Stereotactic body radiation therapy for oligometastases

Lo, Simon S.; Fakiris, Achilles J.; Teh, Bin S.; Cárdenes, Higinia R.; Henderson, M.; Forquer, Jeffrey A.; Papież, Lech; McGarry, Ronald C.; Wang, Jian Z.; Li, Kaile; Mayr, Nina A.; Timmerman, Robert

doi:10.1586/era.09.15

Cited by 79 publications

(55 citation statements)

References 71 publications

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“…[19][20][21][22][23] SABR has also been successfully implemented for the local control of metastatic lesions in multiple sites. 19,[24][25][26] RCC has traditionally been considered a radioresistant tumor. 27 This conclusion was supported by a single study that examined the radiosensitivity of multiple human cancer cell lines in vitro 9 and examined one human RCC cell line, which happened to be the most radioresistant among all tested cell lines.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Hannan

Margulis

Chun

et al. 2015

Cancer Biology & Therapy

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Renal Cell Carcinoma (RCC) is a common malignancy world-wide that is rising in incidence. Up to 10% of RCC patients present with inferior vena cava (IVC) tumor thrombus (IVC-TT). Although surgery is the only treatment with proven efficacy for IVC-TT, the surgical management of advanced (level III and IV) IVC-TT is difficult with high morbidity and mortality, and offers a poor survival outcome. Currently, there are no treatment options in the setting of recurrent or unresectable RCC IVC-TT. Even though RCC may be resistant to conventionally fractionated radiation therapy, hypofractionated radiation has shown excellent control rates for both primary and metastatic RCC. We report our experience treating 2 RCC patients with Level IV IVC-TT -one recurrent and the other unresectable-with stereotactic ablative radiation therapy (SABR). The first patient is a 75-year-old gentleman with a level IV RCC IVC-TT who presented 9 months after his radical nephrectomy and thrombectomy with a growing level IV IVC-TT that became refractory to 4 targeted agents. He received SABR of 50Gy in 5 fractions and at 2-year follow-up is doing well with a significant decrease in the enhancement and size of the IVC-TT. The second patient is an 83-year-old gentleman who presented with metastatic RCC and level IV IVC-TT but was not a surgical candidate. After progression on temsirolimus, he received SABR of 36Gy in 4 fractions to his IVC-TT and survived 18 months post-SABR. Both patients improved symptomatically and did not experience any acute or late treatment-related toxicity. Their survival of 24 months and 18 months are comparable to the reported median survival of 20 months in patients with level IV IVC-TT that underwent surgical resection. Therefore, SABR can be a potentially safe treatment option in the unresectable setting for RCC patients with IVC-TT and should be further evaluated in prospective trials.

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Section: Discussionmentioning

confidence: 99%

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Hannan

Margulis

Chun

et al. 2015

Cancer Biology & Therapy

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“…The clinical rationale of local eradicative treatment is thought to be high for oligometastasis [28] . Brachytherapy has advantages for selective intensive treatment of a small target [29] , and its usefulness is reported in the treatment of ipsilateral recurrence [30] .…”

Section: Reirradiation Brachytherapymentioning

confidence: 99%

Novel eradicative high-dose rate brachytherapy for internal mammary lymph node metastasis from breast cancer

Kishi

Tanino²,

Sonomura³

et al. 2012

WJR

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AIM:To develop a method of delivering an eradicative high radiotherapeutic dose safely preserving the surrounding skin in the treatment of internal mammary lymph node metastasis (IMLNM) of breast cancer. METHODS:We report a 38-year-old female patient with a solo IMLNM showing no response to 60 Gy in 2.5 Gy fractions of external beam radiotherapy. To eradicate this tumor, a boost brachytherapy plan was created after percutaneous insertion of an applicator needle into the IMLNM lesion avoiding the pleura and vessels under ultrasound monitoring. According to the dose distribution, the required thickness of a spacer between the skin and the tumor was determined, and hyaluronic gel was injected up to this thickness under ultrasound monitoring. We evaluated skin doses, target doses and clinical outcome. RESULTS:All procedures were performed easily. Sixteen Gy (34.7 Gy equivalent in 2 Gy fractions calculated by the linear quadratic model at α/β = 10: EQ�2, α/β = 10, cumulative total was 101.9 Gy EQ�10) to 100% of the target volume was irradiated with cumulative maximum skin dose of 70 Gy EQ�2, α/β = 3 which was 98.7 Gy EQ�2, α/β = 3 without spacer. No procedure related-or late complications and no local recurrence at the treated site were observed for three years until expiration. CONCLUSION:We consider that this procedure will provide an eradicative high-dose irradiation to IMLNM of breast cancer, preserving skin from overdose complications.

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“…During the oligometastases phase it is theorized that ablation of metastatic deposits can render a patient cured or in a durable state of remission [2,3]. Stereotactic body radiotherapy (SBRT) is an advanced radiotherapy technique that is used to target relatively small deposits of solid tumors with highly conformal doses of radiation using high-precision image-guided therapy, thereby limiting the dose to surrounding normal tissues [4][5][6][7]. This technique evolved from stereotactic radiosurgery for targets in the brain and, while its efficacy is best documented in the treatment of early-stage non-small cell lung cancer, it is now used in the treatment of tumor sites throughout the body.…”

mentioning

confidence: 99%

A multi-national report on stereotactic body radiotherapy for oligometastases: Patient selection and follow-up*

Dagan

Redmond

et al. 2016

Acta Oncologica

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Stereotactic body radiation therapy for oligometastases

Cited by 79 publications

References 71 publications

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Novel eradicative high-dose rate brachytherapy for internal mammary lymph node metastasis from breast cancer

A multi-national report on stereotactic body radiotherapy for oligometastases: Patient selection and follow-up*

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