Stereotactic radiation therapy for oligometastases or oligorecurrence within mediastinal lymph nodes

Wang, Huan Huan; Zaorsky, Nicholas G.; Mao, Meng; Zeng, Xian; Deng, Lei; Song, Yong; Zhuang, Hong; Li, Feng Tong; Zhao, Lu; Yuan, Zhi Yong; Wang, Ping; Hao, Xi Shan

doi:10.18632/oncotarget.7636

Cited by 28 publications

(38 citation statements)

References 43 publications

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“…selection of SBRT, including large tumors and advanced-stage NSCLC (32,33). Nevertheless, few large-scale studies have reported the effect of SBRT on post-operative oligo-recurrence of NSCLC (34,35). Therefore, the present study aimed to retrospectively assess the efficacy and safety of salvage SBRT for post-operative oligo-recurrence following primary curative lung resection in patients with NSCLC.…”

Section: Salvage Stereotactic Body Radiotherapy For Post-operative Olmentioning

confidence: 99%

Salvage stereotactic body radiotherapy for post‑operative oligo‑recurrence of non‑small cell lung cancer: A single‑institution analysis of 59�patients

et al. 2020

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A standard treatment for patients with early-stage non-small cell lung cancer (NSCLC) who undergo surgery, and subsequently develop local failure or intrathoracic oligorecurrence, has not yet been established. The present study aimed to assess the feasibility of stereotactic body radiotherapy (SBRT) for this subgroup of patients. Consequently, a retrospective analysis was conducted of patients with NSCLC recurrence who were treated with SBRT, and previously underwent curative surgical resection between October 2011 and October 2016. Post-SBRT survival [overall survival (OS); progression-free survival (PFS); and local control (LC)] and toxicity were analyzed. Prognostic factors for OS were identified using univariate and multivariate analysis. A total of 52 patients and 59 tumors were analyzed. The median follow-up time was 25 months (35 months for surviving patients), and median OS following salvage SBRT was 32 months. The 1-and 3-year OS rates were 84.4 and 67.8%, respectively. 1-and 3-year PFS rates were 80.8 and 58.7%, respectively. Only 4 patients (7.7%) developed local failure. Median LC was 71 months and 1-and 3-year LC rate were 97.9 and 94.9%, respectively. A total of 4 patients experienced grade 3 or higher adverse events (AEs) and two experienced grade 5 AEs (pneumonitis and hemoptysis). Central tumor location and the possibility of re-operation were independent prognostic factors for OS. The present study indicated that post-operative salvage SBRT is a promising therapeutic option for patients with NSCLC with locoregional or intrathoracic oligo-recurrence. We regard toxicity was also acceptable. However, further research is required on the appropriate selection of subjects, and stratification of the analysis by certain risk factors would increase the accuracy of the conclusions.

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Section: Salvage Stereotactic Body Radiotherapy For Post-operative Olmentioning

confidence: 99%

Salvage stereotactic body radiotherapy for post‑operative oligo‑recurrence of non‑small cell lung cancer: A single‑institution analysis of 59�patients

et al. 2020

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“…Systemic chemotherapy is the standard of care for metastatic bladder disease, no matter if in presence of a polimetastatic or oligometastatic. RT was introduced as an option to face challenges such as local relapse or oligometastases in the treatment of numerous tumor diseases such as prostate, breast lung, kidney and colorectal cancer [11][12][13][14][15][16][17]. Advances in multimodal treatment strategies involving all major oncologic disciplines have contributed to a remarkably improved prognosis for oligometastatic patients.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the unfit patients with limited metastatic disease might benefit from local approach like stereotactic irradiation. Stereotactic body radiotherapy (SBRT) has been studied in numerous settings including oligometastatic lung, colorectal, prostate and breast cancer [11][12][13][14][15][16][17]. Only limited data are available for SBRT in oligometastatic bladder cancer, including mainly case reports and series of SBRT for primary transitional cell carcinoma (TCC) and renal cell carcinoma of kidney [18][19][20][21].…”

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confidence: 99%

Recurrent oligometastatic transitional cell bladder carcinoma: is there room for radiotherapy?

