Is stereotactic radiotherapy equivalent to metastasectomy in patients with pulmonary oligometastases?

Abstract

Summary A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether stereotactic body radiotherapy (SBRT) was equivalent to metastasectomy in patients with pulmonary oligometastases arising from solid tumours. Altogether, 1612 papers were found using the reported search, of which 5 cohort studies derived from 4 patient populations represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 5 studies demonstrated no significant difference in post-treatment overall survival, disease-free survival or local control between SBRT and metastasectomy for pulmonary oligometastases. One of the 5 studies showed a significantly decreased rate of severe complications among the patients treated with SBRT. The other papers reported higher rates of complications in the SBRT groups, invariably due to radiation, but with uncertain clinical significance. The evidence strength of these findings may be largely attenuated due to the small sample size, heterogeneity of SBRT protocols and incomparable follow-up periods between the 2 treatment groups. The selection criteria for the choice of treatment were not stated. We conclude, based on limited evidence, that SBRT has equivalent outcomes to metastasectomy in the treatment of patients with pulmonary oligometastases.

Radiation Therapy in Adult Soft Tissue Sarcoma—Current Knowledge and Future Directions: A Review and Expert Opinion

“…The general efficacy of SBRT for lung lesions has been proven, for example in early stage lung cancer and lung metastases of different origins, resulting in high local control rates that were similar if not superior to surgical approaches [78][79][80]. Given the rarity of STS per se, data on its specific use in metastases from STS is limited.…”

Lung metastases from hepatocellular carcinoma: multidisciplinary approach—narrative review

“…To date there is a lack of information in literature regarding stereotactic radiotherapy in the treatment of HCC lung metastases (62). Li et al performed a meta-analysis comparing pulmonary metastasectomy and stereotactic body radiotherapy (SBRT) in patients with PM from solid tumors, and no significant difference was observed between the two cohorts of patients in terms of OS and DFS rate (62). Moreover, SBRT was described as a good option for patients with PMs from colorectal cancer who refuse to undergo surgery or considered medically inoperable (63).…”

Survival and Prognostic Factors of 40 Patients with Pulmonary Oligometastases Treated with Tomotherapy Hypofractionated Radiotherapy

“…Due to the continuous advancement and development of precision radiotherapy technology, the target area during radiotherapy has become more precise, and protection of normal tissues is currently more reliable. Radiotherapy has the same therapeutic effect as that of surgical resection (7)(8)(9).This study explored the e cacy of radiotherapy and those prognostic factors that affect survival in patients with pulmonary oligometastatic tumors who undergo helical tomotherapy (TOMO) hypofractionated radiotherapy to provide evidence for clinical decision-making and treatment.…”