Stereotactic Body Radiation Therapy in Oligometastatic Ovarian Cancer: A Promising Therapeutic Approach

Iftode, C.; D’Agostino, Giuseppe; Tozzi, A.; Comito, Tiziana; Franzese, Ciro; Rose, F. De; Franceschini, Davide; Brina, Lucia Di; Tomatis, S.; Scorsetti, Marta

doi:10.1097/igc.0000000000001324

Cited by 39 publications

(32 citation statements)

References 34 publications

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“…As far as the primary endpoint is concerned, we documented a rate of 65.2% CR of irradiated lesions; despite the limits inherent to the heterogeneity over time of frequency and type of imaging for assessment of clinical response, our finding well matches with data of some OC SBRT series . The 100% rate of CR reported by Trippa et al is likely to be ascribed to the small sample size and/or the inclusion of only lymph node disease, which is recognized as presenting a higher response to SBRT compared with parenchymal lesions .…”

Section: Discussionsupporting

confidence: 83%

“…The independent favorable role of younger age and lower tumor volume (PTV) in predicting CR has been already reported by other studies . Conversely, lymph node lesions showed a higher responsiveness compared with parenchymal disease, and this behavior was confirmed in all settings originated from the combinations of variables identified by the multivariate analysis; similar findings have been mentioned in the literature, but these are few , and a comprehensive evaluation of this issue is lacking. In the context of the personalized medicine, further insights on intrinsic biomolecular features of lymph node and parenchymal lesions would be of interest considering that in our series this variable has emerged as the most powerful independent predictor of CR.…”

Section: Discussionsupporting

confidence: 54%

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A Large, Multicenter, Retrospective Study on Efficacy and Safety of Stereotactic Body Radiotherapy (SBRT) in Oligometastatic Ovarian Cancer (MITO RT1 Study): A Collaboration of MITO, AIRO GYN, and MaNGO Groups

et al. 2019

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Background. Recent studies have reported improvement of outcomes (progression-free survival, overall survival, and prolongation of androgen deprivation treatment-free survival) with stereotactic body radiotherapy (SBRT) in nonsmall cell lung cancer and prostate cancer. The aim of this retrospective, multicenter study (MITO RT-01) was to define activity and safety of SBRT in a very large, real-world data set of patients with metastatic, persistent, and recurrent ovarian cancer (MPR-OC).Materials and Methods. The endpoints of the study were the rate of complete response (CR) to SBRT and the 24-month actuarial local control (LC) rate on "per-lesion" basis. The secondary endpoints were acute and late toxicities and the 24-month actuarial late toxicity-free survival. Objective response rate (ORR) included CR and partial response (PR). Clinical benefit (CB) included ORR and stable disease (SD). Toxicity was evaluated by the Radiation Therapy Oncology Group (RTOG) and the The Oncologist 2020;25:e311-e320 www.TheOncologist.com Radiation Oncology(EORTC) and Common Terminology Criteria for Adverse Events (CTCAE) scales, according to center policy. Logistic and Cox regression were used for the uni-and multivariate analysis of factors predicting clinical CR and actuarial outcomes. Results. CR, PR, and SD were observed in 291 (65.2%), 106 (23.8%), and 33 (7.4%) lesions, giving a rate of CB of 96.4%. Patient aged ≤60 years, planning target volume (PTV) ≤18 cm 3 , lymph node disease, and biologically effective dose α/β10 > 70 Gy were associated with higher chance of CR in the multivariate analysis. With a median follow-up of 22 months (range, 3-120), the 24-month actuarial LC rate was 81.9%. Achievement of CR and total dose >25 Gy were associated with better LC rate in the multivariate analysis. Mild toxicity was experienced in 54 (20.7%) patients; of 63 side effects, 48 were grade 1, and 15 were grade 2. The 24-month late toxicity-free survival rate was 95.1%.Conclusions. This study confirms the activity and safety of SBRT in patients with MPR-OC and identifies clinical and treatment parameters able to predict CR and LC rate. The Oncologist 2020;25:e311-e320Implications for Practice: This study aimed to define activity and safety of stereotactic body radiotherapy (SBRT) in a very large, real life data set of patients with metastatic, persistent, recurrent ovarian cancer (MPR-OC). Patient age <60 years, PTV <18 cm 3 , lymph node disease, and biologically effective dose α/β10 >70 Gy were associated with higher chance of complete response (CR). Achievement of CR and total dose >25 Gy were associated with better local control (LC) rate. Mild toxicity was experienced in 20.7% of patients. In conclusion, this study confirms the activity and safety of SBRT in MPR-OC patients and identifies clinical and treatment parameters able to predict CR and LC rate.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 54%

