Stereotactic body radiotherapy for lung metastases as oligo-recurrence: a single institutional study

Aoki, Masahiko; Hatayama, Yoshiomi; Kawaguchi, Hideo; Hirose, Katsumi; Sato, Mariko; Akimoto, Hiroyoshi; Miura, Hiroyuki; Ono, Sachiko; Takai, Yoshihiro

doi:10.1093/jrr/rrv063

Cited by 44 publications

(41 citation statements)

References 20 publications

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“…Data from 18 retrospective studies with 1920 patients were used in the meta-analysis. The patients included 619 patients with pulmonary oligometastases from colorectal cancer treated by SBRT and 1301 patients with pulmonary oligometastases from other cancers treated by SBRT (meta-analysis 1; 2 – 5 , 7 – 20 Table 1 ). The local control rate in patients with pulmonary oligometastases from colorectal cancer was significantly lower than that in patients with pulmonary oligometastases from other cancers (OR = 3.17, 95% CI: 1.98-5.08, P < .00001) with substantial heterogeneity ( P = .02, I 2 = 47%; Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

Stereotactic Radiotherapy for Pulmonary Oligometastases From Colorectal Cancer: A Systematic Review and Meta-Analysis

Jingu

Matsushita

Yamamoto

et al. 2018

Technol Cancer Res Treat

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Purpose:The purpose of this study was to determine whether pulmonary oligometastases from colorectal cancer have greater radioresistance than that of pulmonary oligometastases from other cancers and whether good local control can be achieved by dose escalation in stereotactic body radiotherapy.Materials and Methods:This systematic review and meta-analysis were conducted according to the preferred reporting items for systematic reviews and meta-analyses statement and methods. Studies were obtained from a database search of PubMed, Web of Science, and Google Scholar for publications using search terms designed to identify studies on “oligometastases,” “lung,” “stereotactic radiotherapy,” and “colorectal cancer.” For meta-analysis 1, studies that showed the number of local failures after stereotactic body radiotherapy for pulmonary metastases from colorectal carcinoma and other cancers were included. For meta-analysis2, studies in which a comparison was made of local control rates of pulmonary metastases from colorectal carcinoma by stereotactic body radiotherapy with a higher dose and that with a lower dose were included. A meta-analysis was performed using Mantel-Haenszel statics with the fixed or random-effect model by Review Manager 5.3.Results:Eighteen retrospective studies with 1920 patients with pulmonary oligometastases were used in meta-analysis 1. The local control rate in patients with pulmonary oligometastases from colorectal cancer was significantly lower than that in patients with pulmonary oligometastases from other cancers (odds ratio = 3.10, P < .00001). Next, 8 retrospective studies with 478 patients were included in meta-analysis 2 for dose escalation. Better local control was achieved by a higher prescription dose than by a lower prescription dose (odds ratio = 0.16, P < .00001).Conclusion:Our meta-analysis indicated that local control of pulmonary oligometastases from colorectal cancer by stereotactic body radiotherapy was significantly worse than that of pulmonary metastases from other cancers; however, our results also indicated that good local control of pulmonary oligometastases from colorectal cancer can be achieved by dose escalation.

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Section: Resultsmentioning

confidence: 99%

Stereotactic Radiotherapy for Pulmonary Oligometastases From Colorectal Cancer: A Systematic Review and Meta-Analysis

Jingu

Matsushita

Yamamoto

et al. 2018

Technol Cancer Res Treat

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“…SBRT is a modern radiation technique that delivers a high dose to the tumor in a small number of fractions. For patients with pulmonary oligometastatic disease, SBRT achieves excellent local control and is associated with limited toxicity [9][10][11][12][13][14][15][16][17][18][19][20][21]. Patients treated with SBRT are usually not suitable for surgery, are often elderly and have multiple co-morbidities.…”

