Stereotactic Body Radiotherapy in Oligomestatic/Oligoprogressive Sarcoma

Greto, Daniela; Loi, Mauro; Stocchi, G.; Salvestrini, Viola; Muratori, Francesco; Scoccianti, Guido; Roselli, Giuliana; Palomba, Annarita; Lorenzetti, Victoria; Cerbai, Cecilia; Desideri, Isacco; Bonomo, Pierluigi; Campanacci, Domenico Andrea; Livi, Lorenzo

doi:10.1097/ppo.0000000000000551

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…On the contrary, some studies, which analyzed both intra- and extra-thoracic metastatic lesions, showed a statistically significant dose-response relationship. Greto et al [ 29 ] analyzed 77 metastatic lesions from 40 patients treated by SBRT. 60% of the lesions were pulmonary metastatic lesions.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes of stereotactic body radiation therapy for pulmonary metastasis from sarcoma: a multicenter, retrospective study

Lee

Kim

et al. 2023

Radiat Oncol

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Purpose The aim of this study was to evaluate the treatment outcomes and potential dose-response relationship of stereotactic body radiation therapy (SBRT) for pulmonary metastasis of sarcoma. Materials and methods A retrospective review of 39 patients and 71 lesions treated with SBRT from two institutions was performed. The patients had oligometastatic or oligoprogressive disease, or were receiving palliation. Doses of 20–60 Gy were delivered in 1–5 fractions. The local control per tumor (LCpT) was evaluated according to the biologically effective dose with an α/β ratio of 10 (BED10) of the prescribed dose (BED10 ≥ 100 Gy vs. BED10 < 100 Gy). Clinical outcomes per patient, including local control per patient (LCpP), pulmonary progression-free rate (PPFR), any progression-free rate (APFR), and overall survival (OS) were investigated. Results The median follow-up period was 27.2 months. The 1-, 2-, and 3-year LCpT rates for the entire cohort were 100.0%, 88.3%, and 73.6%, respectively. There was no observed difference in LCpT between the two BED10 groups (p = 0.180). The 3-year LCpP, PPFR, APFR, and OS rates were 78.1%, 22.7%, 12.9%, and 83.7%, respectively. Five (12.8%) patients with oligometastasis had long-term disease-free intervals, with a median survival period of 40.7 months. Factors that were associated with a worse prognosis were oligoprogression (vs. oligometastasis), multiple pulmonary metastases, and simultaneous extrathoracic metastasis. Conclusion SBRT for pulmonary metastasis of sarcoma is effective. Some selected patients may achieve durable response. Considerations of SBRT indication and disease extent may be needed as they may influence the prognosis.

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Section: Discussionmentioning

confidence: 99%

Treatment outcomes of stereotactic body radiation therapy for pulmonary metastasis from sarcoma: a multicenter, retrospective study

Lee

Kim

et al. 2023

Radiat Oncol

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“…The benefit of surgery in controlling lung metastases and improving survival has been shown in STS [23,24]. The role of SBRT for oligometastatic STS appears to be both safe and effective [25,26]. Hypofractionated radiation for palliation may allow for improvement of patient quality of life and compared to conventionally fractioned approaches affords decreased treatment time and possibly an increased durability of palliative response.…”

Section: Future Role For Mri In Radiation For Stsmentioning

confidence: 99%

The Role of MRI-Guided Radiotherapy for Soft Tissue Sarcomas

Blitzer

Yadav

Morris

2022

JCM

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Soft tissue sarcomas (STS) are a rare class of tumors that originate from mesenchymal tissues and occur most frequently in the extremities, trunk, and retroperitoneum. Surgical resection with R0 margins is the primary curative treatment for most localized STS. In this setting, radiation therapy is used either pre-operatively or post-operatively to reduce the rate of local recurrence. Modern pre- or post-operative radiation therapy rely on the use of MRI sequences to guide target delineation during treatment planning. MRI-guided radiotherapy also offers unique advantages over CT-guided approaches in differentiating STS from surrounding normal soft tissues and enabling better identification of target volumes on daily imaging. For patients with unresectable STS, radiation therapy may offer the best chance for local tumor control. However, most STS are relatively radioresistant with modest rates of local control achieved using conventionally fractionated radiation. Specialized techniques such as hypofractionated radiation may allow for dose intensification and may increase rates of local control for STS. In these settings, MRI becomes even more critical for the delineation of targets and organs at risk and management of tumor and organ at risk motion during and between radiotherapy treatment fractions.

