Stereotactic body radiation therapy in the treatment of cancer patients with oligometastatic disease: a real world study

Stefanović, Milica; Calvet, Gemma; Pérez-Montero, Héctor; Esteve, Anna; Bujalance, Montse Ventura; Navarro-Martín, Arturo; Fernández, María Dolores Arnaiz; Gonzalez, F. Ferrer; Borràs, Susanna Marín i; Borbalas, Alicia Lozano; Fernandez, Miriam Nuñez; Garau, Miquel Macià i; Calduch, Anna Lucas; Edo, F. Guedea

doi:10.1007/s12094-022-02923-7

Cited by 3 publications

(12 citation statements)

References 24 publications

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“…Interestingly, patients with brain-only metastases had median survival of 52.2 months, resembling survival data from previous studies of oligometastatic cancer [17][18][19]. In this context, one should note the impact of positron emission tomography staging, which was widely used in our patients and contributes to better staging accuracy.…”

Section: Discussionsupporting

confidence: 78%

Patterns of Care and Survival in Cancer Patients with Brain Metastases Receiving Immune Checkpoint Inhibitors

et al. 2023

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Introduction: Immune checkpoint inhibitors (ICI) have become a mainstay of treatment for different cancer types. The purpose of this study was to evaluate patterns of care and overall survival after diagnosis of brain metastases in patients managed with ICI as component of care. Methods: Retrospective cohort study. Fifty patients were included (34 with brain metastases at first cancer diagnosis, 16 with metachronous spread). Results: Depending on symptoms, lesion number and size, and other individualized criteria, multidisciplinary tumor board (MDT) discussion resulted in highly individualized treatment sequences. Selected patients received systemic treatment alone. Twenty-four patients (48%) had any stereotactic radiosurgery (SRS) or neurosurgical resection at some point in time (upfront/salvage). Only 7 patients (14%) were never treated with brain irradiation or neurosurgery. Median overall survival (OS) was 13.0 months. Better Karnofsky performance status (KPS), absence of extracranial metastases, and time interval between cancer diagnosis and brain metastases of 0-18 months predicted for improved survival. Treatment sequence was not associated with survival. Patients without extracranial metastases had median OS of 52.2 months. Discussion/Conclusion: Long-term survival is possible in patients managed with ICI ± brain-directed treatment. This study did not identify a clear treatment sequence of choice. MDT assessment at diagnosis and each progression is recommended to ensure favorable outcomes.

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Section: Discussionsupporting

confidence: 78%

Patterns of Care and Survival in Cancer Patients with Brain Metastases Receiving Immune Checkpoint Inhibitors

et al. 2023

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“…Unfortunately, while DLTs, particularly SRT, are widely used in clinical practice to manage OMD, there is limited evidence to support their use. A review of scientific literature from PubMed in the past year (when a peak of publications is registered) reveals a high number of heterogeneous, retrospective, and small-scale clinical studies conducted in real-world settings [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. While these studies are important, their results cannot formally change the standard of therapy.…”

Section: Definitive Local Therapies In Omdmentioning

confidence: 99%

“…While these studies are important, their results cannot formally change the standard of therapy. The evidence ranges from case reports and retrospective series [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ] to phase III randomized trials [ 69 ] such as the SINDAS trial. This trial showed that adding SRT to TKIs significantly improves survival in 133 EGFR-mutated NSCLC OMD patients (median OS TKI plus SRT: 25.5 months vs. 17.4 months in TKI monotherapy).…”

Section: Definitive Local Therapies In Omdmentioning

confidence: 99%

“…This trial showed that adding SRT to TKIs significantly improves survival in 133 EGFR-mutated NSCLC OMD patients (median OS TKI plus SRT: 25.5 months vs. 17.4 months in TKI monotherapy). The studies range in size from 39 NSCLC OMD patients (in a study reporting an interesting retrospective comparison between DLTs, predominantly radiotherapy, vs. TKIs) [ 64 ] to 284 OMD patients with different cancers (a single-arm study performed predominantly in lung, colon, and breast OMD) [ 67 ]. The median survivals achieved in these studies with SRT are higher than those reported in the poly-metastatic setting, 30.8 and 53.4 months, respectively, confirming that OMD has a good prognosis.…”

