Stereotactic body radiotherapy (SBRT) for medically inoperable lung metastases—A pooled analysis of the German working group “stereotactic radiotherapy”

Rieber, Juliane; Streblow, Jan; Uhlmann, Lorenz; Flentje, Michael; Duma, Marciana Nona; Ernst, Iris; Blanck, Oliver; Wittig, Andrea; Boda-Heggemann, Judit; Krempien, Robert; Lohaus, Fabian; Klass, N. D.; Eble, Michael J.; Imhoff, Detlef; Kahl, H.; Petersen, Cordula; Gerum, S.; Henkenberens, Christoph; Adebahr, S.; Hass, Peter; Schrade, E.; Wendt, Thomas; Hildebrandt, Guido; Andratschke, Nicolaus; Sterzing, Florian; Gückenberger, Matthias

doi:10.1016/j.lungcan.2016.04.012

Cited by 135 publications

(136 citation statements)

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“…The largest and most recent pooled analysis by the working group Stereotactic Radiotherapy of the German Society for Radiation Oncology analyzed the outcomes of 700 patients with lung oligometastic disease treated with SBRT. They reported a 2-year local control rate of 81.2 % and an OS rate of 54.4 % (median follow-up of 14.3 months) for up to 2 metastases treated per patient [102]. Similar outcomes were observed in a systematic review analyzing 8 studies with a total of 903 patients with lung metastases of colorectal origin treated with thermal ablation.…”

Section: Metastasessupporting

confidence: 62%

Thermal Ablation of Lung Tumors: Focus on Microwave Ablation

Vogl

Nour-Eldin

Albrecht

et al. 2017

Fortschr Röntgenstr

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Section: Metastasessupporting

confidence: 62%

Thermal Ablation of Lung Tumors: Focus on Microwave Ablation

Vogl

Nour-Eldin

Albrecht

et al. 2017

Fortschr Röntgenstr

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“…In the present study, adding margins >8 mm to the ITV led to improved outcomes, although the differences were not significant. When performing SBRT for liver tumors, no margins are usually added to the ITV (12)(13)(14)(16)(17)(18)(19)(20)(21)23). However, only a few studies have demonstrated how many GTV-to-CTV expansions are required in order to reach the gross and microscopic diseases in liver metastasis (41,42).…”

Section: Discussionmentioning

confidence: 99%

“…Modern radiotherapeutic techniques, including intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), have recently become more frequently utilized to curatively treat limited metastatic tumors (10)(11)(12)(13)(14). SBRT, also termed stereotactic ablative radiation therapy, is a proven curative treatment for medically inoperable small tumors in the lung and liver; it delivers highly conformal radiation in a limited number of high-dose fractions, providing excellent primary tumor control with minimal toxicity (12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

“…SBRT, also termed stereotactic ablative radiation therapy, is a proven curative treatment for medically inoperable small tumors in the lung and liver; it delivers highly conformal radiation in a limited number of high-dose fractions, providing excellent primary tumor control with minimal toxicity (12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Radiotherapy in alternatively fractionated regimens with a greater number of fractions may be required to reduce the biologically effective doses (BEDs) to normal tissues when treating liver tumors located in the hepatic portal regions.…”

Section: Introductionmentioning

confidence: 99%

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Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer

