Stereotactic Ablative Radiation Therapy for the Comprehensive Treatment of Oligometastatic Tumors (SABR-COMET): Results of a Randomized Trial

Palma, David A.; Olson, Robert; Harrow, Stephen; Gaede, Stewart; Louie, Alexander V.; Haasbeek, Cornelis J.A.; Mulroy, Liam; Lock, Michael; Rodrigues, George; Yaremko, Brian; Schellenberg, Devin; Ahmad, Belal; Griffioen, Gwendolyn H.M.J.; Senthi, Sashendra; Liu, M. C.; Moore, Karen; Currie, S.; Bauman, Glenn; Warner, Andrew; Senan, Suresh

doi:10.1016/j.ijrobp.2018.06.105

Cited by 98 publications

(71 citation statements)

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“…During follow-up, only 13 of 142 patients (9%) were noted to have late toxicities. Prospective high-level evidence demonstrates that local therapy to oligometastatic lesions improves PFS 10,11 and overall survival 12,18 in a multitude of malignancies. Within the realm of OPCa, the Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence (STOMP) trial demonstrated local therapy, delivered primarily in the form of SABR, and prolonged time to initiation of ADT (21 vs 13 months) compared with surveillance.…”

Section: Discussionmentioning

confidence: 99%

“…Prospectively performed trials demonstrate improvements in PFS 10,11 in non-small-cell lung cancer and overall survival in a variety of primaries, including breast, lung, colorectal, and prostate cancer (PCa). 12 In PCa-specific cohorts, MDT is associated with sustained periods of disease-free survival, and it prolongs the time to initiation of androgen deprivation therapy (ADT). 13,14 At this time, the definition of oligometastatic PCa (OPCa) is based on clinical characteristics such as number of lesions, 15 although biologic parameters might soon supplement or replace this numerical definition.…”

Section: Introductionmentioning

confidence: 99%

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Radiation Therapy in the Definitive Management of Oligometastatic Prostate Cancer: The Johns Hopkins Experience

Deek

Phillips

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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Local consolidation of oligometastatic disease is a rapidly emerging treatment paradigm. This article reviews our institutional experience treating oligometastatic prostate cancer with definitive intent radiation therapy. We demonstrate that metastasisdirected therapy with stereotactic ablative radiation therapy to oligometastatic lesions can be effective across a wide range of oligometastatic prostate cancer Purpose: The use of radiation therapy (RT) in consolidating oligometastatic prostate cancer (OPCa) is a rapidly evolving treatment paradigm. We review our institutional experience using metastasis-directed therapy in the definitive management of men with OPCa. Methods and Materials: Patients with OPCa treated with definitive RT were included. The Kaplan-Meier method and multivariable Cox regression analysis were performed to assess biochemical progression-free survival (bPFS) and time to next intervention. Cumulative incidence functions were used to calculate rates of local failure. Toxicity was assessed using Common Terminology Criteria for Adverse Events (version 4).Results: This study analyzed 156 patients with OPCa and 354 metastatic lesions with median follow-up of 24.6 months. Of 150 patients with toxicity data, 53 (35%) experienced acute grade 1 toxicity, 8 (5%) had grade 2, and none had grade 3 toxicity. Only 13 patients (9%) had late toxicities. At 24 months, the cumulative incidence of local failure was 7.4%. Median bPFS for the entire cohort was 12.9 months and 52% at 1 year. On multivariable analysis, factors associated with prolonged bPFS were peri-RT androgen deprivation therapy (ADT), lower gross tumor volume, and hormonesensitive (HS) OPCa. Median time to next intervention, including repeat RT, was 21.6 months. Median bPFS for men with HS prostate cancer was 17.2 months International Journal of biology physics www.redjournal.org subtypes, but with differential efficacy. Continued study is warranted to investigate the use of radiation therapy over the wide range of patients with oligometastatic prostate cancer. compared with 7.2 months in men with castrate-resistant OPCa (P < .0001), and cumulative incidence of local failure at 24 months was lower with HS OPCa (4.8% vs 12.1%; P Z .034). We analyzed 28 men with HS OPCa treated with a course of peri-RT ADT (median, 4.3 months) with recovery of testosterone. At a median follow-up of 33.5 months, 20 patients had not developed bPFS, median bPFS had not been reached, and 24-month bPFS was 77%. Conclusions: Metastasis-directed therapy can be effective across a wide range of OPCa subtypes, but with differential efficacy. Further study is warranted to investigate the use of RT across the wide range of patients with OPCa. Ó 2019 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Volume 105 Number 5 2019 Radiation for oligometastatic prostate cancer 949 Abbreviations: BED Z biological dose equivalent; GTV Z gross tumor volume; PSA Z prostate-specific ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiation Therapy in the Definitive Management of Oligometastatic Prostate Cancer: The Johns Hopkins Experience