Section: Introductionmentioning

confidence: 99%

Survival and prognostic factors of pulmonary oligometastases treated with stereotactic body radiotherapy

et al. 2018

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Background: Stereotactic body radiotherapy (SBRT) for pulmonary oligometastatic disease achieves excellent treatment outcomes in terms of local control and toxicity. Patients treated with SBRT are often elderly and have multiple co-morbidities. This subset of patients may experience different survival as compared to young and fit patients subjected to radical metastasectomies. The purpose of this retrospective study was to evaluate OS and identify factors associated with OS for inoperable pulmonary oligometastases treated with SBRT. Material and methods: Criteria used for selection of patients with oligometastases included: metastases limited to 2 organs and in total 5 metastases at the time of treatment. Peripheral tumors were treated with 51 Gy to 60 Gy in three fractions or a single fraction of 30 Gy. Central tumors received a dose of 45-60 Gy in 5-8 fractions. Survival probabilities were estimated by means of Kaplan-Meier method and the relation between potential prognostic factors and OS was studied by means of Cox regression analyses. Results: In this study, 327 inoperable pulmonary oligometastases in 206 patients were treated with SBRT from the year 2005 to 2015. Primary sites of pulmonary oligometastases included colorectal carcinoma (n ¼ 118), lung carcinoma (n ¼ 36), melanoma (n ¼ 11), sarcoma (n ¼ 10), breast carcinoma (n ¼ 7), and other tumors sites (n ¼ 24). Median follow-up was 26 months. Median survival was 33 months. The 2-year and 5-year OS rates were 63% and 30%, respectively. On univariate analysis synchronous oligometastases (HR 0.59) and colorectal primary (HR 0.64) were associated with improved OS. On multivariable analysis synchronous oligometastases (HR 0.56), colorectal primary (HR 0.62) and tumor size <3 cm (HR 0.68) were independently associated with OS. Conclusions: SBRT to pulmonary oligometastases was associated with a 2-year OS of 63%. Tumor size <3 cm and colorectal primary tumors experienced improved OS compared to tumors >3 cm and noncolorectal primary tumors.

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“…[ 7 ] However, the clinical evidence supporting the use of SBRT for treating oligometastatic disease is still scarce. [ 7 , 13 , 14 ] Data from these small clinical studies suggest that liver, lung, isolated lymph nodes, spinal and adrenal metastasis, and postsurgical pelvic recurrence can be suitable for SBRT. In unresectable mCRC metastases, a local treatment with SBRT has shown to be able to improve patient's survival and quality of life with low morbidity.…”

Section: Discussionmentioning

confidence: 99%

The role of stereotactic body radiation therapy in oligometastatic colorectal cancer

et al. 2017

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Rationale:Regorafenib is the new standard third-line therapy in metastatic colorectal cancer (mCRC). However, the reported 1-year overall survival rate does not exceed 25%.Patient concerns:A 55-year-old man affected by mCRC, treated with regorafenib combined with stereotactic body radiotherapy (SBRT), showing a durable response.Interventions:After 6 months of regorafenib, a PET/CT scan revealed a focal uptake in a solid lung nodule which was treated with SBRT, whereas continuing regorafenib administration. Fourteen months later, the patient had further progression in a parasternal lymph node, but treatment with regorafenib was continued. The regorafenib-associated side effects, such us the hand-foot syndrome, were favorable managed by reducing the dose from 160 to 120 mg/day.Outcomes:Patient-reported outcome was characterized by a progression-free survival of approximately 3 years.Lessons:in presence of oligometastatic progression, a local SBRT while retaining the same systemic therapy may be a better multidisciplinary approach. Moreover, disease progression is no longer an absolute contraindication for continuing the regorafenib treatment.

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Stereotactic body radiotherapy for lung metastases as oligo-recurrence: a single institutional study

Cited by 44 publications

References 20 publications

Stereotactic Radiotherapy for Pulmonary Oligometastases From Colorectal Cancer: A Systematic Review and Meta-Analysis

Stereotactic Radiotherapy for Pulmonary Oligometastases From Colorectal Cancer: A Systematic Review and Meta-Analysis

Survival and prognostic factors of pulmonary oligometastases treated with stereotactic body radiotherapy

The role of stereotactic body radiation therapy in oligometastatic colorectal cancer

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