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Mutsaers A, Li G, Fernandes J, Ali S, Barnes E, Chen H, Czarnota G, Karam I, Moore-Palhares D, Poon I, Soliman H, Vesprini D, Cheung P, Louie A. Uncovering the armpit of SBRT: An institutional experience with stereotactic radiation of axillary metastases. Clin Transl Radiat Oncol 2024; 45:100730. [PMID: 38317679 PMCID: PMC10839264 DOI: 10.1016/j.ctro.2024.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose/objectives The growing use of stereotactic body radiotherapy (SBRT) in metastatic cancer has led to its use in varying anatomic locations. The objective of this study was to review our institutional SBRT experience for axillary metastases (AM), focusing on outcomes and process. Materials/methods Patients treated with SBRT to AM from 2014 to 2022 were reviewed. Cumulative incidence functions were used to estimate the incidence of local failure (LF), with death as competing risk. Kaplan-Meier method was used to estimate progression-free (PFS) and overall survival (OS). Univariate regression analysis examined predictors of LF. Results We analyzed 37 patients with 39 AM who received SBRT. Patients were predominantly female (60 %) and elderly (median age: 72). Median follow-up was 14.6 months. Common primary cancers included breast (43 %), skin (19 %), and lung (14 %). Treatment indication included oligoprogression (46 %), oligometastases (35 %) and symptomatic progression (19 %). A minority had prior overlapping radiation (18 %) or surgery (11 %). Most had prior systemic therapy (70 %).Significant heterogeneity in planning technique was identified; a minority of patient received 4-D CT scans (46 %), MR-simulation (21 %), or contrast (10 %). Median dose was 40 Gy (interquartile range (IQR): 35-40) in 5 fractions, (BED10 = 72 Gy). Seventeen cases (44 %) utilized a low-dose elective volume to cover remaining axilla.At first assessment, 87 % had partial or complete response, with a single progression. Of symptomatic patients (n = 14), 57 % had complete resolution and 21 % had improvement. One and 2-year LF rate were 16 % and 20 %, respectively. Univariable analysis showed increasing BED reduced risk of LF. Median OS was 21.0 months (95 % [Confidence Interval (CI)] 17.3-not reached) and median PFS was 7.0 months (95 % [CI] 4.3-11.3). Two grade 3 events were identified, and no grade 4/5. Conclusion Using SBRT for AM demonstrated low rates of toxicity and LF, and respectable symptom improvement. Variation in treatment delivery has prompted development of an institutional protocol to standardize technique and increase efficiency. Limited followup may limit detection of local failure and late toxicity.
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Affiliation(s)
- A. Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - G.J. Li
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - J.S. Fernandes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - S. Ali
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - E.A. Barnes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - H. Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - G.J. Czarnota
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - I. Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - D. Moore-Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - I. Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - H. Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - D. Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - P. Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - A.V. Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
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Dey A, Sinha RTK. Clinicopathological Correlation of Axillary Masses – Importance of Fine Needle Aspiration Cytology as a Diagnostic Modality. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2017. [DOI: 10.46347/jmsh.2017.v03i01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Morosin T, Ashford B, Ranson M, Gupta R, Clark J, Iyer NG, Spring K. Circulating tumour cells in regionally metastatic cutaneous squamous cell carcinoma: A pilot study. Oncotarget 2016; 7:47111-47115. [PMID: 27302928 PMCID: PMC5216927 DOI: 10.18632/oncotarget.9946] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/16/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Circulating tumour cells (CTCs) are increasingly being used in the surveillance of cancer, allowing for potential early detection and real-time monitoring of disease progression. The presence of CTCs in patients with metastatic cutaneous head and neck squamous cell carcinoma (cHNSCC) has not been evaluated. RESULTS CTCs were detected in eight of ten patients with regional metastatic cHNSCC (80%; range 1-44 cells/9 mL blood). CTMs were detected in three of ten patients (30%, range 1-4 cells/9 mL blood). METHODS Preoperative blood samples from ten patients with nodal metastases from cutaneous squamous cell carcinomas (cSCC) were analyzed using the IsoFluxTM System for the detection and enumeration of CTCs and circulating tumour microemboli (CTMs). CONCLUSIONS For the first time CTCs have been detected in patients with nodal metastases from cHNSCC. Further work is required to understand their prognostic significance and potential to directly influence clinical practice.
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Affiliation(s)
- Tia Morosin
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Bruce Ashford
- School of Biological Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW 2522, Australia
- Illawarra and Shoalhaven Local Health District (ISLHD), Wollongong, NSW 2522, Australia
- Centre for Oncology Education and Research Translation (CONCERT), Liverpool, NSW 2170, Australia
| | - Marie Ranson
- School of Biological Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW 2522, Australia
- Centre for Oncology Education and Research Translation (CONCERT), Liverpool, NSW 2170, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- The University of Sydney, Sydney, NSW 2006, Australia
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
- Central Clinical School, The University of Sydney, Sydney, NSW 2006, Australia
- South West Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, NSW 2052, Australia
- Singhealth/Duke-NUS Head and Neck Center, National Cancer Center Singapore (NCCS), 169610, Singapore
| | - N. Gopalakrishna Iyer
- Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Kevin Spring
- Centre for Oncology Education and Research Translation (CONCERT), Liverpool, NSW 2170, Australia
- South West Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, NSW 2052, Australia
- Liverpool Clinical School, Western Sydney University, Liverpool, NSW 1871, Australia
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