Multiple Site SBRT in Pediatric, Adolescent, and Young Adult Patients With Recurrent and/or Metastatic Sarcoma

Abstract

Background: Stereotactic body radiation therapy (SBRT) is increasingly used for patients with recurrent and or metastatic tumors. Sarcomas are generally considered not sensitive to radiotherapy and SBRT may allow for increased biological effectiveness. We report intermediate outcomes and toxicity for pediatric, adolescent, and young adult patients treated with SBRT to sites of recurrent and or metastatic sarcoma Procedure: We queried an Institutional Review Board-approved registry of patients treated with SBRT for metastases from pediatric sarcomas. Patients age 29 and below were assessed for local control, survival, and toxicity. Results: Thirty-one patients with a total of 88 lesions met eligibility criteria. Median patient age was 17.9 years at treatment. Sixteen patients were treated with SBRT to >1 site of disease. The median dose was 30 Gy in 5 fractions. The median follow-up time was 7.4 months (range: 0.2 to 31.4 mo). Patients were heavily pretreated with systemic therapy. In 57 lesions with >3 months of radiographic follow-up, the 6-month and 12-month local control rates were 88.3%±4.5% and 83.4%±5.5%, respectively. Radiographic local failures were rare (6/57 in-field, 4/57 marginal). Only 1/88 treated lesions was associated with a radiation-related high-grade toxicity; late grade 3 intestinal obstruction in a re-irradiated field while on concurrent therapy (gemcitabine and docetaxel). No acute grade ≥3 toxicity was observed. Conclusions: SBRT was well tolerated in the majority of patients with favorable local control outcomes. Additional studies will be required to determine the optimal SBRT dose and fractionation, treatment volume, and appropriate concurrent therapies.

Efficacy and Safety of Stereotactic Body Radiation Therapy for Pediatric Malignancies: The LITE-SABR Systematic Review and Meta-Analysis

“…Among 9 published studies meeting inclusion criteria, we identified 142 pediatric and AYA patients with cancer with 217 lesions treated with SBRT. 8 , 9 , 10 , 16 , 26 , 27 , 28 , 29 , 30 Studies were published from 2014 to 2021 with patients from the United States, United Kingdom, and France. Table 1 shows respective data on both primary and secondary outcomes for each study as well as other relevant information regarding patient age, extent of follow-up, primary cancer histologies, primary lesion locations, and dose and fractionation schemes.…”

“…Across 6 studies, 209 lesions had available information on 1-year LC. 8 , 9 , 10 , 16 , 27 , 30 The estimated pooled 1-year LC rate after SBRT was 83.5% (95% confidence interval [CI], 70.9%-96.2%; Fig. 1A ).…”

“…Across 7 studies, 111 patients had available information on 1-year OS. 8 , 9 , 10 , 16 , 26 , 27 , 30 The estimated pooled 1-year OS rate was 75.4% (95% CI, 54.5%-96.3%; Fig. 3A ).…”

Radiation Therapy in Metastatic Soft Tissue Sarcoma: From Palliation to Ablation

“…There was one late grade 3 intestinal obstruction in a patient with re-irradiation on concurrent chemotherapy. There were no acute grade 3 side effects [ 55 ].…”

The Evolving Role of Radiotherapy for Pediatric Cancers With Advancements in Molecular Tumor Characterization and Targeted Therapies

“…Thus, SBRT may become increasingly relevant with effective targeted systemic therapies. Several retrospective and early phase prospective studies (summarized in Table 3) have evaluated SBRT for metastatic and recurrent sarcomas (88)(89)(90)(91). These have generally shown good local control outcomes, but increased toxicity when given with concurrent systemic therapy or in the re-irradiation setting.…”