Comparison of stereotactic body radiotherapy versus metastasectomy outcomes in patients with pulmonary metastases

Abstract

BackgroundWe compared the treatment outcomes of stereotactic body radiotherapy (SBRT) and metastasectomy in patients with pulmonary metastases.MethodsTwenty‐one patients received SBRT (total radiation doses 60 Gy in 3 fractions or 48 Gy in 4 fractions) and 30 underwent metastasectomy, most (93.3%) with wedge resection. The patients were followed for a median of 13.7 months. The tumor size in the SBRT group was larger than in the metastasectomy group (median 2.5 vs. 1.25 cm; P = 0.015). Patients with synchronous metastases were more likely to be treated with SBRT than with metastasectomy (P = 0.006).ResultsThere was no significant difference in the local control rates of the treatment groups (P = 0.163). Progression‐free survival (PFS) was longer in the metastasectomy than in the SBRT group (P = 0.02), with one and two‐year PFS rates of 51.1% and 46% versus 23.8% and 11.9%, respectively. The one and two‐year overall survival (OS) rates were 95% and 81.8% in the metastasectomy group and 79.5% and 68.2%, in the SBRT group, respectively. In multivariate analysis, synchronous metastasis was related to poor PFS, and tumor size was the most significant factor affecting OS. There were no significant differences in PFS and OS between treatment groups after dividing patients according to the presence or absence of synchronous metastases.ConclusionsSBRT is considered a suitable local modality against pulmonary metastases; however, patients with synchronous metastases are only likely to obtain a small benefit from local treatment with either SBRT or surgery.

The Past, Present and Future of Pulmonary Metastasectomy: A Review Article

“…A treatment option traditionally reserved for peripherally located oligometastatic disease in those individuals who are considered poor surgical candidates. 89,90) While encouraging outcomes have been reported in single modality studies, comparisons between SABR and metastasectomy are limited to a small number of retrospective studies. 89,90) In 2018, Lee et al conducted a retrospective study comparing outcomes of SABR with metastasectomy finding no significant difference in local tumor control rates and overall survival.…”

Comparison of pulmonary metastasectomy and stereotactic body radiation therapy for the treatment of lung metastases

“…Lee et al retrospectively compared the treatment outcomes of SBRT and metastasectomy in patients with pulmonary metastases: twenty-one patients received SBRT for 29 pulmonary metastatic lesions and-on the other hand-30 patients underwent pulmonary metastasectomy for 30 metastatic lesions, the vast majority receiving wedge resection while only 2 patients (3.9%) underwent lobectomy (25). Although no differences were observed between the two groups in terms of age, gender, ECOG PS, smoking history, pulmonary function, comorbidities and interval between diagnosis of primary tumors and detection of pulmonary metastases, the median tumor size was larger in the SBRT than in the metastasectomy group.…”

“…Multivariate analysis disclosed that the presence of synchronous metastases significantly and negatively influenced PFS (25).…”

Influence of tumor characteristics on correction differences between cone‐beam computed tomography‐guided patient setup strategies in stereotactic body radiation therapy for lung cancer

“…Stereotactic body radiotherapy (SBRT) has been widely adopted for medically inoperable early‐stage non‐small cell lung cancer (NSCLC) or metastatic lung cancer and has had a high local control rate and acceptable toxicity in most previously reported studies . This approach involves the delivery of an ablative dose to the tumor using highly conformal and oligofractionated (usually less than five fractions) radiation over a short time course.…”