SBRT for elderly oligometastatic patients as a feasible, safe and effective treatment opportunity

Cuccia, Francesco; Mazzola, Rosario; Pastorello, Edoardo; Figlia, Vanessa; Giaj-Levra, Niccolò; Nicosia, Luca; Ricchetti, F.; Rigo, Michele; Attinà, Giorgio; Vitale, Claudio; Ruggieri, R.; Alongi, Filippo

doi:10.1007/s10585-021-10122-x

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…On the contrary, the combination of SBRT with immunotherapy for extracranial melanoma is currently a matter of debate, with some studies reporting a detrimental impact of radiotherapy when combined with immunotherapy [33,34].…”

Section: Discussionmentioning

confidence: 99%

The Role of Radiotherapy in the Management of Vaginal Melanoma: A Literature Review with a Focus on the Potential Synergistic Role of Immunotherapy

Cuccia

D'Alessandro

Blasi³

et al. 2023

JPM

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Among the mucosal melanomas, vaginal melanomas are very rare tumors, accounting for less than 20% of melanomas arising from the female genital tract. They occur most frequently in women in post-menopausal age, but younger patients may also experience this neoplasm, mainly located in the lower third of the vagina or the anterior wall. The optimal management of this tumor remains controversial, with surgery reported as the most frequently adopted approach. However, a clear benefit of surgical treatment in terms of survival has not yet been demonstrated. Conversely, radiotherapy may represent an attractive non-invasive alternative, and there are several favorable reports of the role of radiation therapy, either delivered with photons, brachytherapy, or hadrontherapy. A wide range of techniques and fractionation regimens are reported with substantially good tolerance to the treatment, and acute G3 or higher toxicities are reported only in the case of concurrent immunotherapy. Of note, due to the rarity of the disease, there is a lack of high-level evidence for the optimal therapeutic option. In this scenario, recent studies theorize the possibility of developing combinatorial approaches of radiotherapy with immunotherapy based on cutaneous melanomas reports. In this review, we aim to summarize the evidence available in the literature supporting the role of definitive radiotherapy for vaginal melanomas, with a focus on the combination of RT with immunotherapy, in terms of optimal timing and biological rationale.

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Section: Discussionmentioning

confidence: 99%

The Role of Radiotherapy in the Management of Vaginal Melanoma: A Literature Review with a Focus on the Potential Synergistic Role of Immunotherapy

Cuccia

D'Alessandro

Blasi³

et al. 2023

JPM

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“…The limited literature available has focused on the short-term effects after surgery or on patients starting treatment at the age of 65–70 years ( Cheng et al, 2022 ; Hashimoto et al, 2022 ), Or start at age 65 or 70 ( Takahashi et al, 2021 ). Although there are some relevant clinical studies in patients aged ≥ 75 years, either the ECOG-PS score has been around 0–1 ( Rosati et al, 2019 ), adverse events were severe ( François et al, 2020 ), or there was only one metastatic site ( Cuccia et al, 2021 ). Furthermore, most elderly participants in clinical research have undergone strict screening, requiring, for example, an ECOG-PS score of 0–1 or only one metastatic site for inclusion.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and survival outcomes in patients aged 75 years or older with advanced colorectal cancer treated using traditional Chinese medicine: an observational retrospective study

Cui

et al. 2023

Front. Pharmacol.

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Limited evidence suggests that elderly patients with advanced colorectal cancer (ACRC) may benefit from traditional Chinese medicine (TCM). This study investigated the efficacy and safety of TCM in old ACRC patients treated in the Oncology Department of Xiyuan Hospital between January 2012 and December 2021. The clinical characteristics of these patients were retrospectively reviewed. Their progression-free survival (PFS) and total duration of TCM therapy (TTCM) were analyzed using the Kaplan-Meier curve. Forty-eight patients (F:M 13:35) with a mean age of 78.75 ± 2.99 years (range, 75–87) met the inclusion criteria. There were 18 cases of rectal cancer and 30 of colon cancer. The median PFS was 4 months (range, 1–26; 95% CI 3.26–4.73). The median TTCM was 5.5 months (range, 1–50; 95% CI 1.76–8.24). Subgroup analysis revealed that PFS and TTCM were shorter in patients with bone metastases and an ECOG performance status score of 2–3 (p < 0.05). No hematological toxicity or serious adverse reactions occurred during the study period. This real-world study demonstrates that TCM may be a potentially beneficial therapy for old ACRC patients, including when the ECOG performance status score is 2–3.

