Stereotactic body radiotherapy for multisite extracranial oligometastases

Salama, Joseph K.; Hasselle, Michael D.; Chmura, Steven J.; Malik, Renuka; Mehta, Neil; Yenice, Kamil M.; Villaflor, Victoria M.; Stadler, Walter M.; Hoffman, Philip C.; Cohen, Ezra E.W.; Connell, Philip P.; Haraf, Daniel J.; Vokes, Everett E.; Hellman, Samuel; Weichselbaum, Ralph R.

doi:10.1002/cncr.26611

Cited by 293 publications

(121 citation statements)

References 42 publications

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“…Furthermore, several studies have shown that SBRT can be used in the setting of limited metastatic disease [Rusthoven et al, 2009, Villaruz et al, 2012, Salama et al, 2012, Iyengar et al, 2014.…”

Section: Introductionmentioning

confidence: 99%

In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

et al. 2016

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Stereotactic body image guided radiation therapy (SBRT) shows excellent results for the local control of early stage lung cancer. However, not all patients are eligible for SBRT, and advanced stage treatment is less successful and often associated with severe side effects. Scanned carbon ion therapy (PT) can deliver more conformal dose likely benefiting these patient groups.Therefore an in silico trial was conducted on early and advanced stage patients to identify potential advantages of PT. The patients were treated with SBRT at Champalimaud Center for the Unknown, Lisbon (Portugal). PT plans were simulated on 4DCTs, and rescanning was investigated for motion mitigation in 4D-dose calculations. A dedicated strategy for 4D intensity modulated particle therapy (IMPT) was developed and applied for advanced stage patients with multiple lesions. For clinically valid and reliable results the deformable image registrationnecessary for 4D-dose calculation -a quality assurance tool was developed and applied in the study.The results showed that target coverage was comparable in SBRT and PT, while PT delivered significantly lower doses to most critical structures, especially the heart, lungs, and esophagus.A highly complex case of advanced stage lung cancer could be treated in a single fraction of 24 Gy with PT, while SBRT could not deliver the full ablative dose treatment due to an excessive heart dose. The mean heart dose was reduced from 10 Gy to 0.8 Gy with PT for this specific patient.

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Section: Introductionmentioning

confidence: 99%

In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

et al. 2016

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“…These advanced techniques allow for very large doses of radiotherapy (sometimes up to 34 Gy in one session) to be delivered in a small number of treatment fractions (4,12,13). With appropriate attention to normal tissue doses, SABR can be delivered to multiple organ locations, including lung, liver, brain, bone, adrenal, and nodal metastases (4,(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

New Strategies in Stereotactic Radiotherapy for Oligometastases

Palma

Louie

Rodrigues

2015

Clinical Cancer Research

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Patients with metastatic solid tumors are usually treated with palliative intent. Systemic therapy and palliative radiation are often used, with the goals of prolonging survival or maintaining quality of life, but not of cure. In contrast to this paradigm, the theory of oligometastasis suggests that some patients who have a small number of metastases may be amenable to cure if all lesions can be eradicated. Aggressive treatment of patients with oligometastases, using either surgery or radiotherapy, has become more common in the past decade, yet in most situations, no randomized evidence is available to support such an approach. Stereotactic ablative radiotherapy (SABR) is a novel treatment for oligometastases, delivering large doses of radiotherapy in only a few treatments, with excellent rates of local control, and appears to be an excellent noninvasive alternative to surgical resection of metastases. This article reviews recent biologic and clinical data that support the existence of the oligometastatic state and discusses gaps in this evidence base. The emerging role for SABR in the management of this challenging patient population is discussed with a focus on ongoing clinical trials in an attempt to improve overall survival, delay progression, or induce immunologic anticancer effects through the abscopal effect.

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“…Fifty six tumors in 29 patients were treated and their 1 and 2 year overall survival rate was 81.5% and 56.7%, respectively. And they showed superior outcome in the patient with one to three metastases to the others with four or five metastases (2 year overall survival; 60.3% vs 21.9%) but there was not statistical significance (p=0.22) (Salama et al, 2011). …”

Section: Spine Metastasesmentioning

confidence: 92%