et al. 2017

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Abstract. Metastatic liver tumors (MLTs) from colorectal cancer (CRC) are often treated with stereotactic body radiation therapy (SBRT). The present study aimed to examine the predictive factors for response of MLTs to SBRT. A total of 39 MLTs from 24 patients with CRC were retrospectively analyzed. Radiotherapy for MLT was typically performed with a prescribed dose equivalent to a biologically effective dose (BED) 10 of 100 Gy. The median follow-up period was 16 months (range, 5-64 months). The median prescribed dose and total BED 10 were 56 Gy (range, 45-72 Gy) and 97.5 Gy (range, 71.7-115.5 Gy), respectively, in a median of 8 fractions (range, 4-33 fractions). The 1-and 2-year local control rates were 67.2 and 35.9%, respectively. For patients with MLT treated with ablative SBRT (BED 10 ≥100 Gy in ≤5 fractions), the 1-and 2-year local control rates were 83.3 and 62.5%, respectively. Univariate analysis showed that primary tumor location (left-sided colon), maximum tumor diameter (≤30 mm) and ablative SBRT (BED 10 ≥100 Gy in ≤5 fractions) were significantly associated with improved local control (P=0.0058, P=0.0059 and P=0.0268, respectively). Multivariate analysis showed that tumor diameter was significantly associated with improved local control (P=0.0314). In addition, patients who received ablative SBRT had significantly prolonged overall survival times compared with those treated with non-ablative SBRT (P= 0.0261). To conclude, tumors ≤30 mm that can be treated with ablative SBRT are associated with good local control rates. The primary tumor location may affect the radiosensitivity of MLTs. IntroductionPatients with colorectal cancer (CRC) often have metastases at initial presentation or during follow-up (1,2). The liver is one of the most frequent sites of metastasis (1,2). Newly developed chemotherapeutic agents, including targeted therapies, have improved the progression-free and overall survival times of patients with metastatic CRC (3,4). There is also evidence supporting the benefit of surgery to treat metastases from CRCs, with surgery improving overall survival time (5-7). The prolonged survival times of patients have highlighted the importance of local therapy for CRC and limited metastatic disease. In patients who are unfit for surgery, alternative local therapeutic approaches, including radiofrequency ablation (RFA), are available to treat liver metastases; these approaches are minimally invasive and can achieve good local control (8,9). However, their indication is currently limited to relatively small tumors that are located far away from critical structures (8,9).Modern radiotherapeutic techniques, including intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), have recently become more frequently utilized to curatively treat limited metastatic tumors (10-14). SBRT, also termed stereotactic ablative radiation therapy, is a proven curative treatment for medically inoperable small tumors in the lung and liver; it delivers highly conformal radiation in a ...

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“…Detailed description of the database has been previously published (34)(35)(36). For the current study, an update of the database was performed in April 2017.…”

Section: Methodsmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for pulmonary metastases from renal cell carcinoma—a multicenter analysis of the German working group “Stereotactic Radiotherapy”

Hoerner-Rieber¹,

Duma²,

Blanck³

et al. 2017

J. Thorac. Dis.

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Background: Renal cell carcinoma (RCC) is traditionally considered to be radioresistant. Radiotherapy response rates are believed to improve with hypofractionated, high dose stereotactic body radiotherapy (SBRT).However, limited data exist regarding the role of SBRT in the treatment of pulmonary metastases. Methods: The working group "Stereotactic Radiotherapy" of the German Society of Radiation Oncology analyzed its multi-institutional database of more than 700 patients who received SBRT for pulmonary metastases. Treatment was performed at 10 centers between 2001 and 2016. Patients with metastatic RCC were included in the study. Tumor characteristics, treatment details, and follow-up data including survival, local control (LC), distant metastases, and toxicity were evaluated. Results: A total of 46 RCC patients treated with SBRT for 67 lung metastases were identified, who received a median total biologically effective dose (BED iso ) at planning target volume (PTV) isocenter of 117.0 Gy (range, 48.0-189.0 Gy). A median fractional dose of 20.8 Gy at isocenter (range, 6.0-37.9 Gy) was administered in a median number of 3 fractions (1-8 fractions). After a median follow-up time of 28.3 months for all patients, 1-and 3-year LC rates were 98.1% and 91.9%, with corresponding 1-and 3-year overall survival (OS) of 84.3% and 43.8%, respectively. Pulmonary metastases treated with BEDiso ≥130 Gy showed a trend for superior LC (P=0.054). OS was significantly improved in both uni-and multivariate analysis for patients with higher Karnofsky performance scale, lower maximum pulmonary metastasis diameter and lack of post-SBRT systemic therapy due to progression (P=0.014; P=0.049; P=0.006). Only mild acute and late toxicity was reported.

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Stereotactic body radiotherapy (SBRT) for medically inoperable lung metastases—A pooled analysis of the German working group “stereotactic radiotherapy”

Cited by 135 publications

References 39 publications

Thermal Ablation of Lung Tumors: Focus on Microwave Ablation

Thermal Ablation of Lung Tumors: Focus on Microwave Ablation

Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer

Stereotactic body radiotherapy (SBRT) for pulmonary metastases from renal cell carcinoma—a multicenter analysis of the German working group “Stereotactic Radiotherapy”

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