Definitive Stereotactic Body Radiotherapy (SBRT) for Extracranial Oligometastases

Lewis, Stephen L.; Porceddu, Sandro; Nakamura, Naoki; Palma, David A.; Lo, Simon S.; Hoskin, Peter; Moghanaki, Drew; Chmura, Steven J.; Salama, Joseph K.

doi:10.1097/coc.0000000000000169

Cited by 131 publications

(88 citation statements)

References 24 publications

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“…To address this, randomised clinical trials are required. A recent international survey of >1000 oncologists in 43 countries showed that of those using SBRT, >60% were planning on increasing SBRT use for oligometastatic disease, confirming how rapidly the technique has been accepted into standard practice despite the lack of randomised evidence [27]. It is timely that trials are conducted now, before clinical equipoise is lost.…”

Section: Discussionmentioning

confidence: 88%

Initial UK Experience of Stereotactic Body Radiotherapy for Extracranial Oligometastases: Can We Change the Therapeutic Paradigm?

et al. 2015

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Section: Discussionmentioning

confidence: 88%

Initial UK Experience of Stereotactic Body Radiotherapy for Extracranial Oligometastases: Can We Change the Therapeutic Paradigm?

et al. 2015

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“…Dosimetric planning to multiple lesions receiving differing doses (45–50Gy) and fractionation (3–5) while irradiating the same organs-at-risk is discussed, particularly for metastases in close proximity (≤5cm). The benchmark case was selected to demonstrate the planning trade-offs required to satisfy protocol requirements for two nearby lesions.…”

Section: Resultsmentioning

confidence: 99%

“…Cancer patients with few metastases limited in number and distribution could potentially be cured if all visible tumors were ablated with radiotherapy or surgery. With the increasing availability of the technological advances enabling SBRT (2), the use of ablative radiotherapy to treat oligometastases is increasing (3). To date, several single arm trials using ablative radiotherapy to treat oligometastases have been conducted (4–8).…”

Section: Introductionmentioning

confidence: 99%

Rationale of technical requirements for NRG-BR001: The first NCI-sponsored trial of SBRT for the treatment of multiple metastases

Al‐Hallaq

Chmura

Salama

et al. 2016

Practical Radiation Oncology

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Introduction In 2014, the NRG Oncology Group initiated the first NCI-sponsored, phase I clinical trial of SBRT for the treatment of multiple metastases in multiple organ sites (XXXX; NCTXXX). The primary endpoint is to test the safety of SBRT for the treatment of multiple lesions (2–4) in several anatomic sites in a multi-institutional setting. Because of the technical challenges inherent to treating multiple lesions as their spatial separation decreases, we present the technical requirements for NRG-XXXX and the rationale for their selection. Methods and Materials Patients with controlled primary tumors of breast, non-small cell lung, or prostate are eligible if they have 2–4 metastases distributed among 7 extracranial anatomic locations throughout the body. Prescription and organ-at-risk (OAR) doses were determined by expert consensus. Credentialing requirements include 1) irradiation of the IROC phantom with SBRT, 2) submitting IGRT case studies, and 3) planning the benchmark. Guidelines for navigating challenging planning cases including assessing composite dose are discussed. Results Dosimetric planning to multiple lesions receiving differing doses (45–50Gy) and fractionation (3–5) while irradiating the same organs-at-risk is discussed, particularly for metastases in close proximity (≤5cm). The benchmark case was selected to demonstrate the planning trade-offs required to satisfy protocol requirements for two nearby lesions. Examples of passing benchmark plans exhibited a large variability in plan conformity. Discussion NRG-XXXX was developed using expert consensus on multiple issues from the dose fractionation regimen to the minimum IGRT guidelines. Credentialing was tied to the task rather than the anatomic site in order to reduce its burden. Every effort was made to include a variety of delivery methods to reflect current SBRT technology. While some simplifications were adopted, the successful completion of this trial will inform future designs of both national and institutional would allow immediate clinical adoption of SBRT trials for oligometastases.

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“…The question was systematically reviewed and the authors pointed to the absence of evidence and raised the possibility that this was 'wishful thinking' (6). Despite the absence of evidence for any ablative techniques for metastases, SABR/SBRT has been much publicised for treatment of oligometastatic disease in the last year (19)(20)(21).…”

Section: Stereotactic Ablative Radiation (Sabr) Therapy For Lung Metamentioning

confidence: 99%

Surgery and ablative techniques for lung metastases in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial: is there equivalence?

Treasure¹

2016

J. Thorac. Dis.

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Definitive Stereotactic Body Radiotherapy (SBRT) for Extracranial Oligometastases

Cited by 131 publications

References 24 publications

Initial UK Experience of Stereotactic Body Radiotherapy for Extracranial Oligometastases: Can We Change the Therapeutic Paradigm?

Initial UK Experience of Stereotactic Body Radiotherapy for Extracranial Oligometastases: Can We Change the Therapeutic Paradigm?

Rationale of technical requirements for NRG-BR001: The first NCI-sponsored trial of SBRT for the treatment of multiple metastases

Surgery and ablative techniques for lung metastases in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial: is there equivalence?

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