A single-institution study of stereotactic body radiotherapy for patients with unresectable visceral pulmonary or hepatic oligometastases

Abstract

PurposeThe purpose of this study is to evaluate the feasibility, efficacy and toxicity of SBRT for treatment of unresectable hepatic or lung metastases regardless of their primary tumor site for patients who received prior systemic chemotherapy.Methods and materialsBetween July 2007 and June 2010, 90 patients were treated with the CyberKnife® SBRT system for hepatic or pulmonary metastatic lesions. Medical records were retrospectively reviewed. The endpoints of this study were local control, overall survival (OS), disease-free survival (DFS), local relapse free-survival (LRFS), and treatment toxicity.ResultsA total of 113 liver and 26 lung metastatic lesions in 52 men (58%) and 38 women (42%) were treated. Median follow-up was 17 months. Median age at treatment was 65 years (range, 23–84 years). Primary cancers were 63 GI, three lung, eight breast, four melanoma, three neuro-endocrine tumors, and three sarcomas. Median diameter of the lesions was 28 mm (range, 7–110 mm) for liver and 12.5 mm (range, 5–63.5 mm) for lung. Local control rates at 1 and 2 years were 84.5% and 66.1%, respectively. Two-year overall survival rate was 70% (95% CI: 55–81%). The 1 and 2-year disease-free survival rates were 27% (95% CI: 18–37%) and 10% (95% CI: 4–20%), respectively. Median duration of disease-free survival was 6.7 months (95% CI: 5.1–9.5 months). Observed toxicities included grade 1–3 acute toxicities. One grade 3 and no grade 4 toxicity were reported.ConclusionHigh-dose SBRT for metastatic lesions is both feasible and effective with high local control rates. Overall survival is comparable with other available techniques. Treatment is well tolerated with low toxicity rates. It could represent an interesting treatment option for oligometastatic patients not amenable to surgery, even when patients had been pre-treated with chemotherapy.SummaryStereotactic body radiotherapy (SBRT) has previously been successfully used in the treatment of metastatic lesions. It could be considered as a curative option for oligometastatic patients. This retrospective study involved 90 patients, designed to test potential effectiveness of SBRT in the treatment of oligometastases irrespective of primary. Results suggest SBRT could be an effective treatment extending patients’ life span. This treatment appears to be more effective when used prior to multiple systemic treatment regimens.

Differences Between Colon Cancer Primaries and Metastases Using a Molecular Assay for Tumor Radiation Sensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

“…At our institution, a similar dosing schedule is used for patients who present with oligometastatic lung and liver metastases. Various fractionation schedules have been reported for patients treated for lung [23–25] and liver metastases [13,26,27]. Dose escalation was reported to improve local control rates in a phase I dose-escalation trial of hepatic metastases from Rule et al The study randomized 27 patients to 30 Gy in 3 fractions, 50 Gy in 5 fractions, and 60 Gy in 5 fractions [12].…”

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

“…At our institution, a similar dosing schedule is used for patients who present with oligometastatic lung and liver metastases. Various fractionation schedules have been reported for patients treated for lung [23][24][25] and liver metastases [13,26,27]. Dose escalation was reported to improve local control rates in a phase I dose-escalation trial of hepatic metastases from Rule et al The study randomized 27 patients to 30 Gy in 3 fractions, 50 Gy in 5 fractions, and 60 Gy in 5 fractions [12].…”

“…However, unlike our analysis the study was not restricted to lesions of colon primary. Fumagalli et al suggested a difference in outcome based on anatomical location [26]. The study assessed outcomes in hepatic or pulmonary oligometastases of which 70% were of digestive primary.…”

Stereotactic body radiation therapy for liver metastasis – The linac-based Greater Poland Cancer Centre practice

“…In general, patients with up to four metastases, and with the maximum diameter of the largest metastasis of no more than 40 mm, are selected for the SBRT treatment. 28 However, some authors describe treatment procedures performed for 110-mm hepatic metastasis 3,15 that are also applicable to patients with metastases in two organs. The SBRT requires a highly precise dose planning and delivery.…”