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“…In the current issue of the Cancer Journal , Greto et al 2 report their experience using lung stereotactic body radiation therapy (SBRT) for oligometastatic sarcoma. Their study shows promising rates of local control (2-year local control, 67%) and survival (2-year overall survival, 40%).…”

mentioning

confidence: 99%

“…The article by Greto et al 2 adds to the growing body of evidence supporting the use of lung SBRT for sarcoma metastases. Comparison studies of the various ablative modalities and surgery would be beneficial but are unlikely to happen, given the rarity of sarcoma and challenges in enrolling patients on these types of clinical trials.…”

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confidence: 99%

Role of Stereotactic Body Radiation Therapy in Oligometastatic Sarcoma

Cuneo¹

2021

Cancer J

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M anaging patients with metastatic soft tissue sarcoma can be challenging because of the limited systemic therapy options and lack of randomized data to drive management decisions. Although most patients with sarcoma present with localized disease initially, the development of metastases is very common, especially in high-grade tumors. Sarcoma predominately spreads to the lung, although metastases to other organs, such as the liver or bone, are also seen. Many patients who develop metastases will only do so in a limited number of sites. The optimal management of patients with limited volume metastatic disease has been evolving rapidly over the past decade.Aggressive management of low-volume metastatic sarcoma with surgery has been associated with survival rates of approximately 40%. 1 Surgery is the preferred modality to manage oligometastatic disease; however, many patients are not good candidates for surgical resection because of underlying comorbidities. In addition, in selective situations where surgery would require removing a large volume of lung tissue (i.e., lobectomy or pneumectomy), alternative local therapies can be considered.In the current issue of the Cancer Journal, Greto et al. 2 report their experience using lung stereotactic body radiation therapy (SBRT) for oligometastatic sarcoma. Their study shows promising rates of local control (2-year local control, 67%) and survival (2-year overall survival, 40%). In addition, treatment was very well tolerated with no reported toxicities of grade 3 or higher. Factors that resulted in better outcomes included a higher tumor biologically equivalent dose and a longer interval from time of initial diagnosis to development of metastatic disease. Their study adds to the growing body of evidence supporting the use of lung SBRT for oligometastatic sarcoma.Stereotactic body radiation therapy is a well-established treatment modality for treating cancer of the lung. This technology has been extensively studied in early-stage lung cancer patients and is associated with excellent local control and low toxicity rates when using modern techniques. Comparison studies examining lung SBRT and other ablative therapies, such as radiofrequency ablation, suggest that SBRT has improved control rates 3,4 and is more cost-effective. 5 In addition, our understanding of normal tissue dose tolerance and advances in technology including image guidance have made lung SBRT very safe, even in patients with poor underlying lung function.Sarcomas are often inaccurately classified as being radioresistant. In reality, radiation plays an important role in all stages of this disease. Multiple studies have demonstrated the ability of radiation to decrease the risk of local recurrence before or after surgery by more than half. 6,7 Based off these studies, neoadjuvant or adjuvant radiation is considered standard of care for most soft tissue sarcomas with high-risk features (e.g., high grade, large size, deep location). Radiation is also indicated for palliation of symptoms related to metastatic ...

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Stereotactic Body Radiotherapy in Oligomestatic/Oligoprogressive Sarcoma

Cited by 7 publications

References 21 publications

Treatment outcomes of stereotactic body radiation therapy for pulmonary metastasis from sarcoma: a multicenter, retrospective study

Treatment outcomes of stereotactic body radiation therapy for pulmonary metastasis from sarcoma: a multicenter, retrospective study

The Role of MRI-Guided Radiotherapy for Soft Tissue Sarcomas

Role of Stereotactic Body Radiation Therapy in Oligometastatic Sarcoma

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