Initial Results of a Multicenter Phase 2 Trial of Stereotactic Ablative Radiation Therapy for Oligometastatic Cancer

Sutera, Philip; Clump, D.A.; Kalash, Ronny; D’Ambrosio, David J.; Mihai, Alina; Wang, Hong; Petro, Daniel P.; Burton, Steven A.; Heron, Dwight E.

doi:10.1016/j.ijrobp.2018.08.027

Cited by 71 publications

(60 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some studies reported a better prognosis for metachronous OMD [28,86], but this was not consistently observed [25,74]. Though both synchronous and metachronous metastases are considered OMD, the prognosis, options for treatment and risk of occult disseminated metastases of these patients can differ, with the length of the DFI appearing to have a prognostic impact [46,69,87]. While concerns were raised about prognosis of metastases developing shortly after primary cancer treatment, uncertainty remains regarding the importance of the DFI, as data are lacking to support a consensus for minimum DFI in the definition of metachronous OMD.…”

Section: Oligo-progressionmentioning

confidence: 99%

Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document

Lievens

Gückenberger

Gomez

et al. 2020

Radiotherapy and Oncology

421

278

View full text Add to dashboard Cite

Background: Recognizing the rapidly increasing interest and evidence in using metastasis-directed radiotherapy (MDRT) for oligometastatic disease (OMD), ESTRO and ASTRO convened a committee to establish consensus regarding definitions of OMD and define gaps in current evidence. Methods: A systematic literature review focused on curative intent MDRT was performed in Medline, Embase and Cochrane. Subsequent consensus opinion, using a Delphi process, highlighted the current state of evidence and the limitations in the available literature. Results: Available evidence regarding the use of MDRT for OMD mostly derives from retrospective, singlecentre series, with significant heterogeneity in patient inclusion criteria, definition of OMD, and outcomes reported. Consensus was reached that OMD is largely independent of primary tumour, metastatic location and the presence or length of a disease-free interval, supporting both synchronous and metachronous OMD. In the absence of clinical data supporting a maximum number of metastases and organs to define OMD, and of validated molecular biomarkers, consensus supported the ability to deliver safe and clinically meaningful radiotherapy with curative intent to all metastatic sites as a minimum requirement for defining OMD in the context of radiotherapy. Systemic therapy induced OMD was identified as a distinct state of OMD. High-resolution imaging to assess and confirm OMD is crucial, including brain imaging when indicated. Minimum common endpoints such as progression-free and overall survival, local control, toxicity and quality-of-life should be reported; uncommon endpoints as deferral of systemic therapy and cost were endorsed. Conclusion: While significant heterogeneity exists in the current OMD definitions in the literature, consensus was reached on multiple key questions. Based on available data, OMD can to date be defined as 1-5 metastatic lesions, a controlled primary tumor being optional, but where all metastatic sites must be safely treatable. Consistent definitions and reporting are warranted and encouraged in ongoing trials and reports generating further evidence to optimize patient benefits.

show abstract

Section: Oligo-progressionmentioning

confidence: 99%

Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document

Lievens

Gückenberger

Gomez

et al. 2020

Radiotherapy and Oncology

421

278

View full text Add to dashboard Cite

show abstract

“…To date, radiotherapy, alone and combined with other therapies, such as chemotherapy, targeted therapies, and immunotherapy, is given as a frontline therapy to nearly 60% of all patients newly diagnosed with cancer [1–4]. Stereotactic body radiotherapy (SBRT), known for its high local control rate and insignificant toxicity, has become the primary technique for treating non-small cell lung cancer (NSCLC), especially in the early stage and the oligometastatic types [5–8]. Radiation’s clinical effectiveness has previously been credited to its DNA damage-inducing capacity, which sometimes causes direct tumor-related cell death [9].…”

Section: Introductionmentioning

confidence: 99%

Peripheral memory and naïve T cells in non-small cell lung cancer patients with lung metastases undergoing stereotactic body radiotherapy: predictors of early tumor response

