Top

Published in:

02-05-2022 | Systemic Therapy | Original Article

Stereotactic body radiotherapy for pulmonary oligometastases: a monoinstitutional analysis of clinical outcomes and potential prognostic factors

Authors: Francesco Cuccia, MD, Rosario Mazzola, Vanessa Figlia, Niccolò Giaj-Levra, Luca Nicosia, Francesco Ricchetti, Michele Rigo, Giorgio Attinà, Claudio Vitale, Edoardo Pastorello, Ruggero Ruggieri, Filippo Alongi

Published in: Strahlentherapie und Onkologie | Issue 10/2022

Abstract

Purpose

We report the retrospective data of a cohort of patients who received stereotactic body radiotherapy for pulmonary oligometastases, aiming to assess the clinical factors potentially affecting clinical outcomes.

Methods

The present series reports the outcomes of a cohort of 71 patients with pulmonary oligometastases with no extrapulmonary disease. All patients were treated with stereotactic body radiotherapy (SBRT) performed with volumetric modulated arc therapy-image guided radiotherapy (VMAT-IGRT) to up to five secondary lesions. Survival estimates were performed using the Kaplan–Meier method.

Results

A total of 98 lesions in 71 patients were treated from February 2014 to August 2020. The most frequent histologies were colorectal in 37.7%, lung cancer in 44.8%, head and neck cancer in 8.1%, and other in 9.4%. Median age was 71 years (range 32–93 years). Concurrent systemic therapy was administered in 32.3%. SBRT was delivered to a median total dose of 60 Gy (range 55–70 Gy) in 3–10 fractions for a median BED₁₀ = 105 Gy (range 96–180 Gy). Median follow-up was 29.5 months (range 6–81), with no acute or late G > 2 adverse event. Our LC rates at 2 and 4 years were 92.4 and 89.8%, respectively. DPFS rates at 2 and 4 years were 45.3 and 27.2%, respectively. A second SBRT course was proposed in 21 patients (29.5%) who developed an oligoprogression, resulting in median time to second progression of 9 months (range 2–44) and 2‑year PFS2 rate of 42.4%. At univariate analysis, patients with sequential oligometastases reported better OS rates (p = 0.002), which was also confirmed at multivariate analysis, where distant progression was also related to worse OS (p = 0.022). Higher local control rates relate to better PFS (p = 0.04). The 2‑ and 4‑year OS rates were 61 and 39.7%

Conclusion

SBRT is feasible for pulmonary oligometastases with favorable outcomes and toxicity. At multivariate analysis, patients with sequential oligometastatic progression maintain a survival advantage. Also, local control was found to be related to improved PFS rates.

Herold CJ, Bankier AA, Fleischmann D (1996) Lung metastases. Eur Radiol 6(5):596–606CrossRef

Hellman S, Weichselbaum RR (1995) Oligometastases. J Clin Oncol 13:8–10CrossRef

Filippi AR, Guerrera F, Badellino S, Ceccarelli M, Castiglione A, Guarneri A et al (2016) Exploratory analysis on overall survival after either surgery or stereotactic radiotherapy for lung Oligometastases from colorectal Cancer. J Clin Oncol 28(8):505–512CrossRef

Nuyttens JJ, van der Voort van Zyp NC, Verhoef C, Maat A, van Klaveren RJ, van der Holt B et al (2015) Stereotactic body radiation therapy for oligometastases to the lung: a phase 2 study. Int J Radiat Oncol Biol Phys 91(2):337–343CrossRef

Figlia V, Mazzola R, Cuccia F, Alongi F, Mortellaro G, Cespuglio D, Cucchiara T, Iacoviello G, Valenti V, Molino M, Verderame F, Matranga D, Casto AL, Ferrera G (2018) Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience. Radiol Med 123(6):406–414. https://doi.org/10.1007/s11547-018-0858-7CrossRefPubMed

