Stereotactic Body Radiotherapy in Patients with Lung Oligometastases from Colorectal Cancer

Pasqualetti, Francesco; Montrone, S.; Vivaldi, Caterina; Zani, M.; Fedele, David A.; Fornaro, Lorenzo; Pasqualetti, Giuseppe; Salvatore, Lisa; Manfredi, B.; Laliscia, Concetta; Coraggio, G.; Gonnelli, Alessandra; Loupakis, Fotios; Masi, Gianluca; Sainato, A.; Monzani, Fabio; Falcone, Alfredo; Paiar, Fabiola

doi:10.21873/anticanres.11323

Cited by 24 publications

(30 citation statements)

References 8 publications

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“…They also concluded that local control rates following 48 Gy in 4 fractions were significantly worse in metastatic lung tumors when compared with stage I primary lung cancer, and suggested increasing the SBRT dose for metastatic lung tumors. Several retrospective studies published recently also demonstrated colorectal cancer lung metastases are associated with a higher hazard of local failure and require higher radiation doses [ 42 , 43 , 48 , 49 , 54 , 55 ]. The results of these studies are summarized in Table 3 .…”

Section: Discussionmentioning

confidence: 99%

A matched-pair analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer versus early stage non-small cell lung cancer

Wang¹,

Zamdborg²,

Ye³

et al. 2018

BMC Cancer

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BackgroundThe use of stereotactic body radiotherapy (SBRT) for early-stage primary non-small cell lung cancer (NSCLC) reported excellent local control rates. But the optimal SBRT dose for oligometastatic lung tumors (OLTs) from colorectal cancer (CRC) has not yet been determined. This study aimed to evaluate whether SBRT to a dose of 48–60 Gy in 4–5 fractions could result in similar local outcomes for OLTs from CRC as compared to early-stage NSCLC, and to examine potential dose-response relationships for OLTs from CRC.MethodsOLTs from CRC and primary NSCLCs treated with SBRT to 48–60 Gy in 4–5 fractions at a single institution were evaluated, and a matched-pair analysis was performed. Local recurrence-free survival (LRFS) was estimated by the Kaplan-Meier method. Univariate Cox regression was performed to identify significant predictors.ResultsThere were 72 lung lesions in 61 patients (24 OLTs from CRC in 15 patients and 48 NSCLCs in 46 patients) were analyzed with a median follow-up of 30 months. LRFS for OLTs from CRC was significantly worse than that of NSCLC when treated with 48–60 Gy/4–5 fx (p = 0.006). The 1, 3 and 5-year LRFS of OLTs from CRC vs NSCLC were 80.6% vs. 100%, 68.6% vs. 97.2%, and 68.6% vs. 81.0%, respectively. On univariate analysis, OLTs from CRC treated with higher dose (BED10 = 132 Gy) exhibited significantly better local recurrence-free survival than those treated to lower doses (BED10 ≤ 105.6 Gy) (p = 0.0022). The 1 and 3-year LRFS rates for OLTs treated to a higher dose (BED10 = 132 Gy) were 88.9% and 81.5%, vs 33.3%, and not achieved for lower doses (BED10 ≤ 105.6 Gy).ConclusionThe LRFS of OLTs from CRC after SBRT of 48–60 Gy/4–5 fx was significantly worse than that of primary NSCLC. Lower dose SBRT appeared to have inferior control for OLTs of CRC in this cohort. Further studies with larger sample sizes are needed.