Section: Definitive Local Therapies In Omdmentioning

confidence: 99%

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Oligo-Metastatic Cancers: Putative Biomarkers, Emerging Challenges and New Perspectives

Ottaiano

Santorsola

Circelli³

et al. 2023

Cancers

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Some cancer patients display a less aggressive form of metastatic disease, characterized by a low tumor burden and involving a smaller number of sites, which is referred to as “oligometastatic disease” (OMD). This review discusses new biomarkers, as well as methodological challenges and perspectives characterizing OMD. Recent studies have revealed that specific microRNA profiles, chromosome patterns, driver gene mutations (ERBB2, PBRM1, SETD2, KRAS, PIK3CA, SMAD4), polymorphisms (TCF7L2), and levels of immune cell infiltration into metastases, depending on the tumor type, are associated with an oligometastatic behavior. This suggests that OMD could be a distinct disease with specific biological and molecular characteristics. Therefore, the heterogeneity of initial tumor burden and inclusion of OMD patients in clinical trials pose a crucial methodological question that requires responses in the near future. Additionally, a solid understanding of the molecular and biological features of OMD will be necessary to support and complete the clinical staging systems, enabling a better distinction of metastatic behavior and tailored treatments.

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“…This approach improves local control and overall survival rates without increasing the occurrence of radiation therapy-related adverse effects. [6][7][8] Numerous studies have confirmed that SBRT can achieve comparable efficacy to surgical resection and is a safe and effective treatment option for oligometastases in the lungs. 4,6,8,9 Despite the increasing use of SBRT in the management of oligometastatic lung disease and its favorable treatment outcomes, there is a lack of standardized guidelines to assist clinicians with this treatment.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy takes on Lung Oligometastases: Latest breakthroughs

Liu,

Wu,

Guo

et al. 2024

Precision Radiation Oncology

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Lung oligometastases represent an intermediate state of cancer dissemination between localized and widespread metastases. Stereotactic body radiation therapy (SBRT) has emerged as an effective treatment option, with an efficacy comparable to that of surgical resection. This review aimed to provide a comprehensive summary of the latest advancements and controversial issues regarding SBRT for lung oligometastases. It focuses on four crucial perspectives: efficacy of SBRT, optimal patient selection criteria, technological innovations, and synergistic effects of SBRT combined with systemic therapy. Relevant clinical trials investigating SBRT for lung oligometastases have been conducted, with median 1‐ and 5‐year local control rates of 90% and 79%, respectively. The origin of the primary tumor, size and number of lesions, and biomarker profiles were highlighted as pivotal considerations in patient selection. The precise dose delivery was enhanced using robotic SBRT and optimized dose fractionation schemes. Evidence suggests that dose escalation above 100 Gy biologically effective dose may improve tumor control. Combined immunotherapy and SBRT have demonstrated synergistic effects in prolonging progression‐free survival and overall survival. This review provides valuable insights into the precise treatment of oligometastatic lung diseases using SBRT. Further multicenter randomized trials are warranted to develop definitive patient selection criteria and optimize the integration with systemic therapies.

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Stereotactic body radiation therapy in the treatment of cancer patients with oligometastatic disease: a real world study

Cited by 3 publications

References 24 publications

Patterns of Care and Survival in Cancer Patients with Brain Metastases Receiving Immune Checkpoint Inhibitors

Patterns of Care and Survival in Cancer Patients with Brain Metastases Receiving Immune Checkpoint Inhibitors

Oligo-Metastatic Cancers: Putative Biomarkers, Emerging Challenges and New Perspectives

Stereotactic body radiotherapy takes on Lung Oligometastases: Latest breakthroughs

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