed and reported phase II trial demonstrating important clinical outcomes, herein we review the current landscape of ongoing clinical trials in this context. Materials and methods: A review of currently activated and registered clinical trials was performed using the clinicaltrials.gov database from inception to February 2019. A search of actively recruiting trials, using the key words oligometastases, SABR, and various related terms was performed. Search results were independently reviewed by two investigators, with discrepancies settled by a third. Data abstracted from identified studies included study type, primary disease site, oncologic endpoints, and inclusion/exclusion criteria. Results: Of the initial 216 entries identified, 64 met our review eligibility criteria after full-text review. The most common study type was a phase II clinical trial (n = 35, 55%) with other study designs ranging from observational registry trials to phase III randomized controlled trials (RCTs). A minority of trials were randomized in design (n = 17, 27%). While most studies allowed for metastases from multiple primary disease sites (n = 22, 34%), the most common was prostate (n = 13, 15%), followed by breast, gastrointestinal, non-small cell lung cancer (NSCLC), and renal (n = 6, 9% each). In studies with a solitary target site, the most common was liver (n = 6, 9%) followed by lung (n = 3, 5%). The most common primary endpoints were progression-free survival (PFS) (n = 20, 31%) and toxicity (n = 10, 16%). A combined strategy of systemic therapy and SABR was an emerging theme (n = 23, 36%), with more recent studies specifically evaluating SABR and immunotherapy (n = 9, 14%). Conclusion: The safety and efficacy of SABR as oligometastasis-directed treatment is increasingly being evaluated within prospective clinical trials. These data are awaited to compliment the abundance of existing observational studies and to guide clinical decision-making.
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Affiliation(s)
- Faiez Al-Shafa
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Andrew J. Arifin
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - George B. Rodrigues
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - David A. Palma
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Alexander V. Louie
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Nieder C, Dalhaug A, Pawinski A. Contribution of Serum Biomarkers to Prognostic Assessment in Patients With Oligometastatic Prostate Cancer. In Vivo 2019; 33:465-468. [PMID: 30804126 DOI: 10.21873/invivo.11495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/22/2018] [Accepted: 11/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM The aim of this study was to analyze the prognostic impact of biomarkers, such as serum lactate dehydrogenase (LDH), in patients with oligometastatic castration-resistant prostate cancer, arbitrarily defined as a maximum of five metastatic lesions. PATIENTS AND METHODS This was a retrospective single-institution analysis. Overall 34 patients were included, all of whom received first-line docetaxel without ablative local treatment. RESULTS Twelve patients (35%) had elevated LDH (≥255 U/l). Their median survival was significantly shorter than that of patients with normal LDH. Due to an interaction with other biomarkers, multivariate Cox regression analysis was performed. The latter showed that serum hemoglobin was the only significant predictor of survival. CONCLUSION Correct diagnosis of oligometastatic disease is not trivial, because all radiological modalities are limited by certain thresholds for detection of small metastases. Serum biomarkers may reflect the total burden of malignant disease. However, this relatively small study did not clearly demonstrate that elevation of LDH may be useful for clinical decision-making, e.g. in terms of adding local treatment for all sites of metastatic spread.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway .,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
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Stereotactic radiation therapy in oligometastatic colorectal cancer: outcome of 102 patients and 150 lesions. Clin Exp Metastasis 2019; 36:331-342. [PMID: 31165360 DOI: 10.1007/s10585-019-09976-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
Abstract
To evaluate the local control (LC), progression free survival (PFS), out-field PFS, overall survival (OS), toxicity and failure predictors of SRT in a series of various sites oligometastatic CRC patients. Patients with oligometastatic CRC disease were analyzed retrospectively. The SRT prescribed dose was dependent on the lesion volume and its location. 102 consecutive oligometastatic CRC patients (150 lesions) were included. They underwent SRT between 2012 and 2015. Median prescription dose was 45 Gy (median dose/fraction was 15 Gy/3 fractions biological equivalent dose (BED10) 112.5 Gy). Median follow-up was 11.4 months. No patients experienced G3 and G4 toxicity. No progression was found in 82% (radiological response at 3 months) and 85% (best radiological response) out of 150 evaluable lesions. At 1 and 2 years: LC was 70% and 55%; OS was 90% and 90%; PFS was 37% and 27%; out-field PFS was 37% and 23% respectively. Progressive disease was correlated with BED10 (better LC when BED10 was ≥ 75 Gy (p < 0.0001)). In multivariate analysis, LC was higher in lesions with a Plpnning target volume (PTV) volume < 42 cm3 and BED10 ≥ 75 Gy. Patients with Karnofsky performance status < 90 showed higher out-field progression. SRT is an effective treatment for patients with oligometastases from CRC. Its low treatment-associated morbidity and acceptable LC make of SRT an option not only in selected cases. Further studies should be focused to clarify which patient subgroup will benefit most from this treatment modality and to define the optimal dose to improve LC while maintaining low toxicity profile.
