The role of stereotactic body radiation therapy (SBRT) in the treatment of oligometastatic disease in the elderly

Abstract

Objective: To report about clinical outcome of stereotactic body radiation therapy (SBRT) in the treatment of oligometastatic disease in elderly patients. Methods: Patients with 1-4 inoperable metastases were treated with SBRT. Dose prescription ranged from 40 to 75 Gy in 3-8 fractions. SBRT was delivered using the volumetric modulated arc therapy technique with flattening filter-free photon beams. The primary end points were in-field local control (LC) and toxicity. Secondary end points were overall survival (OS) and disease-specific survival (DSS). Results: 82 patients with 111 total metastases were treated. Median age was 79 years. 64 patients (78%) had a single lesion; the remaining patients had 2-4 lesions. 16 (14.4%) lesions were localized in the abdomen, 50 (45.0%) in the liver and 45 (40.5%) in the lungs. Local response was observed for 87 lesions (78.4%) while local progression was observed in 24 lesions (21.6%). Actuarial 1-year LC was 86.8% 6 3.3%. Actuarial 1-year OS was 93.6% 6 2.7%. 2-year findings were 76.3% 6 4.4% and 72.0% 6 5.6%, respectively. Actuarial 1-and 2-year DSS results were 97.5% 6 2.0% and 81.6% 6 4.9%, respectively. Treatment-related Grade 2-3 toxicity was observed in five patients (4.2%); Grade 1 toxicity in seven patients (5.9%) and no toxicity was observed in 85.4% of the cases. Conclusion: SBRT is a safe and effective therapeutic option for the treatment of oligometastatic disease in the elderly with acceptable rates of LC and low treatmentrelated toxicity. Advances in knowledge: The use of SBRT for oligometastatic disease in the elderly can be considered as a valuable approach, particularly for patients with fragile status or refusing other approaches.

Volumetric modulated arc therapy for thoracic node metastases: a safe and effective treatment for a neglected disease

“…Therefore, elderly patients referred for SBRT are not heavily pretreated with systemic therapies and they are often referred for SBRT early in their oncologic history, due to the lack of other therapeutic options. On the contrary, SBRT is well tolerated also in elderly patients as confirmed in previously published experiences [ 11 ]. Considering that the World Health Organization estimated an increase in the total number of new cancer patients of about 25% for 2030 in Europe, and this increase is expected to be predominantly (91%) observed in patients aged 65 years or above [ 12 ], it deserves to be highlighted that SBRT in elderly patients is safe and efficient and should be considered more and more often.…”

Stereotactic Body Radiation Therapy in Primary and Metastatic Liver Disease

“…In the Phase I study by Lee et al, they observed that the risk of serious liver toxicity was low (95%CI=0-5.3%) (27). In 2015 Scorsetti et al described in elderly patients who received SBRT, Grade 2-3 toxicities in five patients (4.2%); Grade 1 toxicity in seven patients (5.9%) and no toxicity was observed in 85.4% of all cases (28). The limits of our study are: retrospective data, low number of treated lesions and patients, and a variety of pre-SBRT and post-SBRT systemic and liver-directed therapies.…”

Stereotactic ablative radiotherapy for oligometastatic breast cancer in elderly patients

“…Data derived from the studies analyzed in this review shows that SABR has a good adverse effect profile, with grade ≥3 toxicities ranging from none (Scorsetti et al ) to 4.5% (Onal et al ) ( 26 , 47 ). It must be noted, however, that the toxicity present in the subgroup of elder patients is not specified in any of the studies.…”

“…Several authors ( 26 , 27 , 41 , 42 ) have reported that SABR is a feasible, safe and effective technique as treatment for elderly metastatic patients, achieving high rates of prolonged LC in different treatment sites. However, existing clinical evidence backing ablative therapies mostly consists of observational studies with great heterogeneity among their designs.…”