Phase II study of stereotactic body radiotherapy to primary tumor and metastatic locations in oligometastatic nonsmall-cell lung cancer patients

Collen, Christine; Christian, Nicolas; Schallier, Denis; Meysman, Marc; Duchateau, Michaël; Storme, Guy; Ridder, Mark De

doi:10.1093/annonc/mdu370

Cited by 156 publications

(127 citation statements)

References 18 publications

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“…Patients were included if they had fewer than or equal to five metastases at the time of SBRT with at least one treated site being a lymph node. Although there are variable definitions of oligometastatic disease, fewer than or equal to five metastases was used in this study, as this is consistent with the definition used in many published series and a recent international clinical trial [13–15]. The diagnosis of oligometastatic disease was based on clinical examination and imaging studies, preferably by positron emission tomography/computed tomography (PET/CT) scan although imaging with CT alone or MRI was permitted.…”

Section: Methodsmentioning

confidence: 99%

Institutional analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lymph node metastases

et al. 2017

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BackgroundIn limited metastatic burden of disease, stereotactic body radiotherapy (SBRT) has been shown to achieve high local control rates. It has been hypothesized that SBRT may translate to a better quality of life by delaying the need for systemic chemotherapy and possibly increasing survival. There is limited published literature on the efficacy of SBRT in limited nodal metastases. The primary aim is to review institutional outcomes of patients with solitary or oligometastatic lymph nodes treated with SBRT.MethodsA retrospective study of patients treated with SBRT to metastatic lymph nodes (March 2010–June 2015) was conducted. Endpoints of this study were local control (LC), chemotherapy-free survival (CFS) following SBRT, toxicities, progression free survival (PFS), and overall survival (OS).ResultsEighteen patients with a mean age of 65 years underwent SBRT to metastatic lymph nodes. Median follow-up was 33.6 months. There were four hepatocellular carcinoma, seven colorectal, four pancreatic, one esophageal, one gallbladder and one lung primary. Eleven (61%) patients had lymph node metastases at initial presentation of metastatic disease. Seven patients (39%) had systemic therapy prior to SBRT, with five patients receiving two lines of chemotherapy. Eight patients had solitary metastatic disease at the time of radiotherapy. All patients had <5 metastases. Median size of lymph node metastases was 1.95 cm (range: 0.8–6.2 cm). RT doses were 31 to 60 Gy in four to ten fractions, with 44% of patients receiving 35 Gy in 5 fractions. At 1 year, LC was 94% and CFS from SBRT was 60%. One-year PFS and OS were 39% and 89% respectively. There were no grade 3 or higher toxicities.ConclusionsIn this single institution study, SBRT to oligometastatic lymph nodes provided excellent LC and a moderate chemotherapy-free interval with minimal toxicities. Disease progression remains prominent in these patients and larger studies are warranted to identify those who benefit most from SBRT.

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Section: Methodsmentioning

confidence: 99%

Institutional analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lymph node metastases

et al. 2017

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“…We considered all the reports presenting data about oligometastatic NSCLC patients with brain metastases. We excluded the studies enrolling patients with various tumor types (8,(11)(12)(13)27,(29)(30)(31)(32)(33)(34). As reported in Table 2, literature data are available from case reports, retrospective series and phase II trials.…”

Section: Discussionmentioning

confidence: 99%

Unexpected long survival of brain oligometastatic non-small cell lung cancer (NSCLC) treated with multimodal treatment: a single-center experience and review of the literature

Onesti

Iacono

Angelini

et al. 2016

Transl. Lung Cancer Res.

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Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death worldwide.Fifty percent of the cases are metastatic at diagnosis and about 20% develop brain metastasis. The brain involvement represents a negative prognostic factor. However, some patients could benefit from locoregional treatments of metastatic foci and experience an unexpected long survival or healing. In the previous years some classifications were proposed to identify patients' prognostic category, according to stage of the primary tumor, the timing of metastases occurrence (synchronous or metachronous) and the number of metastatic sites. Several data show a benefit in patients receiving resection of both the primary tumor and brain metastases. Whole brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) are the selected options in most cases. Overall, literature data showed highly variable outcome, with an overall survival (OS) ranging from 5.9 to 68 months. No data from randomized and homogeneous trials are currently available. Therefore, a growing interest in this field is observed. Different trials investigating the effectiveness of local treatments and studies analyzing biological mechanisms are ongoing. In this report we analyze literature data and we explore the current field of study. Furthermore, we show a single institutional experience of multimodal management of stage IV NSCLC with brain metastases, experiencing an unexpected long survival. We conclude that a better knowledge of this subpopulation of patients and new studies in this field can lead to distinguish the patients who can benefit from local treatment from those with poor prognosis.

