Stereotactic body radiation therapy for lung metastases

Ricardi, Umberto; Filippi, Andrea Riccardo; Guarneri, Alessia; Ragona, Riccardo; Mantovani, Cristina; Giglioli, F.R.; Botticella, Angela; Ciammella, Patrizia; Iftode, C.; Buffoni, L; Ruffini, Enrico; Scagliotti, Giorgio Vittorio

doi:10.1016/j.lungcan.2011.04.021

Cited by 129 publications

(103 citation statements)

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“…At our institution, a similar dosing schedule is used for patients who present with oligometastatic lung and liver metastases. Various fractionation schedules have been reported for patients treated for lung [23][24][25] and liver metastases [13,26,27]. Dose escalation was reported to improve local control rates in a phase I dose-escalation trial of hepatic metastases from Rule et al The study randomized 27 patients to 30 Gy in 3 fractions, 50 Gy in 5 fractions, and 60 Gy in 5 fractions [12].…”

Section: Discussionmentioning

confidence: 99%

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Ahmed

Berglund

Shridhar

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Purpose/Objectives-We have previously developed a multigene expression model of tumor radiosensitivity (RSI) with clinical validation in multiple independent cohorts (breast, rectal, esophageal, and head and neck). The purpose of this study was to assess differences in RSI scores between primary colon cancer and metastases.Methods and Materials-Patients were identified from our institutional IRB approved prospective observational protocol. A total of 704 metastatic and 1,362 primary lesions were obtained from a de-identified meta-data pool. RSI was calculated using the previously published ranked based algorithm. An independent cohort of 29 lung or liver colon metastases treated with 60 Gy in 5 fractions stereotactic body radiotherapy (SBRT) was used for validation.Results-The most common sites of metastases included liver (n=374; 53%), lung (n=116; 17%), and lymph nodes (n=40; 6%). Sixty percent of metastatic tumors compared with 54% of primaries were in the RSI-radioresistant (RSI-RR) peak, suggesting that, metastatic tumors may be slightly more radioresistant than primaries (p=0.01). In contrast, when we analyzed metastases based on anatomical site, we uncovered large differences in RSI. The median RSIs for metastases Corresponding Author: Javier F. Torres-Roca MD, H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, 12902 Magnolia Dr., Tampa, FL 33612 USA, Telephone: 00-1-813-745-3568, Fax: 00-1-813-745-7231, javier.torresroca@moffitt.org. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflicts of HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript in descending order of radioresistance were ovary (0.48), abdomen (0.47), liver (0.43), brain (0.42), lung (0.32), and lymph nodes (0.31), p<0.0001. These findings were confirmed when the analysis was restricted to lesions from the same patient (n=139). In our independent cohort of treated lung and liver metastases, lung metastases had an improved local control (LC) rate over patients with liver metastases (2 yr LC 100% vs. 73.0%, p=0.026).Conclusions-Assessment of radiosensitivity between primary and metastatic tissues of colon cancer histology, reveals significant differences based on anatomical location of metastases. These initial results warrant validation in a larger clinical cohort.

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Section: Discussionmentioning

confidence: 99%

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Ahmed

Berglund

Shridhar

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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“…Dose limits to organs-at-risk were described previously (9) and were as follows (converted in 2 Gy-equivalent according to Linear Quadratic Model): ipsilateral Mean Lung Dose  15 Gy 2 (radiation pneumonitis, alfa/beta 5 3.5 Gy), spinal cord  36 Gy 2 (alfa/beta 5 2 Gy), skin  56 Gy 2 (necrosis, alfa/beta 5 2.5 Gy), trachea/main bronchi  78 Gy 2 (stenosis/fistula, alfa/beta 5 3 Gy), heart  70 Gy 2 (pericarditis, alfa/beta 5 4 Gy).…”

Section: Follow-up and Statisticsmentioning

confidence: 99%

Outcomes of Single Fraction Stereotactic Ablative Radiotherapy for Lung Metastases

Filippi

Badellino

Guarneri

et al. 2014

Technol Cancer Res Treat

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Stereotactic Ablative Radiotherapy (SABR) has been previously investigated as an alternative to thoracic surgery in patients with a limited number of pulmonary nodules from different primary tumors. We here report the clinical outcomes of a series of consecutive patients homogenously selected and treated with single dose SABR in our Institution. Eligibility criteria were: 1-5 lung metastases, maximum tumor diameter 50 mm, absent or controlled extra-thoracic disease, adequate pulmonary function, no prior radiotherapy, performance status ECOG 0-1. All patients were treated with a single dose of 26 Gy prescribed to the months. Treated metastasis progression at SABR site was observed in 10 lesions (11.1%), and actuarial LC rates at 1 and 2 years were respectively 93.4% and 88.1%. Systemic failure occurred in 37 patients (55.2%) at a median interval of 8 months after SABR. PFS rates were 72% and 55.4% at 1 and 2 year. Seven patients had grade 1 (10.4%) and 8 grade 2-3 late radiological toxicity (11.9%), while 6 experienced late chest wall toxicity (2 rib fractures, 4 chronic chest pain, 8.9%). CSS rates at 1 and 2 years were 90% and 76%, while OS rates were 85.1% and 70.5%, respectively. Median survival time was 40 months. On multivariate analysis, a disease-free interval longer than 24 months was close to significance for a benefit in CSS (p 5 0.07; HR 0.34 [95% CI 0.1-1.12]). The study includes a cohort of patients treated with single fraction 26 Gy SABR followed for a prolonged time interval. Single fraction SABR appears to be an effective treatment option, with little observed acute toxicity and limited late toxicity (15%); its advantages also include a high patients' compliance, a short overall treatment time and an easy combination with systemic therapies. These results might provide supportive evidence to the use of single fraction SABR as a valid and acceptable alternative to surgery for pulmonary metastases from different primary tumors.

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“…Experience has led investigators to use ablative radiation against a variety of tumor types metastasizing to the lung 27,28 . The new SBRT platform introduces a radiation delivery system particularly attuned to the treatment of moving tumors.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

Kunos

Fabien

Shanahan

et al. 2015

JoVE

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Physicians considering stereotactic ablative body radiation therapy (SBRT) for the treatment of extracranial cancer targets must be aware of the sizeable risks for normal tissue injury and the hazards of physical tumor miss. A first-of-its-kind SBRT platform achieves high-precision ablative radiation treatment through a combination of versatile real-time imaging solutions and sophisticated tumor tracking capabilities. It uses dualdiagnostic kV x-ray units for stereoscopic open-loop feedback of cancer target intrafraction movement occurring as a consequence of respiratory motions and heartbeat. Image-guided feedback drives a gimbaled radiation accelerator (maximum 15 x 15 cm field size) capable of real-time ±4 cm pan-and-tilt action. Robot-driven ±60° pivots of an integrated ±185° rotational gantry allow for coplanar and non-coplanar accelerator beam set-up angles, ultimately permitting unique treatment degrees of freedom. State-of-the-art software aids real-time six dimensional positioning, ensuring irradiation of cancer targets with sub-millimeter accuracy (0.4 mm at isocenter). Use of these features enables treating physicians to steer radiation dose to cancer tumor targets while simultaneously reducing radiation dose to normal tissues. By adding respiration correlated computed tomography (CT) and 2-[ . In this article, we describe new radiation plans for the treatment of moving lung tumors.

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Stereotactic body radiation therapy for lung metastases

Cited by 129 publications

References 9 publications

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Outcomes of Single Fraction Stereotactic Ablative Radiotherapy for Lung Metastases

Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

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