Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

Abstract

Background: Patients with oligometastatic disease can potentially be cured by using an ablative therapy for all active lesions. Stereotactic body radiotherapy (SBRT) is a non-invasive treatment option that lately proved to be as effective and safe as surgery in treating lung metastases (LM).However, it is not clear which patients benefit most and what are the most suitable fractionation regimes. The aim of this study was to analyze treatment outcomes after single fraction radiosurgery (SFRS) and fractionated SBRT (fSBRT) in patients with lung oligometastases and identify prognostic clinical features for better survival outcomes. Methods: Fifty-two patients with 94 LM treated with SFRS or fSBRT between 2010 and 2016 were analyzed. The characteristics of primary tumor, LM, treatment, toxicity profiles and outcomes were assessed. Kaplan-Meier and Cox regression analyses were used for estimation of local control (LC), overall survival (OS), progression free survival and distant metastases free survival (DMFS). Results: Ninety-four LM in 52 patients were treated using SFRS/fSBRT with a median of 2 lesions per patient (range: 1-5). The median planning target volume (PTV)-encompassing dose for SFRS was 24 Gy (range: 17-26) compared to 45 Gy (range: 20-60) in 2-12 fractions in fSBRT. The median follow-up time was 21 months (range: 3-68). LC rates at 1 and 2years for SFSR vs. fSBRT were 89% and 83% vs. 75% and 59%, respectively (p=0.026). LM treated with SFSR were significantly smaller (p=0.001). The 1 and 2-year OS rates for all patients were 84% and 71%, respectively. In univariate analysis treatment with SFRS, an interval of ≥ 12 months between diagnosis of LM and treatment, non-colorectal cancer histology and BED <100 Gy were significantly associated with better LC. However, none of these parameters remained significant in the multivariate Cox regression model. OS was significantly better in patients with negative lymph nodes (N0), Karnofsky performance status (KPS) >70% and time to first metastasis ≥12 months. There was no grade 3 acute or late toxicity. Conclusions: We observed good LC and low toxicity rates after SFRS for small lung metastases. Longer time to first metastasis, good KPS and N0 predicted better OS. BackgroundMetastatic progression of cancer is linked to poor prognosis and is the leading cause of cancer-related deaths (1). Few decades ago, the diagnosis of metastatic disease was related with lethal outcomes.

The ECLIPSE Study: Efficacy of Cryoablation on Metastatic Lung Tumors With a 5-Year Follow-Up

“…[17][18][19][20][21] The longer-term survival results of treatment with CA presented here are comparable with those of other forms of percutaneous treatments (i.e., SBRT, RFA, MWA) and with other studies of CA for metastatic lung disease. [22][23][24][25][26][27][28][29][30][31] The phase 2 STRIPE study, which focused on SBRT for metastatic lung disease, reported an OS of 62.2% after 2 years of follow-up, 23 whereas we report 84.3% in our study. In the RSSearch Registry, data were included on lung metastases associated with several different types of solid primary cancers.…”

“…22 Other studies of SBRT have found that rates of local progression-free survival after 2 years range from 26% to 66%. 23,24,32 A recent meta-analysis of 686 colorectal pulmonary metastases across 15 studies reported a local control rate of 81%, 66%, and 60% at 1 year, 2 years, and 3 years, respectively. 33 Results vary similarly across studies of RFA and MWA.…”

“…Follow-up data were collected at 3, 6, and 12 months postablation and annually thereafter (24,36,48, and 60 mo). Follow-up included a clinical examination with physical performance (ECOG and KPS) assessments, chest CT (with and without intravenous contrast), and QoL self-assessment using the QoL Short Form-12 (SF-12).…”

Cellular bases of hypofractionated radiotherapy protocols for lung cancer

“…We verified that SBRT presents optimal therapeutic results. Coinciding with other studies (Wang et al 2016, Suh & Cho 2019, Palma et al 2019, Kalinauskaite et al 2020, Uzel et al 2019, we obtained good overall survival rates and progression-free survival, with no significant increases in toxicity. Only four out of 22 individuals developed mild side effects (esophagitis, pyrosis, dysphagia or cough with mucus), with no fatal or rare effects, 2020).…”

Radiation-induced lung toxicity – cellular and molecular mechanisms of pathogenesis, management, and literature review

“…≥ 30 Gy) may be associated with increased toxicity [40,41]. However, several studies reported low rates of ≥ grade III side effects in selected patient cohorts [35,42].…”