Deek

Phillips

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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“…This is in keeping with recently reported studies demonstrating survival advantage of local ablative radiotherapy in oligometastatic NSCLC. 31,32 Evidence also supports the investigation of intensive radiotherapy in patients with extensive-stage SCLC and a limited number of extracranial extrathoracic metastases. 33 We also report no significant difference in overall survival postradiological progression in patients staged with or without 18 F-FDG PET/CT, providing indirect evidence that salvage therapies at the time of relapse were not different between study groups.…”

Section: F-fdg Pet/ct Is Not As Well Established In Sclcmentioning

confidence: 87%

18F-Fludeoxyglucose PET/CT in SCLC: Analysis of the CONVERT Randomized Controlled Trial

Manoharan

Salem

Mistry

et al. 2019

Journal of Thoracic Oncology

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Introduction We used phase-3 CONVERT trial data to investigate the impact of fludeoxyglucose F 18 ( 18 F-FDG) positron emission tomography (PET)/computed tomography (CT) in SCLC. Methods CONVERT randomized patients with limited-stage SCLC to twice-daily (45 Gy in 30 fractions) or once-daily (66 Gy in 33 fractions) chemoradiotherapy. Patients were divided into two groups in this unplanned analysis: those staged with conventional imaging (contrast-enhanced thorax and abdomen CT and brain imaging with or without bone scintigraphy) and those staged with 18 F-FDG PET/CT in addition. Results Data on a total of 540 patients were analyzed. Compared with patients who underwent conventional imaging (n = 231), patients also staged with 18 F-FDG PET/CT (n = 309) had a smaller gross tumor volume ( p = 0.003), were less likely to have an increased pretreatment serum lactate dehydrogenase level ( p = 0.035), and received more chemotherapy ( p = 0.026). There were no significant differences in overall (hazard ratio = 0.87, 95% confidence interval: 0.70–1.08, p = 0.192) and progression-free survival (hazard ratio = 0.87, 95% confidence interval: 0.71–1.07], p = 0.198) between patients staged with or without 18 F-FDG PET/CT. In the conventional imaging group, we found no survival difference between patients staged with or without bone scintigraphy. Although there were no differences in delivered radiotherapy dose, 18 F-FDG PET/CT–staged patients received lower normal tissue (lung, heart, and esophagus) radiation doses. Apart from a higher incidence of late esophagitis in patients staged with conventional imaging (for grade ≥1, 19% versus 11%; [ p = 0.012]), the incidence of acute and late radiotherapy-related toxicities was not different between the two groups. Conclusion In CONVERT, survival outcomes were not significantly different in patients staged with or without 18 F-FDG PET/CT. However, this analysis cannot support the use or omission of 18 F-FDG PET/CT owing to study limitations.

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“…[10][11][12] More recently, Palma and colleagues demonstrated that SBRT to oligometastatic tumours elsewhere in the body resulted in improvements in overall survival and progression-free survival, with no change to quality of life compared to the palliative standard of care. 13 Randomised controlled trials are also currently in progress to assess whether spine SBRT is superior to EBRT in terms of pain control and improved quality of life. 14,15 The adverse effects of spine SBRT have been reported widely.…”

Section: Introductionmentioning

confidence: 99%

Vertebral fractures following stereotactic body radiotherapy for spine metastases

et al. 2020

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Stereotactic body radiotherapy has emerged as one of the preferred treatments for patients with spine metastases, with the potential for long-term control from lesion irradiation. Post-treatment vertebral compression fractures are a known complication of this therapy, contributing to worsening pain and reduced quality of life, sometimes requiring surgical intervention. This review explores the current knowledge of post-radiotherapy fractures, in terms of the rates and associated predictive factors. A search of databases including Medline, Embase and the Cochrane Library was conducted using keywords such as 'vertebral compression fracture', 'stereotactic body radiotherapy' and 'spine metastases'. The search was limited to published studies up to March 2019, reporting clinical outcomes including both the post-treatment fracture rate and statistical identification of associated risk factors. Rates of post-treatment fractures ranged from 4 to 39%. A variety of factors were found to increase the risk, including the appearance of lytic vertebral disease, degree of pre-existing compression, spinal malalignment, increased dose per fraction and a Spinal Instability Neoplastic Score >6. This knowledge can enable clinicians to counsel patients when considering management options for spine metastases, maintaining the balance between local tumour control and the risk of subsequent fracture.

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Stereotactic Ablative Radiation Therapy for the Comprehensive Treatment of Oligometastatic Tumors (SABR-COMET): Results of a Randomized Trial

Cited by 98 publications

References 0 publications

Radiation Therapy in the Definitive Management of Oligometastatic Prostate Cancer: The Johns Hopkins Experience

Radiation Therapy in the Definitive Management of Oligometastatic Prostate Cancer: The Johns Hopkins Experience

18F-Fludeoxyglucose PET/CT in SCLC: Analysis of the CONVERT Randomized Controlled Trial

Vertebral fractures following stereotactic body radiotherapy for spine metastases

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