Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology and Hepatology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Ophthalmology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
ASH 2024 Annual Meeting 2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Podcast | Sexual health in older age

Dr Holly Thomas helps us unpack the needlessly taboo subject of sex and sexual health in women of older age.

Listen now
ADVANCED SEARCH
Log in
Top
La radiologia medica

12-03-2025 | Original article

Stereotactic body radiotherapy combined with immunotherapy or targeted therapy: a screenshot from Italy on behalf of the Italian Association of Clinical Oncology and Radiotherapy (AIRO)

Authors: Giulia Corrao, Giulia Marvaso, Mattia Zaffaroni, Maria Giulia Vincini, Serena Badellino, Paolo Borghetti, Francesco Cuccia, Manuela Federico, Giampaolo Montesi, Antonio Pontoriero, Ciro Franzese, Mauro Loi, Barbara Alicja Jereczek-Fossa, Marta Scorsetti

Published in: La radiologia medica

Login to get access

Abstract

Aim

Despite the widespread use of immunotherapy (IO) and targeted therapy (TT) in clinical practice, data on toxicity in combination with SBRT are lacking, largely based on retrospective studies and case reports. The present survey, conducted within the AIRO Oligometastatic Study Group, was developed for radiation oncologists to investigate the current clinical practice in Italy regarding hypofractionated SBRT (defined as a dose/fraction ≥ 5 Gy) in cancer patients using IO and TT.

Methods

The online survey, composed of 19 questions, was developed using the cloud-based platform SurveyMonkey® and was sent to all registered AIRO members using the association's mailing list and was administered online and in anonymous form.

Results

Sixty-eight AIRO members from different Italian regions completed the proposed survey. 59% stated that there is sufficient knowledge within their institute regarding the potential interaction between SBRT and TT/IO. According to 76% of the pool, a multidisciplinary protocol is available in their institute. However, 50% of participants report that interdisciplinary consultation with a radiation oncologist did not always take place. Only 6% of the radiation oncologists stated that they lacked sufficient knowledge to adequately consider the treatment of these patients, while 81% of them felt confident in deciding whether or not to combine SBRT and IO/TT. The 26% and the 37% answered that TT and IO, respectively, should be stopped during RT administration.
Regarding which drug types would be of concern when patients are referred for SBRT, the majority of the answers regarded ALK inhibitors (21%), BRAF inhibitors (25%), EGFR inhibitors (26%), immune checkpoint inhibitors (25%) and PARP inhibitors (25%). Only 5% did not consider any of these classes of drugs. Particularly, many radiation oncologists (19%) did not expect a real risk of tumor flare upon discontinuation of TT or IO.