Augugliaro¹,

Marvaso

Ciardo

et al. 2019

neo

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This paper presents a retrospective report on radiotherapy (RT) in the oligometastastic recurrence of bladder cancer. Thirteen patients treated for low-volume metastatic transitional cell urinary bladder carcinoma (TCC) were reviewed, with the primary endpoint to evaluate the safety and efficacy of RT, proposed as an alternative to systemic treatment and/or to defer commencement of systemic therapy. The inclusion criteria were: patients who received RT without other local/ systemic therapy for oligometastatic TCC with lymph node, bone and lung lesions or local recurrence. Previous systemic therapy and surgery on the primary tumor were allowed in this tumor response, and toxicity evaluation and progression free-survival was also assessed. Thirteen patients with 21 lesions were treated with stereotactic body radiotherapy (SBRT) or conformal 3D radiotherapy (3D-CRT) between 2012 and 2017. All participants were discussed by a multidisciplinary urological board. The median age at RT was 68 years (range 50-80), the median Karnofsky performance status (KPS) was 90 (range 80-90) and the median interval between TCC diagnosis and commencement of RT on oligometastasis was 23 months (range 8-105). The median treatment dose was 25 Gy (range 20-36 Gy) given over a median of 5 fractions (range 3-10 fractions) with a median follow-up of 25 months (range 3-43 months). Imaging assessment was available for 20 lesions. The radiological progression of disease was registered in 9 patients at the median of 4.2 months from radiotherapy (range 1.9-18.8 months). This identified in-field and out-field progression in 6 patients and only out-field progression in the remaining 3. At last contact, 3 patients were alive with no evidence of disease, 3 had evidence of disease, 6 died of cancerrelated disease and one died from another cause. No severe acute and late toxicity was observed.The literature contains no consistent data on TCC oligometastatic setting, but radiotherapy on lymph node, bone and/or lung oligo-recurrence from TCC offers durable disease control in a small number of patients with a very low toxicity profile. Further studies are required to establish the radiotherapy role in oligometastatic recurrent bladder cancer.

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“…tumors or lymph node (LN) metastasis directly abutting the central airway [9][10][11]. The treatment of such tumors has been considered risky, including a previous report of grade 5 toxicity (according to the Common Terminology Criteria for Adverse Events, CTCAE v4.0) [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…The gold standard for LN recurrent cancer is the systemic treatment (i.e., chemo-, endocrine-and biological therapy). Few experiences have been published on SBRT for mediastinal LN lesions [10,11]. In our department, SBRT has been used since 2003 for the treatment of several pathologies in different anatomical sites [16][17][18] and this long-lasting experience pushed us to investigate its use in the NFZ.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiation therapy for mediastinal lymph node metastases: how do we fly in a ‘no-fly zone’?

et al. 2018

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Purpose: To evaluate the treatment-induced toxicity (as primary endpoint) and the efficacy (as secondary endpoint) of stereotactic body radiation therapy (SBRT) in the treatment of mediastinal lymph nodes (LNs) in the so-called no-fly zone (NFZ) in cancers with various histology. Material and methods: Forty-two patients were retrospectively analyzed. Institutional dose/volume constraints for organs at risk (OARs) derived by published data were strictly respected. The correlation between treatment-related variables and toxicity was investigated by logistic regression, Chi-squared test or Fisher's exact test. Overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS) and local control (LC) were collected from the follow-up reports. The impact of potential predictive factors on LC, PFS and OS were estimated by Cox proportional-hazard regression. Results: Median follow-up time was 16 months (range 1-41). Four patients had esophageal G1 toxicity. Ten and six patients had G1 and G2 pulmonary toxicity, respectively. Treatment site and irradiation technique were significantly correlated with G ! 2 and G! 1 toxicity, respectively. OS probability at 19 months was 88.3% and corresponded to CSS. LC probability at 16 months was 66.3% (median LC duration: 22 months, range 1-41). Fifteen patients (35.7%) were disease-free at 25 months (median time, range 1-41). The biologically effective dose (BED) and the target dose coverage indexes were significantly correlated with LC. Conclusions: SBRT can be considered as a safe treatment option for selected patients with oligo-metastases/recurrences in the NFZ, if strict dose/volume constraints are applied.

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Stereotactic radiation therapy for oligometastases or oligorecurrence within mediastinal lymph nodes

Cited by 28 publications

References 43 publications

Salvage stereotactic body radiotherapy for post‑operative oligo‑recurrence of non‑small cell lung cancer: A single‑institution analysis of 59�patients

Salvage stereotactic body radiotherapy for post‑operative oligo‑recurrence of non‑small cell lung cancer: A single‑institution analysis of 59�patients

Recurrent oligometastatic transitional cell bladder carcinoma: is there room for radiotherapy?

Stereotactic body radiation therapy for mediastinal lymph node metastases: how do we fly in a ‘no-fly zone’?

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