Liu

et al. 2019

Cancer Cell Int

View full text Add to dashboard Cite

Background Further analysis of phase I trial of the KEYNOTE-001 has shown that previous radiotherapy improves the outcomes of patients with advanced non-small cell lung cancer (NSCLC) who received pembrolizumab treatment, possibly explained by the radiation-induced specific anti-cancer immunity with a memory effect. In this study, we aimed to investigate the peripheral memory and naïve T cells as predictors of early response in lung metastases post-stereotactic body radiotherapy (SBRT). Methods Sixty-six lung metastases patients with NSCLC who received SBRT were enrolled in this study. Analyses of peripheral memory CD4+ T, memory CD8+ T, naive CD4+ T, and naive CD8+ T in NSCLC patients were performed by flow cytometry. Evaluations of the link between immune cells and early radiation response a month after SBRT were carried out via logistic regression analyses. Results Higher levels of memory CD4+ T, memory CD8+ T, and lower levels of naïve CD4+ T, CD4+ naïve/memory ratio, and CD8+ naïve/memory ratio were shown in responders compared with non-responders (all P < 0.05). Logistic regression analyses of univariate and multivariate revealed that peripheral memory CD4+ T (OR: 0.14, 95% CI 0.04–0.50, P = 0.003; OR: 0.17, 95% CI 0.05–0.66, P = 0.010), memory CD8+ T (OR: 0.11, 95% CI 0.01–0.87, P = 0.037; OR: 0.11, 95% CI 0.01–0.97, P = 0.047), naïve CD4+ T (OR: 16.25, 95% CI 3.17–83.13, P = 0.001; OR: 12.67, 95% CI 2.26–71.18, P = 0.004) and CD4+ naïve/memory ratio (OR: 11.27, 95% CI 2.67–47.58, P = 0.001; OR: 8.50, 95% CI 1.90–38.14, P = 0.005) were independent predictors for tumor response to SBRT in the lung metastases of NSCLC patients. Conclusions The tumor response of lung metastases a month after SBRT independently correlated with peripheral memory CD4+ T, memory CD8+ T, naïve CD4+ T, and CD4+ naïve/memory ratio. These findings could be helpful in incorporating additional treatments to improve clinical outcomes in the case of poor responders. Electronic supplementary material The online version of this article (10.1186/s12935-019-0839-5) contains supplementary material, which is available to authorized users.

show abstract

“…Owing to an excess of early deaths, median overall survival of 17.6 months in 16 patients with head and neck cancer, out of which 11 had squamous cell carcinoma, was inferior to that observed in other primary tumor subgroups. However, the 42% 5-year overall survival yielded in this cohort compares favorably to outcomes yielded in surgical studies but can be biased by the small patient number (43). As of yet, the only randomized trial exploring the addition of SABR to a standard systemic palliative treatment according to primary cancer was the SABR-COMET phase II study with a 2:1 randomization in favor of the experimental arm.…”

Section: Radiotherapymentioning

confidence: 80%

Oligometastatic Disease Management: Finding the Sweet Spot

Szturz¹,

Nevens

Vermorken

2020

Front. Oncol.

View full text Add to dashboard Cite

Hematogenous dissemination represents a common manifestation of squamous cell carcinoma of the head and neck, and the recommended therapeutic options usually consist of systemically administered drugs with palliative intent. However, mounting evidence suggests that patients with few and slowly progressive distant lesions of small size may benefit from various local ablation techniques, which have already been established as standard-of-care modalities for example in colorectal and renal cell carcinomas and in sarcomas. In principle, serving as radical approaches to eradicate cancer, these interventions can be curative. Their impact on local control and overall survival has been shown in numerous retrospective and prospective studies. The term oligometastatic refers to the number of distant lesions which should generally not surpass five in total, ideally in one organ. Currently, surgical resection remains the method of choice supported by the majority of published data. More recently, stereotactic (ablative) body radiotherapy (SABR/SBRT) has emerged as a viable alternative. In cases technically amenable to such local interventions, several other clinical variables need to be taken into account also, including patient-related factors (general health status, patient preferences, socioeconomic background) and disease-related factors (primary tumor site, growth kinetics, synchronous or metachronous metastases). In head and neck cancer, patients presenting with late development of slowly progressive oligometastatic lesions in the lungs secondary to human papillomavirus (HPV)-positive oropharyngeal cancer are the ideal candidates for metastasectomy or other local therapies. However, literature data are still limited to say whether there are other subgroups benefiting from this approach. One of the plausible explanations is that radiological follow-up after primary curative therapy is usually not recommended because its impact on survival has not been unequivocal, which is also due to the rarity of oligometastatic manifestations in this disease. At the same time, aggressive treatment of synchronous metastases early in the disease course should be weighed against the risk of futile interventions in a disease with already multimetastatic microscopic dissemination. Therefore, attentive treatment sequencing, meticulous appraisal of cancer extension, refinement of post-treatment surveillance, and understanding of tumor biology and kinetics are crucial in the management of oligometastases.

show abstract

Initial Results of a Multicenter Phase 2 Trial of Stereotactic Ablative Radiation Therapy for Oligometastatic Cancer

Cited by 71 publications

References 24 publications

Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document

Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document

Peripheral memory and naïve T cells in non-small cell lung cancer patients with lung metastases undergoing stereotactic body radiotherapy: predictors of early tumor response

Oligometastatic Disease Management: Finding the Sweet Spot

Contact Info

Product

Resources

About