Outcomes of extra-cranial stereotactic body radiotherapy for metastatic breast cancer: Treatment indication matters

Tan, Hendrick; Cheung, Patrick; Louie, Alexander V.; Myrehaug, Sten; Niglas, Mark; Atenafu, Eshetu G.; Chu, William; Chung, Hans T.; Poon, Ian; Sahgal, Arjun; Soliman, Hany

doi:10.1016/j.radonc.2021.06.012

Cited by 21 publications

(26 citation statements)

References 49 publications

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“…Weykamp et al [ 54 ], using the 0.3 T system for MR-Linac for hepatocellular carcinoma, showed that 5-fraction hypofractionation was well-tolerable with minimum toxicity with 2 years of overall survival of 82%, which is an impressive outcome. For oligometastatic cases arising from breast cancer, Tan et al [ 55 ] showed better outcomes with minimal toxicity, as reported by the patients. The most difficult disease site, pancreas, with poor outcome, has been the main theme for MR-Linac, as it can provide better visualization, targeting, and adaptive therapy to minimize normal tissue toxicities.…”

Section: Successmentioning

confidence: 77%

Emergence of MR-Linac in Radiation Oncology: Successes and Challenges of Riding on the MRgRT Bandwagon

Das

Yadav

Mittal

2022

JCM

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The special issue of JCM on “Advances of MRI in Radiation Oncology” provides a unique forum for scientific literature related to MR imaging in radiation oncology. This issue covered many aspects, such as MR technology, motion management, economics, soft-tissue–air interface issues, and disease sites such as the pancreas, spine, sarcoma, prostate, head and neck, and rectum from both camps—the Unity and MRIdian systems. This paper provides additional information on the success and challenges of the two systems. A challenging aspect of this technology is low throughput and the monumental task of education and training that hinders its use for the majority of therapy centers. Additionally, the cost of this technology is too high for most institutions, and hence widespread use is still limited. This article highlights some of the difficulties and how to resolve them.

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Section: Successmentioning

confidence: 77%

Emergence of MR-Linac in Radiation Oncology: Successes and Challenges of Riding on the MRgRT Bandwagon

Das

Yadav

Mittal

2022

JCM

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“…Similar observation was reported in the study with a cohort of metastatic breast cancer patients treated with SRT. 5 Interestingly, in another exploratory analysis, we found that survival of oligometastatic patients after first SRT was worse when they received systemic treatment. Probably, chemotherapy was administered for patients with more aggressive sarcoma subtypes associated with poorer survival.…”

Section: Discussionmentioning

confidence: 88%

Stereotactic radiotherapy for soft tissue and bone sarcomas: real-world evidence

et al. 2022

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Introduction: Selected patients with locally advanced or metastatic soft tissue and bone sarcomas (STBS) may benefit from intensive local treatment, such as stereotactic radiotherapy (SRT). This study aimed to summarize the utilization and outcomes of SRT in STBS and to identify predictive factors for progression and survival. Materials and methods: Consecutive patients with advanced STBS who underwent STBS in a sarcoma tertiary center were identified. We collected tumor- and treatment-related factors. Endpoints comprised time to local progression (TTLP), local progression-free survival (LPFS), time to progression, progression-free survival, and overall survival (OS). The Cox proportional-hazards model was used to identify prognostic factors. Results: We identified 141 patients who underwent 233 SRTs. Median follow-up was 21 months. Local and distant progression occurred after 19 and 163 SRTs, respectively. SRT for lung metastases was predictive for better TTLP and LPFS (hazard ratio, HR = 0.12, p = 0.007 and HR = 0.42, p = 0.002, respectively). Bone sarcoma (HR for TTLP = 3.18, p = 0.043; HR for LPFS = 1.99, p = 0.028) and lower administered dose (HR for TTLP = 0.98, p = 0.007; HR for LPFS = 0.99, p = 0.012) were predictive for worse TTLP and LPFS. SRT for oligometastases (HR = 0.46, p = 0.021) and lung metastases (HR = 0.55, p = 0.046) was predictive for better OS, whereas diagnosis of bone sarcoma (HR = 2.05, p = 0.029) was predictive for worse OS. Conclusion: SRT provides excellent local control in STBS patients without significant toxicity. Patients with oligometastatic disease, lung metastases, and soft tissue sarcomas benefit the most from SRT. The dose escalation moderately enhances local control; however, it does not translate into better survival.

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“…Analyses from seven studies [ 10 , 17 – 22 ] encompassing a sample size of 15–120 patients with 1–5 metastases (mostly ≤ 2 lesions in 70.9–100 % of cases) reported LC rates at 1 and 2 years between 86.9 and 100 % and 79.2 and 100 %, respectively. The 1‑ and 2‑year PFS ranged from 38 to 80 % (seven studies) and 8 to 75 % (nine studies), respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Tan et al. demonstrated that for patients treated with SBRT, those with oligoprogressive disease had an inferior prognosis as compared to patients with OMD, with 1‑ and 2‑year PFS rates of 19.6 and 8 % compared to 66 and 52 %, respectively [ 22 ]. Despite this, or even because of it, oligoprogression may be a particularly interesting subclass for local therapies within OMD.…”

Section: Methodsmentioning

confidence: 99%

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Oligometastasis in breast cancer—current status and treatment options from a radiation oncology perspective

et al. 2022

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Evidence from a few small randomized trials and retrospective cohorts mostly including various tumor entities indicates a prolongation of disease free survival (DFS) and overall survival (OS) from local ablative therapies in oligometastatic disease (OMD). However, it is still unclear which patients benefit most from this approach. We give an overview of the several aspects of stereotactic body radiotherapy (SBRT) in extracranial OMD in breast cancer from a radiation oncology perspective. A PubMed search referring to this was conducted. An attempt was made to relate the therapeutic efficacy of SBRT to various prognostic factors. Data from approximately 500 breast cancer patients treated with SBRT for OMD in mostly in small cohort studies have been published, consistently indicating high local tumor control rates and favorable progression-free (PFS) and overall survival (OS). Predictors for a good prognosis after SBRT are favorable biological subtype (hormone receptor positive, HER2 negative), solitary metastasis, bone-only metastasis, and long metastasis-free interval. However, definitive proof that SBRT in OMD breast cancer prolongs DFS or OS is lacking, since, with the exception of one small randomized trial (n = 22 in the SBRT arm), none of the cohort studies had an adequate control group. Further studies are needed to prove the benefit of SBRT in OMD breast cancer and to define adequate selection criteria. Currently, the use of local ablative SBRT should always be discussed in a multidisciplinary tumor board.

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Outcomes of extra-cranial stereotactic body radiotherapy for metastatic breast cancer: Treatment indication matters

Cited by 21 publications

References 49 publications

Emergence of MR-Linac in Radiation Oncology: Successes and Challenges of Riding on the MRgRT Bandwagon

Emergence of MR-Linac in Radiation Oncology: Successes and Challenges of Riding on the MRgRT Bandwagon

Stereotactic radiotherapy for soft tissue and bone sarcomas: real-world evidence

Oligometastasis in breast cancer—current status and treatment options from a radiation oncology perspective

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