Outcomes of Single Fraction Stereotactic Ablative Radiotherapy for Lung Metastases

Abstract

Stereotactic Ablative Radiotherapy (SABR) has been previously investigated as an alternative to thoracic surgery in patients with a limited number of pulmonary nodules from different primary tumors. We here report the clinical outcomes of a series of consecutive patients homogenously selected and treated with single dose SABR in our Institution. Eligibility criteria were: 1-5 lung metastases, maximum tumor diameter 50 mm, absent or controlled extra-thoracic disease, adequate pulmonary function, no prior radiotherapy, performance status ECOG 0-1. All patients were treated with a single dose of 26 Gy prescribed to the months. Treated metastasis progression at SABR site was observed in 10 lesions (11.1%), and actuarial LC rates at 1 and 2 years were respectively 93.4% and 88.1%. Systemic failure occurred in 37 patients (55.2%) at a median interval of 8 months after SABR. PFS rates were 72% and 55.4% at 1 and 2 year. Seven patients had grade 1 (10.4%) and 8 grade 2-3 late radiological toxicity (11.9%), while 6 experienced late chest wall toxicity (2 rib fractures, 4 chronic chest pain, 8.9%). CSS rates at 1 and 2 years were 90% and 76%, while OS rates were 85.1% and 70.5%, respectively. Median survival time was 40 months. On multivariate analysis, a disease-free interval longer than 24 months was close to significance for a benefit in CSS (p 5 0.07; HR 0.34 [95% CI 0.1-1.12]). The study includes a cohort of patients treated with single fraction 26 Gy SABR followed for a prolonged time interval. Single fraction SABR appears to be an effective treatment option, with little observed acute toxicity and limited late toxicity (15%); its advantages also include a high patients' compliance, a short overall treatment time and an easy combination with systemic therapies. These results might provide supportive evidence to the use of single fraction SABR as a valid and acceptable alternative to surgery for pulmonary metastases from different primary tumors.

Stereotactic Radiosurgery (SRS) with Volumetric Modulated Arc Therapy (VMAT): Interim Results of a Multi-arm Phase I Trial (DESTROY-2)

“…These data are coherent with previous personal ones as reported in [15]. Moreover, Filippi and coworkers in a very recent paper [16] treated 56 and 34 lung lesions by threedimensional conformal radiotherapy and image-guided radiotherapy-VMAT, respectively. The authors used a single dose of 26 Gy prescribed to the 80% isodose and, with a median follow-up time of 24 months, observed progression at the SRS site in 10 lesions (11.1%) and actuarial local control rates at 1 and 2 years were 93.4 and 88.1%, respectively [16].…”

“…This result was probably related to the use of relatively small doses according to the first phase of the dose-escalation study. However, a preliminary comparison of acute pulmonary toxicity seemed encouraging (grade 1 lung: 9.2%) and comparable with data (10.4%) reported by Filippi et al [16]. Moreover, the analysis of quality of life and fatigue-related indicators before and after treatment showed that SRS-VMAT was not associated with any detrimental effects.…”

“…Also the actual capacity of VMAT to respect dose/ volume constraints even in the case of high doses per fraction is uncertain. Except for a previous personal report and a very recent paper investigating exclusive pulmonary nodules treated by various techniques [15,16], to the best of our knowledge, no clinical data on SRS-VMAT have been published.…”

SBRT for lung oligometastases: Who is the perfect candidate?

“…On multivariate analysis, a disease-free interval longer than 24 months was close to significance for a benefit in Cancer-Specific Survival. 22 Osti et al analyzed data from selected patients with 1-5 lung …”

Hasüregi daganatáttétek stereotaxiás sugárkezelése egy ülésben. Beszámoló az első hazai, koponyán kívüli sugársebészeti beavatkozásról

“…Úgynevezett volumetrikus ívterápiát (VMAT) alkalmazva a nagy dózisú kezelések átlagosan mindössze 6-7 percig tartottak [11]. Filippi és mtsai 102 tüdőáttétes beteget egyszeri 26 Gy dózisú sugársebészeti ellátásban részesítve 93%-os 1 éves lokális kontrollt jeleztek, de grade 3 korai és késői mellékhatásokat leírva [22]. Osti és mtsai 66 tüdőáttétes betegnél 23, illetve 30 Gy egyszeri dózisokat alkalmazva 89%-os 1 éves lokális kontrollt és 12 hónapos medián teljes túlélést értek el [23].…”