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01-06-2023 | Radiotherapy | Clinical

Metabolic factors associated with the prognosis of oligometastatic patients treated with stereotactic body radiotherapy

Authors: Rainer J. Klement, Reinhart A. Sweeney

Published in: Cancer and Metastasis Reviews | Issue 3/2023

Abstract

Over the past two decades, it has been established that cancer patients with oligometastases, i.e., only a few detectable metastases confined to one or a few organs, may benefit from an aggressive local treatment approach such as the application of high-precision stereotactic body radiotherapy (SBRT). Specifically, some studies have indicated that achieving long-term local tumor control of oligometastases is associated with prolonged overall survival. This motivates investigations into which factors may modify the dose-response relationship of SBRT by making metastases more or less radioresistant. One such factor relates to the uptake of the positron emission tomography tracer 2-deoxy-2-[¹⁸F]fluoro-D-glucose (FDG) which reflects the extent of tumor cell glycolysis or the Warburg effect, respectively. Here we review the biological mechanisms how the Warburg effect drives tumor cell radioresistance and metastasis and draw connections to clinical studies reporting associations between high FDG uptake and worse clinical outcomes after SBRT for oligometastases. We further review the evidence for distinct metabolic phenotypes of metastases preferentially seeding to specific organs and their possible translation into distinct radioresistance. Finally, evidence that obesity and hyperglycemia also affect outcomes after SBRT will be presented. While delivered dose is the main determinant of a high local tumor control probability, there might be clinical scenarios when metabolic targeting could make the difference between achieving local control or not, for example when doses have to be compromised in order to spare neighboring high-risk organs, or when tumors are expected to be highly therapy-resistant due to heavy pretreatment such as chemotherapy and/or radiotherapy.

We apply the standard oncological definition of “cure” which is a five-year disease-free interval after therapy.

While SBRT refers to extracranial sites, the analogous, highly conformal radiation technique for treating individual brain tumors is usually called radiosurgery. This will not be the subject of this review.

BED denotes the biologically effective dose which is calculated as \(\textrm{BED}= nd\left(1+\frac{d}{\alpha /\beta}\right)\), with n being the number of fractions, d the single fraction dose and α/β was assumed to be 10 Gy.

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Title: Metabolic factors associated with the prognosis of oligometastatic patients treated with stereotactic body radiotherapy
Authors: Rainer J. Klement
Reinhart A. Sweeney
Publication date: 01-06-2023
Publisher: Springer US
Keywords: Radiotherapy
Metastasis
Published in: Cancer and Metastasis Reviews / Issue 3/2023
Print ISSN: 0167-7659
Electronic ISSN: 1573-7233
DOI: https://doi.org/10.1007/s10555-023-10110-5

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