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“…It is reported that local control rates can reach

85 normal% - 90 normal%

after SBRT for early stage lung cancer, which is almost equal to surgery alone 1 , 2 . Up to now, the clinical application of SBRT has been extended to oligometastatic lung tumors and other types of malignancies, such as liver cancer and pancreatic cancer 4 , 5 , 6 . However, the implementation of SBRT technique is a great concern for its single high dose irradiated to target volume within a short time.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of interfractional variation of the centroid position and volume of internal target volume during stereotactic body radiotherapy of lung cancer using cone‐beam computed tomography

Sun

Cheng

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to determine interfractional variation of the centroid position and volume of internal target volume (ITV) during stereotactic body radiation therapy (SBRT) of lung cancer. From January 2014 to August 2014, a total of 32 patients with 37 primary or metastatic lung tumors were enrolled in our study. All patients received SBRT treatment in 4–5 fractions to a median dose of 48 Gy. Both 3D CT and 4D CT scans were used for radiotherapy treatment planning. 3D CBCT was acquired prior to treatment delivery to verify patient positioning. A total of 163 3D CBCT images were available for evaluation. 3D CBCT scans acquired for verification were registered with simulation CT scans. The ITVs were contoured on all verification 3D CBCT scans and compared to the initial gross target volume (GTV) or ITV in treatment planning system. GTV was based on 3D CT while ITV was based on both 3D CT and 4D CT. To assess the interfractional variation of ITV centroid position, we used vertebrae body adjacent to the tumor as reference point when performing the registration procedure. To eliminate the effect of time on tumor volume between simulation CT scan and the first fraction, the interfractional variation of ITV was evaluated from the first fraction to the last fraction. The overall 3D vector shift was 4.4±2.5 mm (range: 0.4−13.8 mm). The interfractional variation of ITV centroid position in superior‐inferior, anterior‐posterior, and left‐right directions were −0.7±2.7 mm, −1.4±3.4 mm, and −0.5±2.2 mm, respectively. No significant difference was observed between three directions (p=0.147). Large interfractional variations (≥5 mm) were observed in 12 fractions (9.3%) in superior‐inferior direction, 24 fractions (18.6%) in anterior‐posterior direction, and 5 fractions (3.9%) in left‐right direction. No time trend of tumor volume change measured in 3D CBCT was detected during four fractions (p=0.074). A significant (p=0.010) time trend was detected when evaluating the time trend of ITV change during 5 fractions and diameter was found to be significantly correlated with the ITV change (p=0.000). ITV did not show significant regression during SBRT treatment, but interfractional variation in the ITV centroid position was observed, especially in anterior‐posterior direction. An isotropic margin of 7 mm around ITV might be necessary for adequate coverage of interfractional variation of ITV centroid position, but only in case no soft tissue‐based setup is performed during SBRT treatment.PACS number(s): 87.55.dk

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Phase II study of stereotactic body radiotherapy to primary tumor and metastatic locations in oligometastatic nonsmall-cell lung cancer patients

Abstract: SBRT to all disease sites, primary tumor and metastatic locations, in oligometastatic NSCLC patients produced an acceptable median PFS of 11.2 months.

Cited by 156 publications

References 18 publications

Institutional analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lymph node metastases

Institutional analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lymph node metastases

Unexpected long survival of brain oligometastatic non-small cell lung cancer (NSCLC) treated with multimodal treatment: a single-center experience and review of the literature

Evaluation of interfractional variation of the centroid position and volume of internal target volume during stereotactic body radiotherapy of lung cancer using cone‐beam computed tomography

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