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Bonvalot S, Tetreau R, Llacer-Moscardo C, Roland C. The Landmark Series: Multimodal Management of Oligometastatic Sarcoma. Ann Surg Oncol 2024:10.1245/s10434-024-16103-0. [PMID: 39214938 DOI: 10.1245/s10434-024-16103-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
The concept of "oligometastatic" disease suggests the presence of intermediate states between localized disease and widespread metastases, which may be potentially treatable with curative therapeutic strategies. Metastases local therapy (MLT) can be accomplished through various techniques such as stereotactic ablative radiotherapy (SABR), radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, or surgical metastasectomy. The incorporation of MLT in the multidisciplinary treatment of patients with metastatic sarcoma is complex. Retrospective studies support consideration of MLT for selected patients based on factors such as patient condition, disease biology, histologic type, and disease burden. Decisions regarding type and timing of MLT should be made after multidisciplinary discussion including radiation oncologists, surgical and orthopedic oncologists, medical oncologists, and interventional radiology to explore all options before treatment decsions. All MLT techniques have advantages and disadvantages and should be performed in centers specialized in the care of complex oncology patients where various options can be explored concurrently or sequentially for each patient. Future studies evaluating quality of life and patient-reported outcomes are necessary to adequately align patient goals and optimal outcomes. This article reviews the medical scenarios that may benefit the use of MLT, evaluates the distinct advantages and disadvantages associated with these various techniques, and analyzes the findings from pivotal series to provide a comprehensive understanding of its role in clinical practice.
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Affiliation(s)
- Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, Paris University, Paris, France.
| | - Raphael Tetreau
- Department of Radiology, Institut du Cancer de Montpellier, Montpellier, France
| | - Carmen Llacer-Moscardo
- Department of Radiation Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Christina Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
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Franceschini D, Greto D, Dicuonzo S, Navarria F, Federico M, La Vecchia M, Sangalli C, Allajbej A, Di Cristina L, Mazzola R, Pontoriero A, Montesi G, Navarria P, Baldaccini D, Clerici E, Lo Faro L, Franzese C, Di Biase S, Pergolizzi S, Alongi F, Bignardi M, Fazio I, Mascarin M, Jereczek-Fossa BA, Livi L, Scorsetti M. Oligometastatic sarcoma treated with Curative intent Ablative Radiotherapy (OSCAR): A multicenter study on behalf of AIRO (Italian association of Radiotherapy and clinical Oncology). Radiother Oncol 2024; 191:110078. [PMID: 38163485 DOI: 10.1016/j.radonc.2023.110078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND PURPOSE Stereotactic Ablative Radiotherapy (SABR) is emerging as a valid alternative to surgery in the oligometastatic setting in soft tissue sarcomas (STS), although robust data are lacking. The aim of this study is to evaluate toxicity and efficacy of SABR in oligometastatic STS. MATERIALS AND METHODS This is a retrospective multicenter study including adult patients affected by stage IV STS, treated with SABR for a maximum of 5 cranial or extracranial metastases in up to 3 different organs. SABR was delivered with ablative purposes. Study endpoints were overall survival (OS), local control (LC), distant progression free survival (DPFS), time to polymetastatic progression (TTPP), time to new systemic therapy (TTNS) and toxicity. RESULTS From 10 Italian RT centers, 138 patients (202 metastases) treated between 2010 and 2022 were enrolled in the study. Treatment was generally well tolerated, no acute or late toxicity ≥ G3 was recorded. Median follow up was 42.5 months. Median OS was 39.7 months. Actuarial OS at 1 and 2 years was 91.5 % and 72.7 %. Actuarial LC at 1 and 2 years was 94.8 % and 88.0 %. Median DPFS was 9.7 months. Actuarial DPFS at 1 and 2 years was 40.8 % and 19.4 %. CONCLUSION SABR is a safe and effective approach for the treatment of oligometastatic sarcoma. One out of 5 patients is free of progression at 2-years.
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Affiliation(s)
- D Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy.
| | - D Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - S Dicuonzo
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F Navarria
- Radiation Oncology Department, IRCCS Centro di Riferimento Oncologico, Aviano, Italy
| | - M Federico
- Radiotherapy Unit, Casa di Cura Macchiarella, Palermo, Italy
| | - M La Vecchia
- Radiotherapy Unit, Casa di Cura Macchiarella, Palermo, Italy
| | - C Sangalli
- Department of Radiation Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Allajbej
- Department of Radiation Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Di Cristina
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - R Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37034, Negrar Di Valpolicella, Verona, Italy
| | - A Pontoriero
- Radiation Oncology Unit, A.O.U. "G. Martino", Messina, Italy; Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - G Montesi
- Radiation Therapy Unit ULSS5 Veneto, Rovigo, Italy
| | - P Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - D Baldaccini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - E Clerici
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - L Lo Faro
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - C Franzese
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - S Di Biase
- Radiation Therapy Unit ULSS5 Veneto, Rovigo, Italy
| | - S Pergolizzi
- Radiation Oncology Unit, A.O.U. "G. Martino", Messina, Italy; Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - F Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37034, Negrar Di Valpolicella, Verona, Italy; University of Brescia, Brescia, Italy
| | - M Bignardi
- Department of Radiation Oncology, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - I Fazio
- Radiotherapy Unit, Casa di Cura Macchiarella, Palermo, Italy
| | - M Mascarin
- Radiation Oncology Department, IRCCS Centro di Riferimento Oncologico, Aviano, Italy; AYA Oncology and Pediatric Radiotherapy Unit, IRCCS Centro di Riferimento Oncologico, Aviano, Italy
| | - B A Jereczek-Fossa
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - L Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Biomedical, Experimental and Clinical Sciences, Serio" University of Florence, Florence, Italy
| | - M Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
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