Stereotactic body radiation therapy induces fast tumor control and symptom relief in patients with iliac lymph node metastasis

Wang, Zhongqiu; Wang, Jing; Zhuang, Hongqing; Wang, Ping; Yuan, Zhi Yong

doi:10.1038/srep37987

Cited by 16 publications

(20 citation statements)

References 21 publications

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“…Local consolidative therapy, including radiotherapy or other ablative therapy, combined with systemic therapy could provide synergistic effects. This result was similar to previous studies about liver or iliac lymph node metastases 16,17,21 . Wang et al 17 analyzed the clinical efficacy of SBRT for iliac lymph node metastasis.…”

Section: Discussionsupporting

confidence: 93%

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Clinical efficacy of Stereotactic Body Radiation Therapy (SBRT) for adrenal gland metastases: A multi-center retrospective study from China

Zhao

Zhu

Zhuang

et al. 2020

Sci Rep

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To evaluate the efficacy and safety of CyberKnife Stereotactic Body Radiation Therapy (SBRT) in the treatment of adrenal gland metastases (AGM), we designed a large-scale multicenter retrospective study to report the safety and efficacy of SBRT for inoperable AGM. In this study, 75 (61 males, 14 females) patients with 84 AGM and Karnofsky performance score ≥70 were treated by SBRT from October 2006 to January 2017. Of these, the purpose of treatment were controlling all known metastatic sites for 21 patients while 54 for palliation of bulky adrenal metastases. The efficacy and safety of SBRT were evaluated during follow-up. Potential factors predictive of local control (LC) and overall survival (OS) were identified by univariate and multivariate analysis. Median follow-up time was 12.7 months (range 1.8-96.4). The complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) rates were 23.8%, 23.8%, 31.0% and 21.4%, respectively. The 0.5, 1, and 2-year LC rates were 93.6%, 83.8%, and 62.1%, respectively; OS rates on the same follow-up intervals were 93.7%, 62.5%, and 49.6%, respectively, and the corresponding PFS rates were 48.5%, 33.9%, and 16.0%, respectively. The treatment was well tolerated with 2 patients reporting grade-3 diarrhea and fatigue, respectively. Multivariate analysis showed that simultaneous treatment of SBRT for other metastatic lesions, the number of AGM, initiation of systemic therapy, and the maximum diameter of AGM were predictive of LC rates. Moreover, patients with AGM < 5 cm had a superior OS compared with those with AGM ≥ 5 cm (28.0 months vs. 17.6 months, P = 0.032). SBRT is an effective therapeutic option for treatment of AGM with high LC rates with minimal toxicity. The adrenal gland is one of the commonest metastatic sites in primary tumors of lungs, liver, renal, colorectal, and lymphoma 1. Patients with adrenal gland metastases (AGM) have back or abdominal pain occasionally along with the growth of tumor 2. Rarely, patients with bilateral adrenal metastases may occur adrenal insufficiency which compromises quality of life (QOL) and results in worse outcomes 2. Although salvage chemotherapy and surgery are commonly used to treat AGM, limitations are inevitable. It is mandatory that pathological examinations of the primary tumor should be performed to guide decision making of chemotherapy regimens. Nevertheless, second-line chemotherapy may be less effective or may contribute to severe toxicities when the disease progresses after first-line chemotherapy has failed. Moreover, surgical resection may bring about adrenal insufficiency or other morbidities albeit it is regarded with curative intent 3. Hence, radiotherapy may be an alternative due to its potential efficacy and less risk of adverse effects compared to chemotherapy and surgery.

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Section: Discussionsupporting

confidence: 93%

“…Recent studies have reported clinical practices of SBRT for different metastases, including the lung, liver, iliac lymph node, brain and bone metastases [15][16][17] . Nevertheless, the efficacy of SBRT for AGM has been evaluated in only a few studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31] .…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of Stereotactic Body Radiation Therapy (SBRT) for adrenal gland metastases: A multi-center retrospective study from China

Zhao

Zhu

Zhuang

et al. 2020

Sci Rep

Self Cite

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“…For these reasons, stereotactic body radiotherapy (SBRT) limited to macroscopic lymphadenopathies has been investigated by a number of authors, reporting promising results in terms of 1-years local control > 90% [ 16 – 22 ], optimal symptom control [ 22 ], long systemic therapy-free interval [ 21 ] and the possibility to iteratively perform SBRT in case of limited secondary relapse [ 19 , 23 ]. Nevertheless, toxicity reports and lack of data regarding distant failure and impact on survival, raised doubts about the efficacy of this strategy [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Locoregional control and survival after lymph node SBRT in oligometastatic disease