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Section: Discussionmentioning

confidence: 99%

A matched-pair analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer versus early stage non-small cell lung cancer

Wang¹,

Zamdborg²,

Ye³

et al. 2018

BMC Cancer

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“…With currently available minimally invasive treatments, it has now become possible to control recurrent lung metastases by local treatment and to delay the emergence of end-stage symptoms. In recent years, three-dimensional stereotactically guided local treatments such as radiofrequency ablation, stereotactic body radiation therapy (SBRT), and 125 I seed implantation, have achieved good results in the treatment of pulmonary metastases [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”

Section: Purposementioning

confidence: 99%

Comparison of clinical efficacy and complications of 125I seed brachytherapy and stereotactic body radiation therapy for recurrent pulmonary metastases from colorectal carcinoma

Li¹,

Zhang²,

Xie³

et al. 2018

jcb

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PurposeTo evaluate the efficacies of 125I seed implantation and stereotactic body radiation therapy (SBRT) in treatment of recurrent lung metastases from colorectal cancer, to compare the tolerance of lung tissue to both forms of radiotherapy, and to analyze the factors that affect the prognosis.Material and methodsAccording to treatment received, thirty colorectal cancer patients with post-operative lung metastases were separated into two groups: 125I seed implantation group (group A; n = 16) and SBRT group (group B; n = 14). Patients were followed up, and local control rate, survival, and post-operative complications were analyzed retrospectively. Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used to identify the independent predictors of poor prognosis.ResultsSurvival was significantly different between group A and group B (median survival, 15 months and 11.5 months, respectively; p = 0.015). Local control rates at the first, third, sixth, and twelfth months after treatment were all > 80%, with no significant difference between the two groups (p = 0.829). Significant differences were seen between the two groups in the number of treatments received (p = 0.009) and the incidence of radiation pneumonitis (p < 0.001) as well as radiation-induced pulmonary fibrosis (p = 0.005). On multivariate regression analysis radiation pneumonitis was an independent predictor of poor prognosis (HR = 3.356, 95% CI: 1.518-7.421; p = 0.003).Conclusions125I seeds brachytherapy and SBRT are both effective for control of lung metastases but the former causes milder lung tissue damage. It can be repeated after short intervals, and appears to be a safe and efficient treatment for lung metastases.

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“…Furthermore, with the development of anticancer drugs and immunotherapy, long-term survival has been obtained even in cases with distant metastases. As several papers report the usefulness of SBRT for 'oligo-metastasis or oligo-recurrence,' SBRT is expected to play a role as radical local therapy for pulmonary oligo-recurrence (8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

et al. 2018

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Abstract. The present study sought to evaluate the impact of the flattening filter-free (FFF) technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy. Its clinical safety and availability were compared with the flattening filter (FF) method. The cases of 65 patients who underwent lung volumetric modulated arc therapy-stereotactic body radiotherapy (VMAT-SBRT) using FF or FFF techniques were reviewed. A total of 55 Gy/4 fractions (fr) was prescribed for peripheral lesions or 56 Gy/7 fr for central lesions. The total monitor units (MU), treatment time, dose to tumors, dose to organs at risk, tumor control (local control rate, overall survival, progression-free survival) and adverse events between cases treated with FF and cases treated with the FFF technique were compared. A total of 35 patients were treated with conventional FF techniques prior to November 2014 and 30 patients were treated with FFF techniques after this date. It was revealed that the beam-on time was significantly shortened by the FFF technique (P<0.01). Other factors were similar for FFF and FF plans in respect to conformity (P=0.95), homogeneity (P=0.20) and other dosimetric values, including total MU and planning target volume/internal target volume coverage. The median follow-up period was 18 months (range, 2-35). One-year local control rates were 97.1 and 90.0% in the FF group and FFF groups, respectively (P=0.33). Grade 3 pneumonitis was observed in 5.8% of FF patients and 3.4% of FFF patients (P=1.00). No other adverse events ≥grade 3 were observed. The results of the study suggest that VMAT-SBRT using the FFF technique shortens the treatment time for lung SBRT while maintaining a high local control rate with low toxicity.

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Stereotactic Body Radiotherapy in Patients with Lung Oligometastases from Colorectal Cancer

Abstract: SBRT can be considered as local therapy in patients with lung metastases from CRC.

Cited by 24 publications

References 8 publications

A matched-pair analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer versus early stage non-small cell lung cancer

A matched-pair analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer versus early stage non-small cell lung cancer

Comparison of clinical efficacy and complications of 125I seed brachytherapy and stereotactic body radiation therapy for recurrent pulmonary metastases from colorectal carcinoma

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

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