Cuccia F, Mortellaro G, Mazzola R, Donofrio A, Valenti V, Tripoli A, Matranga D, Casto LA, Failla G, Di Miceli G, Ferrera G (2020) Prognostic value of two geriatric screening tools in a cohort of older patients with early stage Non-Small Cell Lung Cancer treated with hypofractionated stereotactic radiotherapy. J Geriatr Oncol 11(3):475–481. https://doi.org/10.1016/j.jgo.2019.05.002CrossRefPubMed

Nicosia L, Franceschini D, Perrone-Congedi F, Casamassima F, Gerardi MA, Rigo M, Mazzola R, Perna M, Scotti V, Fodor A, Iurato A, Pasqualetti F, Gadducci G, Chiesa S, Niespolo RM, Bruni A, Alicino G, Frassinelli L, Borghetti P, Di Marzo A, Ravasio A, De Bari B, Sepulcri M, Aiello D, Mortellaro G, Sangalli C, Franceschini M, Montesi G, Aquilanti FM, Lunardi G, Valdagni R, Fazio I, Corti L, Vavassori V, Maranzano E, Magrini SM, Arcangeli S, Valentini V, Paiar F, Ramella S, Di Muzio NG, Livi L, Jereczek-Fossa BA, Osti MF, Scorsetti M, Alongi F (2021) A multicenter LArge retrospectIve daTabase on the personalization of Stereotactic ABlative Radiotherapy use in lung metastases from colon-rectal cancer: the LaIT-SABR study. Radiother Oncol. https://doi.org/10.1016/j.radonc.2021.10.023CrossRefPubMed

Singh D, Chen Y, Hare MZ, Usuki KY, Zhang H, Lundquist T, Joyce N, Schell MC, Milano MT (2014) Local control rates with five-fraction stereotactic body radiotherapy for oligometastatic cancer to the lung. J Thorac Dis 6(4):369–374. https://doi.org/10.3978/j.issn.2072-1439.2013.12.03CrossRefPubMedPubMedCentral

Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Schlijper R, Bauman GS, Laba J, Qu XM, Warner A, Senan S (2020) Stereotactic ablative radiotherapy for the comprehensive treatment of oligometastatic cancers: long-term results of the SABR-COMET phase II randomized trial. J Clin Oncol 38(25):2830–2838. https://doi.org/10.1200/JCO.20.00818CrossRefPubMedPubMedCentral

10.

Pastorino U, Buyse M, Friedel G, Ginsberg RJ, Girard P, Goldstraw P, Johnston M, McCormack P, Pass H, Putnam JB Jr, International Registry of Lung Metastases (1997) Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 113(1):37–49. https://doi.org/10.1016/s0022-5223(97)70397-0CrossRefPubMed

11.

Li S, Nie S, Li Z, Che G (2019) Is stereotactic radiotherapy equivalent to metastasectomy in patients with pulmonary oligometastases? Interact CardioVasc Thorac Surg 29(4):544–550. https://doi.org/10.1093/icvts/ivz133CrossRefPubMed

12.

Lindsay DP, Caster JM, Wang K, Myung JH, Chen RC, Chera B et al (2017) Nanotechnology-based quantification of circulating tumor cells in oligometastatic patients undergoing definitive radiation therapy. Int J Radiat Oncol Biol Phys 99(2):S51CrossRef

13.

Zhao Y, Khawandanh E, Thomas S, Zhang S, Dunne EM, Liu M, Schellenberg D (2020) Outcomes of stereotactic body radiotherapy 60 Gy in 8 fractions when prioritizing organs at risk for central and ultracentral lung tumors. Radiat Oncol 15(1):61. https://doi.org/10.1186/s13014-020-01491-wCrossRefPubMed

14.

Hanna GG, Murray L, Patel R et al (2018) UK consensus on normal tissue dose constraints for stereotactic radiotherapy. Clin Oncol 30(1):5–14. https://doi.org/10.1016/j.clon.2017.09.007CrossRef

15.

Adebahr S, Collette S, Shash E, Lambrecht M, Le Pechoux C, Faivre-Finn C, De Ruysscher D, Peulen H, Belderbos J, Dziadziuszko R, Fink C, Guckenberger M, Hurkmans C, Nestle U (2015) LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective. Br J Radiol 88(1051):20150036. https://doi.org/10.1259/bjr.20150036CrossRefPubMedPubMedCentral

16.