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“…Compared to conventional radiotherapy, SRS and SBRT have numerous advantages that increase the probability of local control while maintaining the risk of normal tissue toxicity at acceptable levels ( 36 ). Cuccia et al ( 37 ) reported that 61 elderly patients (median age 82 years) with 90 oligometastases were treated with SBRT with a median BED10 100 Gy (range, 48–180 Gy). Local control rates at 1- and 2-years were 98.8 and 88.2%, respectively, and there were no grade 2 or higher adverse events.…”

Section: Discussionmentioning

confidence: 99%

First-Line Tyrosine Kinase Inhibitors Combined With Local Consolidative Radiation Therapy for Elderly Patients With Oligometastatic Non-Small Cell Lung Cancer Harboring EGFR Activating Mutations

Kang

et al. 2022

Front. Oncol.

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ObjectiveThe aim of this study was to investigate the efficacy and safety of combined applications of local consolidative radiation therapy (LCRT) and first-line tyrosine kinase inhibitors (TKIs) for the treatment of primary tumors and oligometastatic sites in oligometastatic NSCLC harboring Epidermal Growth Factor Receptor (EGFR) activating mutations.Patients and MethodsElderly patients with oligometastatic NSCLC (≤5 metastases) harboring EGFR activating mutations at the time of diagnosis were identified. They were treated with first-line TKIs alone or in combination with LCRT. Progression‐free survival (PFS) and overall survival (OS) were estimated through the Kaplan–Meier method.ResultsA total of 122 elderly patients were enrolled between February 2010 and January 2018. Among them, 41.0% (n = 50) received TKIs combined with LCRT (TKIs + LCRT group), whereas 59.0% (n = 72) received TKIs monotherapy (TKIs alone group). Patients were followed up for a median length of 34 months (ranging from 7.0 to 64 months). The median PFS in TKIs + LCRT group was 17 months (95%CI: 15.37–18.63), which was significantly longer than that of the TKIs-alone group (12 months; 95%CI: 11.05–12.95) (p <0.001). Median OS in TKIs + LCRT group was 38 months (95%CI: 35.61–40.39), while that of the TKIs-alone group was 29 months (95%CI: 26.86–31.14) (p <0.001). Multivariate analyses revealed that LCRT, one to two metastases, and good ECOG PS were independent predictors for better PFS (p <0.001, p = 0.004, and p = 0.027). Moreover, LCRT, good ECOG PS, and T1-2 stage were independent predictors for better OS (p <0.001, p = 0.007 and p = 0.007). Most of the patients suffered from grade 1 to 2 toxicities, and treatment-related deaths were not recorded.ConclusionFirst-line TKIs combined with LCRT may improve survival outcomes for elderly patients with oligometastatic NSCLC harboring EGFR activating mutations. This approach was not associated with much toxicity, therefore, it can be used for the treatment of elderly patients with oligometastatic disease.

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SBRT for elderly oligometastatic patients as a feasible, safe and effective treatment opportunity

Cited by 8 publications

References 27 publications

The Role of Radiotherapy in the Management of Vaginal Melanoma: A Literature Review with a Focus on the Potential Synergistic Role of Immunotherapy

The Role of Radiotherapy in the Management of Vaginal Melanoma: A Literature Review with a Focus on the Potential Synergistic Role of Immunotherapy

Clinical characteristics and survival outcomes in patients aged 75 years or older with advanced colorectal cancer treated using traditional Chinese medicine: an observational retrospective study

First-Line Tyrosine Kinase Inhibitors Combined With Local Consolidative Radiation Therapy for Elderly Patients With Oligometastatic Non-Small Cell Lung Cancer Harboring EGFR Activating Mutations

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