Conclusion

The findings from the present survey underscore significant variability in clinical practice regarding the combination of SBRT with IO and TT across Italy. Therefore, there is an urgent need for prospective clinical studies to evaluate the safety and efficacy of combining SBRT with IO/TT. These studies should aim to generate robust data that can inform the development of comprehensive, evidence-based guidelines.
Appendix
Available only for authorised users
Literature
1.
Lievens Y et al (2020) Defining oligometastatic disease from a radiation oncology perspective: an ESTRO-ASTRO consensus document. Radiother Oncol 148:157–166CrossRefPubMed
2.
Harrow S et al (2022) Stereotactic radiation for the comprehensive treatment of oligometastases (SABR-COMET): extended long-term outcomes. Int J Radiat Oncol Biol Phys 114:611–616CrossRefPubMed
3.
Billing DL, Rimner A (2021) Results of radiation therapy as local ablative therapy for oligometastatic non-small cell lung cancer. Cancers (Basel) 13:5773CrossRefPubMed
4.
Gharwan H, Groninger H (2016) Kinase inhibitors and monoclonal antibodies in oncology: clinical implications. Nat Rev Clin Oncol 13:209–227CrossRefPubMed
5.
Belgioia L et al (2019) Safety and efficacy of combined radiotherapy, immunotherapy and targeted agents in elderly patients: a literature review. Crit Rev Oncol Hematol 133:163–170CrossRefPubMed
6.
7.
8.
van Aken ESM et al (2022) Hypofractionated radiotherapy combined with targeted therapy or immunotherapy: dutch survey on current practice, knowledge and challenges. Clin Transl Radiat Oncol 33:93–98PubMedPubMedCentral
9.
Kroeze SGC et al (2023) Metastases-directed stereotactic body radiotherapy in combination with targeted therapy or immunotherapy: systematic review and consensus recommendations by the EORTC-ESTRO OligoCare consortium. Lancet Oncol 24:e121–e132CrossRefPubMed
10.
Marvaso G et al (2024) Delphi consensus on stereotactic ablative radiotherapy for oligometastatic and oligoprogressive renal cell carcinoma-a european society for radiotherapy and oncology study endorsed by the european association of urology. Lancet Oncol 25:e193–e204CrossRefPubMed
11.
Kroeze SGC et al (2021) Stereotactic radiotherapy combined with immunotherapy or targeted therapy for metastatic renal cell carcinoma. BJU Int 127:703–711CrossRefPubMed
12.
Higa J et al (2020) Real world experience with pembrolizumab in recurrent or advanced prostate cancer. Clin Genitourin Cancer 18:e397–e401CrossRefPubMed
13.
Gan GN et al (2014) Stereotactic radiation therapy can safely and durably control sites of extra-central nervous system oligoprogressive disease in anaplastic lymphoma kinase-positive lung cancer patients receiving crizotinib. Int J Radiat Oncol Biol Phys 88:892–898CrossRefPubMedPubMedCentral
14.
Weickhardt AJ et al (2012) Local ablative therapy of oligoprogressive disease prolongs disease control by tyrosine kinase inhibitors in oncogene-addicted non-small-cell lung cancer. J Thorac Oncol 7:1807–1814CrossRefPubMedPubMedCentral
15.
Stefan D et al (2016) Vemurafenib and concomitant stereotactic radiation for the treatment of melanoma with spinal metastases: a case report. Rep Pract Oncol Radiother 21:76–80CrossRefPubMed
16.
Blake-Cerda M et al (2021) Consolidative stereotactic ablative radiotherapy (SABR) to intrapulmonary lesions is associated with prolonged progression-free survival and overall survival in oligometastatic NSCLC patients: a prospective phase 2 study. Lung Cancer 152:119–126CrossRefPubMed
17.
Bruno R et al (2017) Squamous cell transformation and EGFR T790M mutation as acquired resistance mechanisms in a patient with lung adenocarcinoma treated with a tyrosine kinase inhibitor: a case report. Oncol Lett 14:5947–5951PubMedPubMedCentral
18.
Chan OSH et al (2020) ATOM: A phase II study to assess efficacy of preemptive local ablative therapy to residual oligometastases of NSCLC after EGFR TKI. Lung Cancer 142:41–46CrossRefPubMed
19.
Chan OSH et al (2017) The role of radiotherapy in epidermal growth factor receptor mutation-positive patients with oligoprogression: a matched-cohort analysis. Clin Oncol (R Coll Radiol) 29:568–575CrossRefPubMed
20.
Iyengar P et al (2014) Phase II trial of stereotactic body radiation therapy combined with erlotinib for patients with limited but progressive metastatic non-small-cell lung cancer. J Clin Oncol 32:3824–3830CrossRefPubMed
21.
Hsu K-H et al (2021) Primary tumor radiotherapy during EGFR-TKI disease control improves survival of treatment naïve advanced EGFR-mutant lung adenocarcinoma patients. Onco Targets Ther 14:2139–2148CrossRefPubMedPubMedCentral
22.
Kroeze SGC et al (2021) Continued versus interrupted targeted therapy during metastasis-directed stereotactic radiotherapy: a retrospective multi-center safety and efficacy analysis. Cancers (Basel) 13:4780CrossRefPubMed
23.
Kroeze SGC et al (2021) Metastasis directed stereotactic radiotherapy in NSCLC patients progressing under targeted- or immunotherapy: efficacy and safety reporting from the ‘TOaSTT’ database. Radiat Oncol 16:4CrossRefPubMedPubMedCentral
24.
Pollom EL et al (2015) Gastrointestinal toxicities with combined antiangiogenic and stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 92:568–576CrossRefPubMedPubMedCentral
25.
Wang C et al (2019) Analysis of toxic effects with antiangiogenic agents plus stereotactic body radiation in ultracentral lung tumors. JAMA Oncol 5:737–739CrossRefPubMedPubMedCentral
26.
Anker CJ et al (2016) Avoiding severe toxicity from combined braf inhibitor and radiation treatment: consensus guidelines from the eastern cooperative oncology group (ECOG). Int J Radiat Oncol Biol Phys 95:632–646CrossRefPubMedPubMedCentral
27.
Kroeze SGC et al (2017) Toxicity of concurrent stereotactic radiotherapy and targeted therapy or immunotherapy: a systematic review. Cancer Treat Rev 53:25–37CrossRefPubMed
28.
Barney BM et al (2013) Increased bowel toxicity in patients treated with a vascular endothelial growth factor inhibitor (VEGFI) after stereotactic body radiation therapy (SBRT). Int J Radiat Oncol Biol Phys 87:73–80CrossRefPubMed
29.
Haji MohdYasin NA, Gray AR, Bevin TH, Kelly LE, Molteno AC (2016) Choroidal melanoma treated with stereotactic fractionated radiotherapy and prophylactic intravitreal bevacizumab: the dunedin hospital experience. J Med Imaging Radiat Oncol 60:756–763CrossRef
Metadata
Title
Stereotactic body radiotherapy combined with immunotherapy or targeted therapy: a screenshot from Italy on behalf of the Italian Association of Clinical Oncology and Radiotherapy (AIRO)
Authors
Giulia Corrao
Giulia Marvaso
Mattia Zaffaroni
Maria Giulia Vincini
Serena Badellino
Paolo Borghetti
Francesco Cuccia
Manuela Federico
Giampaolo Montesi
Antonio Pontoriero
Ciro Franzese
Mauro Loi
Barbara Alicja Jereczek-Fossa
Marta Scorsetti
Publication date
12-03-2025
Publisher
Springer Milan
Published in
La radiologia medica
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI
https://doi.org/10.1007/s11547-025-01977-1