Local control and fracture risk following stereotactic body radiation therapy for non-spine bone metastases

Erler, Darby; Brotherston, Drew; Sahgal, Arjun; Cheung, Patrick; Loblaw, Andrew; Chu, William; Soliman, Hany; Chung, Hans T.; Kiss, Alex; Chow, Edward; Poon, Ian

doi:10.1016/j.radonc.2018.03.030

Cited by 50 publications

(30 citation statements)

References 31 publications

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“…Few lesions progress on a background of widespread but stable metastatic disease [83] + Link with other therapies Progression occurs in a limited number of tumors/metastases while the majority of other metastases are responding or stable while on a systemic treatment strategy [41,48,61] Progression occurs after a cytoreductive treatment [67] Progression while other sites including the primary disease remain stable on systemic treatment or observation [113] Resistant clones can result in isolated progression [42] + Disease load <5 enlarging metastases in an otherwise well-controlled disease state [39] <5 sites of metastatic disease progression while other sites including primary remain stable on systemic treatment [113] 3-5 slowly progressive metastases [36,48] Oligo-Persistence Persistent disease after systemic therapy [67] + Disease load <5 persistent lesions after systemic therapy [39] Statements 7 and 9:…”

Section: Oligo-progressionmentioning

confidence: 99%

“…More advanced technologies and/or techniques that facilitate smaller set-up margins, without compromising tumour coverage while limiting dose to normal tissues, have facilitated the increased interest in defining and treating OMD. Lack of motion management use [52,63], planning target volume size [23,63,84,97] and coverage [73,76] have been associated with lower tumour control. Overall however, detailed reporting of planning constraints and protocol deviations is minimal in the literature reviewed, highlighting an area in need of improvement.…”

Section: Statements 15 and 16mentioning

confidence: 99%

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

Lievens

Gückenberger

Gomez

et al. 2020

Radiotherapy and Oncology

460

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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Section: Oligo-progressionmentioning

confidence: 99%

Section: Statements 15 and 16mentioning

confidence: 99%

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

Lievens

Gückenberger

Gomez

et al. 2020

Radiotherapy and Oncology

460

278

View full text Add to dashboard Cite

show abstract

“…There is no consensus on the definition of SBRT volumes in application to bone oligometastases. The largest series published to date[28] included 106 metastases in 81 patients, of which 32% had PCa. The gross tumor volume was defined as the lesion evidenced on CT and/or MRI images.…”

Section: Scenarios In Oligometastatic Pcamentioning

confidence: 99%

Oligometastases in prostate cancer: Ablative treatment

Palacios-Eito

Béjar-Luque

Rodríguez-Liñán

et al. 2019

WJCO

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Technological advances in radiotherapy have led to the introduction of techniques such as stereotactic body radiation therapy (SBRT), allowing the administration of ablative doses. The hypothesis that oligometastatic disease may be cured through local eradication therapies has led to the increasing use of SBRT in patients with this type of disease. At the same time, scientific advances are being made to allow the confirmation of clinically suspected oligometastatic status at molecular level. There is growing interest in identifying patients with oligometastatic prostate cancer (PCa) who may benefit from curative intent metastasis-directed therapy, including SBRT. The aim is to complement, replace or delay the introduction of hormone therapy or other systemic therapies. The present review aims to compile the evidence from the main ongoing studies and results on SBRT in relation to oligometastatic PCa; examine aspects where gaps in knowledge or a lack of consensus persist ( e.g ., optimum schemes, response assessment, identification and diagnosis of oligometastatic patients); and document the lack of first-level evidence supporting the use of such techniques.

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“…Recently, SAbR-COMET study [13] showed that stereotactic body radiotherapy (SBRT) for oligometastasis provided a survival bene t (standard of care alone vs. SBRT arm; 28 vs. 41 months of median overall survival). Another previous study [14] has shown that high dose prescription by SBRT yields high rates of great local control of greater than 85% for non-spine BMs. Thus, the higher dose PORT regimens might also lead to good local control as well as survival bene t in case of oligometastasis.…”

Section: Discussionmentioning

confidence: 94%

Practice Patterns for Postoperative Radiation Therapy in Patients with Metastases to the Long Bones: Survey of the Japanese Radiation Oncology Study Group

Kubota

Nakamura

Shikama

et al. 2020

Preprint

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BackgroundBecause of the lack of evidence on practice patterns of postoperative radiation therapy (PORT)in patients with metastases to the long bones, it is essential to characterize the current practice patterns and identify factors affecting dose-fractionation to aid future clinical trials. MethodsThe palliative radiation therapy subgroup of the Japanese Radiation Oncology Study Group conducted an internet-based survey to determine the prescription practices and various dose-fractionations used for PORT. Additionally, responders were asked to recommend dose-fractionations in four hypothetical cancer cases, wherein each case represented a patient with impending pathological fractures and one of the four features: limited prognosis, solitary metastasis, radio-resistant primary tumor, or long-term survival. Responders were asked to indicate their preferred irradiation fields and the reasons for choosing long-course radiotherapy over short-course radiotherapy (RT). ResultsEighty-nine radiation oncologists from 67 institutions and 151 RT plans were included. Twenty-two different dose-fractionations were used; the most commonly used and recommended dose-fractionation was 30 Gy in 10 fractions. “Local control” was most the common reason for preferring longer course RT. While fractionated higher-dose regimens were preferred in case of oligometastasis, low dose regimens were preferred in case of limited prognosis; single fraction RT was never preferred. Most respondents recommended involvement of “the entire orthopedic prosthesis.” ConclusionFor PORT of metastases to the long bones, 30 Gy in 10 fractions for the entire orthopedic prosthesis is preferred in current practice. Oligometastasis and a limited prognosis influence the selection of high- and low-dose regimens, respectively. Single fraction RT is never preferred.

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Local control and fracture risk following stereotactic body radiation therapy for non-spine bone metastases

Cited by 50 publications

References 31 publications

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

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

Oligometastases in prostate cancer: Ablative treatment

Practice Patterns for Postoperative Radiation Therapy in Patients with Metastases to the Long Bones: Survey of the Japanese Radiation Oncology Study Group

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