Loi

Frelinghuysen

Klass

et al. 2018

Clin Exp Metastasis

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Stereotactic body radiotherapy (SBRT) has emerged as an effective option in oligo-metastatic cancer patients affected by lymph node metastases, but its use might be questioned due to risk of regional and distant dissemination through the lymph node chain. The primary aim of our study was to assess the loco-regional control following SBRT in this setting. Ninety-one patients undergoing SBRT for at least one lymph node metastasis from miscellaneous primary tumors were retrospectively evaluated for patterns of failure and toxicity. locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) at 4 years were 79 and 44%. Repeated use of local therapy after progression resulted in a median interval of 17 months until allocation to systemic therapy or supportive care. Forty-three percent of patients were alive at 4 years. Local failure, occurring in 15% of patients, was the only predictor of poor survival (HR: 3.06). Tumor diameter ≥ 30 mm and urothelial primary tumor predicted for impaired local control (HR: 4.59 and 5.43, respectively). Metastases from pulmonary cancer showed a significant earlier distant dissemination (HR: 3.53). Only acute and late grade 1–2 toxicities were reported except for 1 case of G3 dysphagia. Loco-regional failure risk is low (18%) and justifies the use of local therapies for patients with oligometastatic disease. Durable disease remission can be achieved by iterative use of local approaches. Local control is correlated to improved OS. Diameter and primary tumor type may affect response to SBRT and risk for early metastatic dissemination.Electronic supplementary materialThe online version of this article (10.1007/s10585-018-9922-x) contains supplementary material, which is available to authorized users.

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“…Although there have been some reports about SBRT for recurrent gynecological malignancies 13 – 15 and some reports about SBRT for pelvic lymph node metastases from various primary diseases, 16 as far as we know, there have been few review reports about particular cases of SBRT for recurrent lymph node metastasis from gynecological cancers. In 2009, Choi et al reported results of treatment for PALN metastases from uterine cancer.…”

Section: Gynecological Cancermentioning

confidence: 99%

Stereotactic Radiotherapy for Oligometastases in Lymph Nodes—A Review

Matsushita

Jingu

Umezawa

et al. 2018

Technol Cancer Res Treat

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In recent years, the concept of oligometastases has become accepted and reports on stereotactic body radiotherapy as a treatment method have been published. Lesions in the brain, lung, and liver have been reported as target lesions. However, lymph node oligometastases could be a good candidate for stereotactic body radiotherapy as well. In this study, the usability of stereotactic body radiotherapy for oligometastases to lymph nodes is assessed by researching for each primary site. As a result, we could consider that stereotactic body radiotherapy could be almost well applied for lymph node oligometastases from the breast, gynecological organs, and prostate. However, doubts remain concerning the usefulness of stereotactic body radiotherapy for cervical node metastases from head and neck cancer or for mediastinal node metastases from lung or esophageal cancer since late toxicities have occurred with a large radiation dose at hypofractionation to major vessels or the central respiratory tract, especially in patients with irradiation histories. In addition, high-dose irradiation is required to control lymph node metastases from colorectal cancer due to its radioresistance, and severe late adverse events would therefore occur in adjacent organs such as the gastrointestinal tract. In cases of lymph node oligometastases with a primary tumor in the stomach or esophagus, stereotactic body radiotherapy should be used limitedly at present because this patient population is not so large and these metastases are often located close to organs at risk. Because of the varied status of recurrence and varied conditions of patients, it is difficult to determine the optimal dose for tumor control. It might be reasonable to determine the treatment dose individually based on dose constraints of adjacent organs. The oligometastatic state is becoming more frequently identified with more sensitive methods of detecting such oligometastases. In addition, there seems to be another type of oligometastases, so-called induced oligometastases, following successful systemic treatment. To determine the optimal indication of stereotactic body radiotherapy for lymph node oligometastases, further investigation about the mechanisms of oligometastases and further clinical studies including a phase III study are needed.

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Stereotactic body radiation therapy induces fast tumor control and symptom relief in patients with iliac lymph node metastasis

Cited by 16 publications

References 21 publications

Clinical efficacy of Stereotactic Body Radiation Therapy (SBRT) for adrenal gland metastases: A multi-center retrospective study from China

Clinical efficacy of Stereotactic Body Radiation Therapy (SBRT) for adrenal gland metastases: A multi-center retrospective study from China

Locoregional control and survival after lymph node SBRT in oligometastatic disease

Stereotactic Radiotherapy for Oligometastases in Lymph Nodes—A Review

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