Lung metastases in oligometastatic patients: outcome with stereotactic body radiation therapy (SBRT)

García-Cabezas, Sonia; Bueno, Coralia; Rivin, E.; Roldán, J. M.; Palacios-Eito, Amalia

doi:10.1007/s12094-015-1291-1

Cited by 13 publications

(24 citation statements)

References 19 publications

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“…Radiotherapy dose escalation improved local control. The 5‐year TMC of 69% in patients who received a minimum dose of 36 Gy in 3 fractions fell within the 65% to 95% range of local control rates published in similar SBRT experiences, most of which had shorter follow‐up . Other institutions have observed that escalation to biologically effective doses >100 Gy was needed to achieve approximately ≥90% local control .…”

Section: Discussionmentioning

confidence: 63%

“…The 5-year TMC of 69% in patients who received a minimum dose of 36 Gy in 3 fractions fell within the 65% to 95% range of local control rates published in similar SBRT experiences, most of which had shorter followup. [6][7][8][9][10][11][12][13] Other institutions have observed that escalation to biologically effective doses >100 Gy was needed to achieve approximately 90% local control. 8,13,24 Like other reports, dose escalation in our cohort failed to improve OS, likely because of high rates of failure outside of treated lesions and eventual polymetastatic progression.…”

Section: Discussionmentioning

confidence: 99%

“…The development of ablative stereotactic body radiotherapy (SBRT) has enabled potentially curative, metastasis‐directed therapy for non‐surgical candidates. SBRT and surgery provide comparable treated metastasis control (TMC) and OS rates . However, appropriate patient selection, optimal treatment modality, and the long‐term benefit from curative‐intent interventions of any modality in patients with oligometastases have yet to be established …”

Section: Introductionmentioning

confidence: 99%

“…SBRT and surgery provide comparable treated metastasis control (TMC) and OS rates. [6][7][8][9][10][11][12][13] However, appropriate patient selection, optimal treatment modality, and the longterm benefit from curative-intent interventions of any modality in patients with oligometastases have yet to be established. 14 We previously reported outcomes of the first prospective, multiorgan oligometastasis-directed SBRT dose-escalation trial with a median follow-up of 2.6 years for survivors.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and molecular markers of long‐term survival after oligometastasis‐directed stereotactic body radiotherapy (SBRT)

Wong

Watson

Pitroda

et al. 2016

Cancer

116

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BACKGROUND:The selection of patients for oligometastasis-directed ablative therapy remains a challenge. The authors report on clinical and molecular predictors of survival from a stereotactic body radiotherapy (SBRT) dose-escalation trial for oligometastases. METHODS: Patients who had from 1 to 5 metastases, a life expectancy of >3 months, and a Karnofsky performance status of >60 received escalating SBRT doses to all known cancer sites. Time to progression, progression-free survival, and overall survival (OS) were calculated at the completion of SBRT, and clinical predictors of OS were modeled. Primary tumor microRNA expression was analyzed to identify molecular predictors of OS. RESULTS: Sixty-one evaluable patients were enrolled from 2004 to 2009. The median follow-up was 2.3 years for all patients (range, 0.2-9.3 years) and 6.8 years for survivors (range, 2.0-9.3 years). The median, 2-year, and 5-year estimated OS were 2.4 years, 57%, and 32%, respectively. The rate of progression after SBRT was associated with an increased risk of death (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.24-1.82). The time from initial cancer diagnosis to metastasis (HR, 0.98; 95% CI, 0.98-0.99), the time from metastasis to SBRT (HR, 0.98; 95% CI, 0.98-0.99), and breast cancer histology (HR, 0.12; 95% CI, 0.07-0.37) were significant predictors of OS. In an exploratory analysis, a candidate classifier using expression levels of 3 microRNAs (miR-23b, miR-449a, and miR-449b) predicted survival among 17 patients who had primary tumor microRNA expression data available. CONCLUSIONS: A subset of oligometastatic patients achieves long-term survival after metastasis-directed SBRT. Clinical features and primary tumor microRNA expression profiling, if validated in an independent dataset, may help select oligometastatic patients most likely to benefit from metastasis-directed therapy. Cancer 2016;122:2242

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical and molecular markers of long‐term survival after oligometastasis‐directed stereotactic body radiotherapy (SBRT)