A Large, Multicenter, Retrospective Study on Efficacy and Safety of Stereotactic Body Radiotherapy (SBRT) in Oligometastatic Ovarian Cancer (MITO RT1 Study): A Collaboration of MITO, AIRO GYN, and MaNGO Groups

et al. 2019

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“…Even so, SBRT has proven to be efficacious in this setting, with some local control rates reported as high as 92.9% at one year [41]. Furthermore, toxicity is minimal, with Lazzari et al reporting no grade ≥ 3 toxicity [42].…”

Section: Discussionmentioning

confidence: 99%

Recursive Partitioning Analysis for Local Control Achieved With Stereotactic Body Radiation Therapy for the Liver, Spine, or Lymph Nodes

Kowalchuk

Waters

Dutta

et al. 2021

Advances in Radiation Oncology

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Purpose This study aims to develop a local control risk stratification using recursive partitioning analysis (RPA) for patients receiving stereotactic body radiation therapy (SBRT) for metastatic cancer. Methods and Materials A single institutional database of 397 SBRT treatments to the liver, spine, and lymph nodes was constructed. All treatments required imaging follow-up to assess for local control. Cox proportional hazards analysis was implemented before the decision tree analysis. The data were split into training (70%), validation (10%), and testing (20%) sets for RPA to optimize the training set. Results In the study, 361 treatments were included in the local control analysis. Two-year local control was 71%. A decision tree analysis was used and the resulting model demonstrated 93.10% fidelity for the validation set and 87.67% for the test set. RPA class 3 was composed of patients with non-small cell lung cancer (NSCLC) primary tumors and treatment targets other than the cervical, thoracic, and lumbar spines. RPA class 2 included patients with primary cancers other than NSCLC or breast and treatments targets of the sacral spine or liver. RPA class 1 consisted of all other patients (including lymph node targets and patients with primary breast cancer). Classes 3, 2, and 1 demonstrated 3-year local controls rates of 29%, 50%, and 83%, respectively. On subgroup analysis using the Kaplan-Meier method, treatments for lymph nodes and primary ovarian disease demonstrated improved local control relative to other treatment targets ( P < .005) and primary disease sites ( P < .005), respectively. Conclusions A local control risk stratification model for SBRT to sites of metastatic disease was developed. Treatment target and primary tumor were identified as critical factors determining local control. NSCLC primary lesions have increased local failure for targets other than the cervical, thoracic, or lumbar spines, and improved local control was identified for lymph node sites and breast or ovarian primary tumors.

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“…One, 2, and 5 year local control was 92.9%, and 1, 2, and 5 year progression-free survival was 69.3%, 38%, and 19%, respectively. Platinum sensitivity had no impact on the results, and no grade >2 toxicity was recorded 50…”

Section: Alternate Treatment Strategies When Platinum Is Not An Optionmentioning

confidence: 93%

Management of recurrent ovarian cancer: when platinum-based regimens are not a therapeutic option

Bergamini

Bocciolone

Fodor

et al. 2019

Int J Gynecol Cancer

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Ovarian cancer relapses have been traditionally classified according to the platinum-free interval, leading to an arbitrary categorization of possible scenarios and treatment options. Its relevance in assessing treatment strategies has been revised in the last several years, as the panorama is constantly changing in the era of personalized medicine and targeted therapies. Factors to be considered while defining the best management of recurrent disease, and, consequently, the available treatment alternatives are increasing. Platinum remains one of the milestones of ovarian cancer treatment, but for some patients it might not be an ideal choice for several reasons other than limited platinum sensitivity. This review aims to analyze the scenarios in which platinum is not considered suitable in the management of patients with recurrent ovarian cancer, and the currently available alternatives.

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Stereotactic Body Radiation Therapy in Oligometastatic Ovarian Cancer: A Promising Therapeutic Approach

Abstract: In conclusion, SBRT is a feasible and safe approach for selected cases of oligometastatic ovarian cancer, with satisfactory results in terms of LC and disease free survival.

Cited by 39 publications

References 34 publications

A Large, Multicenter, Retrospective Study on Efficacy and Safety of Stereotactic Body Radiotherapy (SBRT) in Oligometastatic Ovarian Cancer (MITO RT1 Study): A Collaboration of MITO, AIRO GYN, and MaNGO Groups

A Large, Multicenter, Retrospective Study on Efficacy and Safety of Stereotactic Body Radiotherapy (SBRT) in Oligometastatic Ovarian Cancer (MITO RT1 Study): A Collaboration of MITO, AIRO GYN, and MaNGO Groups

Recursive Partitioning Analysis for Local Control Achieved With Stereotactic Body Radiation Therapy for the Liver, Spine, or Lymph Nodes

Management of recurrent ovarian cancer: when platinum-based regimens are not a therapeutic option

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