Advanced radiotherapy for metastatic disease—a major stride or a futile effort?

Butala, Anish A.; Jones, Joshua

doi:10.21037/apm.2019.07.07

Cited by 10 publications

(7 citation statements)

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“…Studies on the use of radiotherapy in the final year and last 30 days of life show a shift from the use of simple 2D planning techniques towards more resource‐intensive techniques including intensity‐modulated radiotherapy (IMRT) and SBRT 95,96 . The adoption of these advanced technologies in the clinic setting for patients with metastatic disease often precedes the availability of robust clinical and health economic data, in spite of rising costs and the reality that some patients may not live long enough to gain benefit from an ablative treatment 97 …”

Section: Resultsmentioning

confidence: 99%

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Imaging response assessment following stereotactic body radiotherapy for solid tumour metastases of the spine: Current challenges and future directions

O'Sullivan

McDermott

Keys³

et al. 2020

J Med Imag Rad Onc

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Patients with metastatic disease are routinely serially imaged to assess disease burden and response to systemic and local therapies, which places ever‐expanding demands on our healthcare resources. Image interpretation following stereotactic body radiotherapy (SBRT) for spine metastases can be challenging; however, appropriate and accurate assessment is critical to ensure patients are managed correctly and resources are optimised. Here, we take a critical review of the merits and pitfalls of various imaging modalities, current response assessment guidelines, and explore novel imaging approaches and the potential for radiomics to add value in imaging assessment.

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Section: Resultsmentioning

confidence: 99%

“…Conventional EBRT is approximately 29–71% the cost of spinal SBRT 97,101 . Two studies have reported that for vertebral metastases, SBRT is cost‐effective compared to palliative EBRT based on quality‐adjusted life years (QALYs) gained, 102 fewer acute toxicities and a lower retreatment rate (9% for SBRT vs. 23% for EBRT) 101 .…”

Section: Resultsmentioning

confidence: 99%

Imaging response assessment following stereotactic body radiotherapy for solid tumour metastases of the spine: Current challenges and future directions

O'Sullivan

McDermott

Keys³

et al. 2020

J Med Imag Rad Onc

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“…Importantly, survival of prognostically poor patients after single fraction radiotherapy was very short (median 1 month, 12-month rate 0%), suggesting that many of these patients are unlikely to derive clinical benefit. Current strategies for patients with limited disease extent and long predicted survival include stereotactic and other advanced radiotherapy modalities [32]. It would be interesting to study the Rades et al score in patient cohorts managed with these approaches as well.…”

Section: Discussionmentioning

confidence: 99%

Independent External Validation of a Score Predicting Survival After Radiotherapy for Bone Metastases and Expansion to Patients Treated With Single Fraction Radiotherapy

2020

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Background: Recently a prognostic score that predicts 12-month survival in patients treated with fractionated radiotherapy for painful bone metastases has been developed. Fractionated radiotherapy might cause unnecessary burden for patients with limited survival, thus estimation of survival is clinically relevant. The purpose of the present study was independent external validation of the new score and, in addition, its application in patients who received single fraction irradiation, a convenient option currently endorsed in several guidelines. Methods: We conducted a retrospective analysis of 270 patients, including 24% who had received single fraction irradiation. The threetiered score was assigned as described in the development study, and included age, performance status and primary tumor type. Additional prognostic factors not studied in the development cohort, such as the Glasgow prognostic score (GPS) and presence of liver metastases, were included in this validation study. Results: The three-tiered score was valid in this independent cohort (12-month survival rates were 7%, 30% and 71%, respectively, P = 0.0001). Its performance and validity were also confirmed in the single fraction radiotherapy group. Three additional prognostic factors were significant in the multivariate analysis and may therefore contribute to decision making. Conclusions: Irrespective of fractionation, the score based on age, performance status and primary tumor type provides a readily available estimate of 12-month survival.

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“…Cranial radiation therapy is the leading mode of treatment for primary and metastatic malignancies in the brain with protocols that depend on several factors; including patient age, current comorbidities, tumor prognosis, and tumor burden (1,2). Unfortunately, cranial radiation is associated with significant late-delayed effects and depending on dose and irradiated tissue volume, as well as the brain region(s) affected, progressive, irreversible symptoms may manifest as physical weakness, changes in mood, and cognitive dysfunction (3,4).…”

Section: Introductionmentioning

confidence: 99%

Pharmacologic manipulation of complement receptor 3 prevents dendritic spine loss and cognitive impairment after acute cranial radiation

et al. 2020

Preprint

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Cranial irradiation induces healthy tissue damage that can lead to neurocognitive complications and negatively impact patient quality of life. One type of damage associated with cognitive impairment is loss of neuronal spine density. Based on developmental and disease studies implicating microglia and complement in dendritic spine loss, we hypothesized that irradiation-mediated spine loss is microglial complement receptor 3 (CR3)-dependent, and associated with late-delayed cognitive deficits. Utilizing a model of cranial irradiation (acute, 10 Gy gamma) in C57BL/6 mice we found that male mice demonstrate irradiation-mediated spine loss and cognitive deficits whereas female mice and CR3 knockout mice do not. Moreover, pharmacological blockade of CR3 with leukadherin-1 (LA1) prevented these changes in irradiated male mice. Interestingly, CR3 KO mice showed reduced behavioral task performance suggesting that CR3 is important for normal learning and memory. Improving our understanding of irradiation-mediated mechanisms and sexual dimorphic responses is essential for the identification of novel therapeutics to reduce irradiation-induced cognitive decline and improve patient quality of life.

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Advanced radiotherapy for metastatic disease—a major stride or a futile effort?

Cited by 10 publications

References 0 publications

Imaging response assessment following stereotactic body radiotherapy for solid tumour metastases of the spine: Current challenges and future directions

Imaging response assessment following stereotactic body radiotherapy for solid tumour metastases of the spine: Current challenges and future directions

Independent External Validation of a Score Predicting Survival After Radiotherapy for Bone Metastases and Expansion to Patients Treated With Single Fraction Radiotherapy

Pharmacologic manipulation of complement receptor 3 prevents dendritic spine loss and cognitive impairment after acute cranial radiation

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