Phase I Trial of Stereotactic Body Radiation Therapy (SBRT) to Multiple Metastatic Sites: A NRG Oncology Study

Chmura, Steven J.; Winter, Kathryn; Salama, Joseph K.; Robinson, C.G.; Pisansky, Thomas M.; Borges, Virginia F.; Al‐Hallaq, Hania; Matuszak, Martha M.; Park, S.S.; Gonzalez, Victor; Hasan, Yasmin; Bazan, Jose G.; Wong, Philip; Yoon, Harold; Horton, Janet K.; Gan, Gregory N.; Milano, Michael T.; Sigurdson, Elin R.; Moughan, Jennifer; White, Julia

doi:10.1016/j.ijrobp.2018.06.187

Cited by 27 publications

(38 citation statements)

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“…The applied radiation doses were not in the range of the ablative doses applied in phase I or II studies regarding oligometastatic lesions of other primary disease. In the NRG-BR001 and SABR-COMET trials, the treatment dose was 30–50 Gy in 3–5 fractions and 30–60 Gy in 3–8 fractions, respectively (15, 17). Nevertheless, the local control in our patient cohort appears to be very promising.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy (SBRT) as Salvage Therapy for Oligorecurrent Pleural Mesothelioma After Multi-Modality Therapy

et al. 2019

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Introduction: Therapy options for patients with oligoprogressive malignant pleural mesothelioma (MPM) are limited. Stereotactic Body Radiotherapy (SBRT) may be a promising therapeutic option, as it delivers a localized ablative dose of radiation and therefore balances efficacy and treatment related toxicities. The intent of this retrospective analysis was to evaluate the feasibility of SBRT for limited pleural recurrences.Methods and Materials: This retrospective single-institution study is based on the 21 consecutive patients treated with hypofractionated radiotherapy for oligoprogressive MPM. Clinical and radiological data was collected at regular follow-up visits including toxicity, local control and survival.Results: At primary diagnosis, 57% of the patients presented with stage III disease. Initial treatment of MPM consisted of induction chemotherapy (n = 12) prior to a macroscopic complete resection (n = 18). Three patients received additional intracavitary chemotherapy and another three patients were treated with chemotherapy alone without another treatment at the time of first diagnosis. A total of 50 lesions in recurrent MPM were treated with SBRT. The median number of radiotherapy fractions was 5 (range 3–20) with a median dose per fraction of 5 Gy (range 2.5–12.5 Gy). The median total treatment dose was 30 Gy (20–50 Gy) with a median prescription isodose line (IDL) of 65% (65–100%). Median follow-up of all patients from diagnosis was 28 months (range 7–152 months). Analyzing all lesions separately, the 12-months-local control from SBRT was 73.5%. The median progression free survival (PFS) after SBRT was 6 months (range 0–21 months) and the median OS from first first SBRT was 29 months (range 0–61 months). Only one patients experienced above Grade 3 toxicities.Conclusion: This analysis demonstrates the feasibility of a SBRT approach for oligorecurrent MPM. SBRT was well-tolerated even after multiple repetitions and local control was high with a promising median OS.

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Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy (SBRT) as Salvage Therapy for Oligorecurrent Pleural Mesothelioma After Multi-Modality Therapy

et al. 2019

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“…Advantages of this approach include its non-invasive nature, ease of delivery in the outpatient setting, ability to treat multiple sites in the body in a short time frame, and relatively low toxicity profile. 38 Limitations to the use of SABR reflect those situations mentioned earlier in which surgery is often favored, including difficulty meeting dose constraints in large tumors (with an upper limit of 5-6 cm, depending on the institution) and in lesions adjacent to highly dose-sensitive critical organs. It is notable that the local control rates of treated metastases are correlated with radiotherapy dose delivered, with reported series ranging from 70 to 85%.…”

Section: Treatment Techniquesmentioning

confidence: 99%

Local Ablative Therapies in Oligometastatic NSCLC: New Data and New Directions

Lang

Gomez

Palma

2020

Semin Respir Crit Care Med

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The oligometastatic and oligoprogressive disease states have been recently recognized as common clinical scenarios in the management of non-small cell lung cancer (NSCLC). As a result, there has been increasing interest in treating these patients with locally ablative therapies including surgery, conventionally fractionated radiotherapy, stereotactic ablative radiotherapy, and radiofrequency ablation. This article provides an overview of oligometastatic and oligoprogressive disease in the setting of NSCLC and reviews the evidence supporting ablative treatment. Phase II randomized controlled trials and retrospective series suggest that ablative treatment of oligometastases may substantially improve progression-free survival and overall survival, and additional large randomized studies testing this hypothesis in a definitive context are ongoing. However, several challenges remain, including quantifying the possible benefits of ablative therapies for oligoprogressive disease and developing prognostic and predictive models to assist in clinical decision making.

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“…The volumes were as follows: PTV1 = 2.98 cm 3 , PTV2 = 7.75 cm 3 , PTV3 = 3.98 cm 3 , PTV4 = 4.24 cm 3 , and PTV5 = 9.74 cm 3 . Figure 2 shows the lesions to be treated.…”

Section: Case Presentationmentioning

confidence: 99%

“…A positron emission tomography/CT (PET/CT) scan confirmed the presence of these right lung metastasis and he was referred back to Radiation Oncology at the University of Kentucky for further management. We then simulated and planned the patient in a similar fashion as before and treated the two right lower lobe lesions synchronously using 50 Gy in five fractions (PTV1 = 22.57 cm 3 ) and 45 Gy in five fractions (PTV2 = 13.28 cm 3 ). A combined DVH was created, which included the prior SBRT plan, and showed the bilateral lung-PTV was 10% and the right lung-PTV was 21%.…”

Section: Case Presentationmentioning

confidence: 99%

“…A recent National Surgical Adjuvant Breast and Bowel Project, Radiation Therapy Oncology Group, Gynecologic Oncology Group (NRG) study began in hopes of determining the safety and efficacy of SBRT treatment to four or less metastatic lesions [2]. Results from the study published by Chmura et al demonstrated the safety of treating between two and four metastases with SBRT [3]. However, there is no consensus on the safety of treating greater than or equal to five lesions, the number of treatments that can be delivered, the safety of treating neighboring lesions, or of the delivery method of the SBRT treatments.…”

Section: Introductionmentioning

confidence: 99%

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Safety of Stereotactic Body Radiation Therapy for Seven Ipsilateral Lung lesions

Bernard¹,

Critchfield²,

Kudrimoti³

2020

Cureus

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Phase I Trial of Stereotactic Body Radiation Therapy (SBRT) to Multiple Metastatic Sites: A NRG Oncology Study

Cited by 27 publications

References 0 publications

Stereotactic Body Radiation Therapy (SBRT) as Salvage Therapy for Oligorecurrent Pleural Mesothelioma After Multi-Modality Therapy

Stereotactic Body Radiation Therapy (SBRT) as Salvage Therapy for Oligorecurrent Pleural Mesothelioma After Multi-Modality Therapy

Local Ablative Therapies in Oligometastatic NSCLC: New Data and New Directions

Safety of Stereotactic Body Radiation Therapy for Seven Ipsilateral Lung lesions

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