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

Sharma, Aman; Duijm, M.; Hoop, Esther Oomen–de; Aerts, Joachim; Verhoef, Cornelis; Hoogeman, M.; Nuyttens, J.

doi:10.1080/0284186x.2018.1521986

Cited by 39 publications

(47 citation statements)

References 33 publications

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“…The 1-, 2-year LC and OS rates for the entire cohort were 82, 70 and 84%, 71%, respectively. Our findings are comparable with the current findings in the literature (Table 7) [8][9][10][11][12][13][14][15][16].…”

Section: Discussionsupporting

confidence: 93%

Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

et al. 2020

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Background: Patients with oligometastatic disease can potentially be cured by using an ablative therapy for all active lesions. Stereotactic body radiotherapy (SBRT) is a non-invasive treatment option that lately proved to be as effective and safe as surgery in treating lung metastases (LM). However, it is not clear which patients benefit most and what are the most suitable fractionation regimens. The aim of this study was to analyze treatment outcomes after single fraction radiosurgery (SFRS) and fractionated SBRT (fSBRT) in patients with lung oligometastases and identify prognostic clinical features for better survival outcomes. Methods: Fifty-two patients with 94 LM treated with SFRS or fSBRT between 2010 and 2016 were analyzed. The characteristics of primary tumor, LM, treatment, toxicity profiles and outcomes were assessed. Kaplan-Meier and Cox regression analyses were used for estimation of local control (LC), overall survival (OS) and progression-free survival. Results: Ninety-four LM in 52 patients were treated using SFRS/fSBRT with a median of 2 lesions per patient (range: 1-5). The median planning target volume (PTV)-encompassing dose for SFRS was 24 Gy (range: 17-26) compared to 45 Gy (range: 20-60) in 2-12 fractions with fSBRT. The median follow-up time was 21 months (range: 3-68). LC rates at 1 and 2 years for SFSR vs. fSBRT were 89 and 83% vs. 75 and 59%, respectively (p = 0.026). LM treated with SFSR were significantly smaller (p = 0.001). The 1 and 2-year OS rates for all patients were 84 and 71%, respectively. In univariate analysis treatment with SFRS, an interval of ≥12 months between diagnosis of LM and treatment, noncolorectal cancer histology and BED < 100 Gy were significantly associated with better LC. However, none of these parameters remained significant in the multivariate Cox regression model. OS was significantly better in patients with negative lymph nodes (N0), Karnofsky performance status (KPS) > 70% and time to first metastasis ≥12 months. There was no grade 3 acute or late toxicity. Conclusions: Longer time to first metastasis, good KPS and N0 predicted better OS. Good LC and low toxicity rates were achieved after short SBRT schedules.

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Section: Discussionsupporting

confidence: 93%

Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

et al. 2020

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“…Our findings are comparable with the current findings in the literature (Tab. 7) (8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

Kalinauskaitė

Tinhofer

Kufeld

et al. 2019

Preprint

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Background: Patients with oligometastatic disease can potentially be cured by using an ablative therapy for all active lesions. Stereotactic body radiotherapy (SBRT) is a non-invasive treatment option that lately proved to be as effective and safe as surgery in treating lung metastases (LM).However, it is not clear which patients benefit most and what are the most suitable fractionation regimes. The aim of this study was to analyze treatment outcomes after single fraction radiosurgery (SFRS) and fractionated SBRT (fSBRT) in patients with lung oligometastases and identify prognostic clinical features for better survival outcomes. Methods: Fifty-two patients with 94 LM treated with SFRS or fSBRT between 2010 and 2016 were analyzed. The characteristics of primary tumor, LM, treatment, toxicity profiles and outcomes were assessed. Kaplan-Meier and Cox regression analyses were used for estimation of local control (LC), overall survival (OS), progression free survival and distant metastases free survival (DMFS). Results: Ninety-four LM in 52 patients were treated using SFRS/fSBRT with a median of 2 lesions per patient (range: 1-5). The median planning target volume (PTV)-encompassing dose for SFRS was 24 Gy (range: 17-26) compared to 45 Gy (range: 20-60) in 2-12 fractions in fSBRT. The median follow-up time was 21 months (range: 3-68). LC rates at 1 and 2years for SFSR vs. fSBRT were 89% and 83% vs. 75% and 59%, respectively (p=0.026). LM treated with SFSR were significantly smaller (p=0.001). The 1 and 2-year OS rates for all patients were 84% and 71%, respectively. In univariate analysis treatment with SFRS, an interval of ≥ 12 months between diagnosis of LM and treatment, non-colorectal cancer histology and BED <100 Gy were significantly associated with better LC. However, none of these parameters remained significant in the multivariate Cox regression model. OS was significantly better in patients with negative lymph nodes (N0), Karnofsky performance status (KPS) >70% and time to first metastasis ≥12 months. There was no grade 3 acute or late toxicity. Conclusions: We observed good LC and low toxicity rates after SFRS for small lung metastases. Longer time to first metastasis, good KPS and N0 predicted better OS. BackgroundMetastatic progression of cancer is linked to poor prognosis and is the leading cause of cancer-related deaths (1). Few decades ago, the diagnosis of metastatic disease was related with lethal outcomes.

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“…A locoregionally controlled primary tumour is not a precondition but should be considered a prognostic parameter which is critical to report specifically. Some studies reported a better prognosis for metachronous OMD [28,86], but this was not consistently observed [25,74]. Though both synchronous and metachronous metastases are considered OMD, the prognosis, options for treatment and risk of occult disseminated metastases of these patients can differ, with the length of the DFI appearing to have a prognostic impact [46,69,87].…”

Section: Oligo-progressionmentioning

confidence: 99%

Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document

Lievens

Gückenberger

Gomez

et al. 2020

Radiotherapy and Oncology

421

278

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Background: Recognizing the rapidly increasing interest and evidence in using metastasis-directed radiotherapy (MDRT) for oligometastatic disease (OMD), ESTRO and ASTRO convened a committee to establish consensus regarding definitions of OMD and define gaps in current evidence. Methods: A systematic literature review focused on curative intent MDRT was performed in Medline, Embase and Cochrane. Subsequent consensus opinion, using a Delphi process, highlighted the current state of evidence and the limitations in the available literature. Results: Available evidence regarding the use of MDRT for OMD mostly derives from retrospective, singlecentre series, with significant heterogeneity in patient inclusion criteria, definition of OMD, and outcomes reported. Consensus was reached that OMD is largely independent of primary tumour, metastatic location and the presence or length of a disease-free interval, supporting both synchronous and metachronous OMD. In the absence of clinical data supporting a maximum number of metastases and organs to define OMD, and of validated molecular biomarkers, consensus supported the ability to deliver safe and clinically meaningful radiotherapy with curative intent to all metastatic sites as a minimum requirement for defining OMD in the context of radiotherapy. Systemic therapy induced OMD was identified as a distinct state of OMD. High-resolution imaging to assess and confirm OMD is crucial, including brain imaging when indicated. Minimum common endpoints such as progression-free and overall survival, local control, toxicity and quality-of-life should be reported; uncommon endpoints as deferral of systemic therapy and cost were endorsed. Conclusion: While significant heterogeneity exists in the current OMD definitions in the literature, consensus was reached on multiple key questions. Based on available data, OMD can to date be defined as 1-5 metastatic lesions, a controlled primary tumor being optional, but where all metastatic sites must be safely treatable. Consistent definitions and reporting are warranted and encouraged in ongoing trials and reports generating further evidence to optimize patient benefits.

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

Cited by 39 publications

References 33 publications

Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document

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