Stereotactic Body Radiotherapy in the Management of Oligometastatic Disease

Ahmed, Kamran A.; Torres-Roca, Javier F.

doi:10.1177/107327481602300105

Cited by 31 publications

(18 citation statements)

References 64 publications

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“…Although differences in local control were noted in our series by primary histologic type, the overall local control rate is high as reported by other institutions. 1 Furthermore, we noted a separation of colon and renal lung samples into both radioresistant and radiosensitive populations on the basis of RSI, a finding that could be explored in future analyses.…”

Section: Discussionmentioning

confidence: 82%

“…The RSI was calculated by using the previously published rank-based algorithm. 8,9 Each of the 10 genes in the assay was ranked according to gene expression (from the highest expressed [10] to the lowest expressed [1]). The RSI was determined by using the previously published rank-based linear algorithm:…”

Section: Radiosensitivity Signaturementioning

confidence: 99%

“…The management of oligometastatic disease has become increasingly common among radiation oncologists. 1 One of the primary sites in which radiation therapy is utilized in this setting is for the management of lung metastases. Stereotactic body radiation therapy *Corresponding author.…”

Section: Introductionmentioning

confidence: 99%

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Radiosensitivity of Lung Metastases by Primary Histology and Implications for Stereotactic Body Radiation Therapy Using the Genomically Adjusted Radiation Dose

Ahmed

Scott

Arrington

et al. 2018

Journal of Thoracic Oncology

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Section: Discussionmentioning

confidence: 82%

Section: Radiosensitivity Signaturementioning

confidence: 99%

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Radiosensitivity of Lung Metastases by Primary Histology and Implications for Stereotactic Body Radiation Therapy Using the Genomically Adjusted Radiation Dose

Ahmed

Scott

Arrington

et al. 2018

Journal of Thoracic Oncology

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“…In addition to classical outcomes such as overall survival and local and distant control, we also focused on outcomes important for the patient's perception of the disease course -functional survival with Karnofsky performance status at least 70% (borderline where patients are able to care for themselves) and also the freedom from widespread distant metastasis (FFWD), mirrored by freedom from new treatment (FFNT) when the patient had adequate performance status for palliative treatment of widespread disease [29]. Since oligometastatic disease is treated by radical SBRT with curative potential [30][31][32], FFNT may be the most important outcome from patient view-point. To the best of our knowledge, this is the first report of FFNT of a large cohort of patients treated with high BED 10 ablative dose.…”

Section: Discussionmentioning

confidence: 99%

Ablative dose stereotactic body radiation therapy for oligometastatic disease: a prospective single institution study

Burkoň¹,

Kazda²,

Pospíšil³

et al. 2019

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Localized, metastasis-directed stereotactic body radiation therapy (SBRT) of oligometastatic disease (OD) is currently rapidly evolving standard of care in many institutions. Further reports of outcomes are required to strengthen the level of evidence in the absence of comparative trials evaluating different practical procedures. The aim of this prospective single institutional study is to analyse, in unselected cohort of patients from real-world clinical practice, the long-term survival, tumor control outcomes and safety of SBRT in OD (radical ablative radiotherapy with biological equivalent dose BED 10 >100 Gy). In addition to standard toxicity and survival parameters, we report unique outcomes as FFWD-Freedom from widespread dissemination, FFNT-Freedom from the need of subsequent treatment and functional survival with Karnofsky performance status higher than 70%. A total of 110 patients were prospectively evaluated, 60% and 40% were treated for lung and liver oligometastatic disease, respectively. No grade 3 or 4 acute toxicities (CTCAE) were reported. With median follow up of 22.2 months and 2-year overall survival of 88.3%, four patients (6.1%) experienced local progression in the lung SBRT cohort. In the liver SBRT cohort, median follow up was 33 months, 2-year overall survival was 68.5% and 11 patients (25%) experienced local and 36 (81.8%) distal progression. Higher BED 10 of 150-170 Gy compared to 100-150 Gy was an independent positive prognostic factor for local progression-free survival for all patients with hazard ratio 0.25. This confirms SBRT ablative radiobiology effects to be independent of OD primary histology and location. The best outcomes in terms of FFNT were observed in the multivariable analysis of patients with 1-2 lung OD compared to both the liver OD cohort and patients with more than 2 lung metastases. Better FFNT in the liver SBRT cohort was observed in patients with 1-2 liver metastases and in patients whose liver OD was irradiated by higher BED 10. In conclusion, SBRT is a suitable option for patients who are not surgical candidates; with approximately 30% of patients not requiring subsequent treatment 2 years after SBRT. We believe that this treatment represents a safe and effective option for oligometastatic involvement in patients with various primary tumors.

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“…Stereotactic body radiation therapy (SBRT) delivers large doses of radiation with great accuracy and it has been successfully used in both metastatic lung and breast tumors, obtaining a DCR of approximately 80%. [ 5 , 6 ] However, the clinical experience in the treatment of mCRC is still scarce. [ 7 ]…”

Section: Introductionmentioning

confidence: 99%

The role of stereotactic body radiation therapy in oligometastatic colorectal cancer

et al. 2017

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Rationale:Regorafenib is the new standard third-line therapy in metastatic colorectal cancer (mCRC). However, the reported 1-year overall survival rate does not exceed 25%.Patient concerns:A 55-year-old man affected by mCRC, treated with regorafenib combined with stereotactic body radiotherapy (SBRT), showing a durable response.Interventions:After 6 months of regorafenib, a PET/CT scan revealed a focal uptake in a solid lung nodule which was treated with SBRT, whereas continuing regorafenib administration. Fourteen months later, the patient had further progression in a parasternal lymph node, but treatment with regorafenib was continued. The regorafenib-associated side effects, such us the hand-foot syndrome, were favorable managed by reducing the dose from 160 to 120 mg/day.Outcomes:Patient-reported outcome was characterized by a progression-free survival of approximately 3 years.Lessons:in presence of oligometastatic progression, a local SBRT while retaining the same systemic therapy may be a better multidisciplinary approach. Moreover, disease progression is no longer an absolute contraindication for continuing the regorafenib treatment.

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Stereotactic Body Radiotherapy in the Management of Oligometastatic Disease

Abstract: SBRT offers an excellent management option for patients with oligometastases. However, additional research is still needed to optimize dose and fractionation schedules.

Cited by 31 publications

References 64 publications

Radiosensitivity of Lung Metastases by Primary Histology and Implications for Stereotactic Body Radiation Therapy Using the Genomically Adjusted Radiation Dose

Radiosensitivity of Lung Metastases by Primary Histology and Implications for Stereotactic Body Radiation Therapy Using the Genomically Adjusted Radiation Dose

Ablative dose stereotactic body radiation therapy for oligometastatic disease: a prospective single institution study

The role of stereotactic body radiation therapy in oligometastatic colorectal cancer

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