Wong

Watson

Pitroda

et al. 2016

Cancer

116

View full text Add to dashboard Cite

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“…However, the optimal prescription dose still needs further investigation. Former studies have proven that biologically effective doses (BED) of over 105 Gy are required for increased local control rates [7,12]. When delivering an increased fraction dose to the tumor, the risk of normal tissue toxicity can increase.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) in patients with lung metastases - prognostic factors and long-term survival using patient self-reported outcome (PRO)

et al. 2020

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Objectives: The present study aims to evaluate long-term side-effects and outcomes and confirm prognostic factors after stereotactic body radiotherapy (SBRT) of pulmonary lesions. This is the first work that combines the investigated data from patient charts and patient-reported outcome (PRO) up to 14 years after therapy. Materials and methods: We analyzed 219 patients and 316 lung metastases treated between 2004 and 2019. The pulmonary lesions received a median dose and dose per fraction of 35 Gy (range: 14-60.5 Gy) and 8 Gy (range: 3-20 Gy) to the surrounding isodose. During the last 1.5 years of monitoring, we added PRO assessment to our follow-up routine. We sent an invitation to a web-based survey questionnaire to all living patients whose last visit was more than 6 months ago. Results: Median OS was 27.6 months. Univariate analysis showed a significant influence on OS for KPS ≥90%, small gross tumor volume (GTV) and planning target volume (PTV), the absence of external metastases, ≤3 pulmonary metastases, and controlled primary tumor. The number of pulmonary metastases and age influenced local control (LC) significantly. During follow-up, physicians reported severe side-effects ≥ grade 3 in only 2.9% within the first 6 months and in 2.5% after 1 year. Acute symptomatic pneumonitis grade 2 was observed in 9.7%, as grade 3 in 0.5%. During PRO assessment, 39 patients were contacted, 38 patients participated, 14 participated twice during follow-up. Patients reported 15 cases of severe side effects (grade ≥ 3) according to PROCTCAE classification. Severe dyspnea (n = 6) was reported mostly.

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Radiation treatment planning study to investigate feasibility of delivering Immunotherapy in Combination with Ablative Radiosurgery to Ultra‐High DoSes (ICARUS)

Rokni

Pointer

George

et al. 2021

J Applied Clin Med Phys

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Immune checkpoint inhibitors improve survival in metastatic diseases for some cancers. Multisite SBRT with pembrolizumab (SBRT + Pembro) was shown to be safe with promising local control using biologically effective doses (BEDs) = 95-120 Gy. Increased BED may improve response rate; however, SBRT doses are limited by surrounding organs at risk (OARs). The purpose of this work was to develop and validate methods for safe delivery of ultra-high doses of radiation (BED 10 > 300) to be used in future clinical trials. Methods and Materials: The radiation plans from 15 patients enrolled on a phase I trial of SBRT + pembro were reanalyzed. Metastatic disease sites included liver (8/ 15), inguinal region (1/15), pelvis (2/15), lung (1/15), abdomen (1/15), spleen (1/15), and groin (1/15). Gross tumor volumes (GTVs) ranged from 80 to 708 cc. Following the same methodology used in the Phase I trial on which these patients were treated, GTVs > 65 cc were contracted to a 65 cc subvolume (SubGTV) resulting in only a portion of the GTV receiving prescription dose. Volumetric modulated arc therapy (VMAT) was used to plan treatments BED 10 = 360 Gy. Plans utilizing both 6FFF and 10FFF beams were compared to clinical plans delivering BED 10 = 112.50 Gy. The target primary goal was V100% > 95% with a secondary goal of V70% > 99% and OAR objectives per the trial. To demonstrate feasibility, plans were delivered to a diode array phantom and evaluated for fidelity using gamma analysis. Results: All 30 plans met the secondary coverage goal and satisfied all OAR constraints. The primary goal was achieved in 12/15 of the 6FFF plans and 13/15 of the 10FFF plans. Average gamma analysis passing rate using criteria of 3% dose difference

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Lung metastases in oligometastatic patients: outcome with stereotactic body radiation therapy (SBRT)

Abstract: SBRT is effective and safe. The main failure pattern is distant progression. The selection of patients with a high probability of remaining oligometastatic is crucial for the efficiency of SBRT, both clinically and in terms of resources.

Cited by 13 publications

References 19 publications

Clinical and molecular markers of long‐term survival after oligometastasis‐directed stereotactic body radiotherapy (SBRT)

Clinical and molecular markers of long‐term survival after oligometastasis‐directed stereotactic body radiotherapy (SBRT)

Stereotactic body radiotherapy (SBRT) in patients with lung metastases - prognostic factors and long-term survival using patient self-reported outcome (PRO)

Radiation treatment planning study to investigate feasibility of delivering Immunotherapy in Combination with Ablative Radiosurgery to Ultra‐High DoSes (ICARUS)

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