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Malik NH, Keilty DM, Louie AV. Stereotactic ablative radiotherapy versus metastasectomy for pulmonary metastases: guiding treatment in the oligometastatic era. J Thorac Dis 2019; 11:S1333-S1335. [PMID: 31245125 DOI: 10.21037/jtd.2019.04.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Nauman H Malik
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Dana M Keilty
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
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Nieder C, Dalhaug A, Pawinski A. Serum Lactate Dehydrogenase Contributes to Prognostic Assessment in Patients With Oligometastatic Cancer and Brain Involvement. In Vivo 2019; 33:229-232. [PMID: 30587628 DOI: 10.21873/invivo.11464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIM The aim of this study was to analyze the prognostic impact of serum lactate dehydrogenase (LDH) in patients with oligometastatic brain metastases, arbitrarily defined as max. Four brain lesions and 5 metastatic lesions overall. PATIENTS AND METHODS This was a retrospective single institution analysis. Overall, 42 patients were identified from a prospectively maintained database. RESULTS Seventeen patients (40%) had extracranial metastases. Twelve patients (29%) had elevated LDH (≥255 U/l). Their median survival was significantly shorter than that of patients with normal LDH. Due to an interaction with performance status, this result was separately confirmed in patients with performance status ≥70. CONCLUSION Oligometastatic disease is not always correctly diagnosed, because all radiological modalities are limited by certain thresholds for detection of small metastases. We hypothesize that LDH is associated with survival, because this biomarker may reflect the total burden of malignant disease. Future studies should examine whether or not ablative local treatment of oligometastases is warranted in patients with elevated LDH.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway .,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
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Aujla KS, Katz AW, Singh DP, Okunieff P, Milano MT. Hypofractionated Stereotactic Radiotherapy for Non-breast or Prostate Cancer Oligometastases: A Tail of Survival Beyond 10 Years. Front Oncol 2019; 9:111. [PMID: 30873385 PMCID: PMC6400963 DOI: 10.3389/fonc.2019.00111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/06/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose and Objective(s): We sought to analyze the long-term follow-up of patients treated with hypofractionated, stereotactic radiotherapy (HSRT) for oligometastases from malignancies other than breast or prostate cancer. Materials and Methods: From 2001 to 2006, 82 cancer patients with 1-5 radiographically apparent metastatic lesions (in 1-3 organs) from primary sites other than breast or prostate cancer, were enrolled on a prospective study of HSRT. Freedom from widespread metastasis (FFWM) was defined from date of enrollment until death, an event (i.e., widespread distant metastasis not amenable to local therapy), or last radiographic study. Local recurrence was scored as an event if pathologically confirmed or if a treated lesion increased by ≥20% using RECIST criteria. Prognostic variables were assessed using Cox regression analysis. Results: The mean age was 61 ± 11 years, with a male to female ratio of 46:36. The most common metastatic sites were liver (50%), lung (48%), thoracic lymph nodes (18%), and bone (5%). Sixty-one patients (74%) had 1 involved organ and 18 (22%) had 1 lesion treated. The preferred dose-fractionation scheduled was 50 Gy in 10 fractions (52 patients). The median follow-up was 1.7 years. Eleven patients lived >5 years, and 6 lived >10 years. The 5-year OS, PFS, FFWM, and LC rates were 13.4, 7.3, 18.3, and 63.4%, and the 10-years OS, PFS, FFWM, and patient LC rates were 7.3, 6.1, 13.4, and 62.2%, respectively. A greater net gross tumor volume (GTV) was significantly adverse for OS (p < 0.01) and LC (p < 0.01). For FFWM, net GTV was not a significant factor (p = 0.14). Four patients remain alive at >13 years from enrollment and treatment, without evidence of active disease. Conclusion: A small subset of select non-breast, non-prostate cancer patients with limited metastasis treated with HSRT are long-term survivors. Net GTV is a significant factor for tumor control and survival. Further research is needed to help better select patients most likely to benefit from local therapy for metastatic disease.
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Affiliation(s)
- Khush S. Aujla
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States
| | - Alan W. Katz
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States
| | - Deepinder P. Singh
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States
| | - Paul Okunieff
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Michael T. Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States
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Bates JE, De Leo AN, Morris CG, Amdur RJ, Dagan R. Oligometastatic squamous cell carcinoma of the head and neck treated with stereotactic body ablative radiotherapy: Single‐institution outcomes. Head Neck 2019; 41:2309-2314. [DOI: 10.1002/hed.25695] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/17/2019] [Accepted: 01/24/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
- James E. Bates
- Department of Radiation OncologyUniversity of Florida Gainesville Florida
| | | | | | - Robert J. Amdur
- Department of Radiation OncologyUniversity of Florida Gainesville Florida
| | - Roi Dagan
- Department of Radiation OncologyUniversity of Florida Gainesville Florida
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