Treatment of Sarcoma Lung Metastases with Stereotactic Body Radiotherapy

Abstract

Background The most common site of sarcoma metastasis is the lung. Surgical resection of pulmonary metastases and chemotherapy are treatment options that have been employed, but many patients are poor candidates for these treatments for multiple host or tumor-related reasons. In this group of patients, radiation might provide a less morbid treatment alternative. We sought to evaluate the efficacy of radiotherapy in the treatment of metastatic sarcoma to the lung. Methods Stereotactic body radiotherapy (SBRT) was used to treat 117 pulmonary metastases in 44 patients. Patients were followed with serial computed tomography imaging of the chest. The primary endpoint was failure of control of a pulmonary lesion as measured by continued growth. Radiation-associated complications were recorded. Results The majority of patients (84%) received a total dose of 50 Gy per metastatic nodule utilizing an image-guided SBRT technique. The median interval follow-up was 14.2 months (range 1.6–98.6 months). Overall survival was 82% at two years and 50% at five years. Of 117 metastatic nodules treated, six nodules showed failure of treatment (95% control rate). Twenty patients (27%) developed new metastatic lesions and underwent further SBRT. The side effects of SBRT included transient radiation pneumonitis (n=6), cough (n=2), rib fracture (n=1), chronic pain (n=1), dermatitis (n=1), and dyspnea (n=1). Conclusion Stereotactic body radiotherapy is an effective and safe treatment for the ablation of pulmonary metastasis from sarcoma. Further work is needed to evaluate the optimal role of SBRT relative to surgery or chemotherapy for treatment of metastatic sarcoma.

Multi‐institutional analysis of stereotactic body radiotherapy for sarcoma pulmonary metastases: High rates of local control with favorable toxicity

“…Rates of grade 2 pneumonitis were low in our series and these others, in which relatively few patients received multiple courses of lung SBRT, even though our series and the UCLA series had many patients previously treated with metastatectomy. These results are in contrast to the higher toxicity reported in the series by Lindsay et al 29 in which 44 patients were treated with SBRT to 117 separate sarcoma pulmonary metastases between 2005 and 2014. In that series, the median number of lesions treated per patient was 2 (range, 1‐7 lesions) and median lesion size was 2.1 cm (range, 0.8‐7 cm).…”

“…Rates of pneumonitis in this series were higher (11 patients [25%] vs 1 patient [2%] in our series), which may be due to the higher percentage of patients receiving SBRT to more than one lesion, since the median lesion size (2.1 vs 2.0 cm) and radiation dose/fractionation were very similar between the two studies. Lindsay et al 29 reported one grade 3 complication (esophageal stricture requiring balloon dilatation).…”

Oligometastatic squamous cell carcinoma of the head and neck treated with stereotactic body ablative radiotherapy: Single‐institution outcomes

“…This surprising finding suggests that further dose escalation beyond the standard fractionation currently used at our institution of 50 Gy in 5 fractions (BED 10 = 100 Gy) may be warranted for patients with OM‐HNSCC. Prior analyses using the same SABR dose‐fractionation and treatment strategy at our institution for patients with primarily T1‐2 non‐small cell lung cancer showed a 91% LC rate at 2 years and patients with lung metastases from soft tissue sarcoma had a 95% TM‐LC rate with a median follow‐up of 14.2 months, suggesting that this dose is sufficient for oligometastases of other primary sites . Alternatively, the findings may suggest that other local therapy options such as surgical metastasectomy may be considered in this patient population .…”

Epithelioid Sarcoma—From Genetics to Clinical Practice

“…Definitive radiotherapy could be applied in selected patients with oligometastatic ES ( Figure 4 B–D). There is a growing number of evidence that stereotactic body radiotherapy (SBRT) is beneficial in patients with oligometastatic sarcomas, providing local control around 90% [ 89 , 90 ]. Palliative RT should be considered in the case of symptomatic ES metastases.…”