Nicosia L, Cuccia F, Mazzola R, Ricchetti F, Figlia V, Giaj-Levra N, Rigo M, Tomasini D, Pasinetti N, Corradini S, Ruggieri R, Alongi F (2020) Disease course of lung oligometastatic colorectal cancer treated with stereotactic body radiotherapy. Strahlenther Onkol. https://doi.org/10.1007/s00066-020-01627-7CrossRefPubMed

17.

Greco C, Pares O, Pimentel N, Louro V, Morales J, Nunes B, Castanheira J, Oliveira C, Silva A, Vaz S, Costa D, Zelefsky M, Kolesnick R, Fuks Z (2019) Phenotype-oriented ablation of oligometastatic cancer with single dose radiation therapy. Int J Radiat Oncol Biol Phys 104(3):593–603. https://doi.org/10.1016/j.ijrobp.2019.02.033CrossRefPubMed

18.

Kalinauskaite GG, Tinhofer II, Kufeld MM, Kluge AA, Grün AA, Budach VV, Senger CC, Stromberger CC (2020) Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases. BMC Cancer 20(1):404. https://doi.org/10.1186/s12885-020-06892-4CrossRefPubMedPubMedCentral

19.

Niibe Y, Yamamoto T, Onishi H, Yamashita H, Katsui K, Matsumoto Y, Oh RJ, Aoki M, Shintani T, Yamada K, Kobayashi M, Ozaki M, Manabe Y, Yahara K, Nishikawa A, Kakuhara H, Yamamoto K, Inoue T, Takada YU, Nagata K, Suzuki O, Terahara A, Jingu K (2020) Pulmonary oligometastases treated by stereotactic body radiation therapy: a nationwide survey of 1,378 patients. Anticancer Res 40(1):393–399. https://doi.org/10.21873/anticanres.13965CrossRefPubMed

20.

Yamamoto T, Niibe Y, Matsumoto Y, Onishi H, Aoki M, Nishikawa A, Oh RJ, Shintani T, Yahara K, Ozaki M, Manabe Y, Jingu K (2020) Analyses of local control and survival after stereotactic body radiotherapy for pulmonary oligometastases from colorectal adenocarcinoma. J Radiat Res 61(6):935–944. https://doi.org/10.1093/jrr/rraa071CrossRefPubMedPubMedCentral

Title: Stereotactic body radiotherapy for pulmonary oligometastases: a monoinstitutional analysis of clinical outcomes and potential prognostic factors
Authors: Francesco Cuccia, MD
Rosario Mazzola
Vanessa Figlia
Niccolò Giaj-Levra
Luca Nicosia
Francesco Ricchetti
Michele Rigo
Giorgio Attinà
Claudio Vitale
Edoardo Pastorello
Ruggero Ruggieri
Filippo Alongi
Publication date: 02-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Systemic Therapy
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 10/2022
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-01951-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Stereotactic body radiotherapy for pulmonary oligometastases: a monoinstitutional analysis of clinical outcomes and potential prognostic factors

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2022

Wöchentliche versus dreiwöchentliche Cisplatingabe bei der postoperativen Radiochemotherapie von lokal fortgeschrittenen Kopf-Hals-Plattenepithelkarzinomen – Ergebnisse der JCOG1008-Studie

Risikostandardisierte Mortalitätsraten übertreffen als Qualitätsindikator die typischen „Mindestzahlen“ in der onkologischen Chirurgie – ein neuer Blick auf Krankenhauszentralisationen mithilfe nationaler bevölkerungsbezogener Daten

Long-term neurocognitive function after whole-brain radiotherapy in patients with melanoma brain metastases in the era of immunotherapy

Stereotactic radiosurgery and radiotherapy for resected brain metastases: current pattern of care in the Radiosurgery and Stereotactic Radiotherapy Working Group of the German Association for Radiation Oncology (DEGRO)

Multimodale Therapieansätze beim Hochrisikoprostatakarzinom – was wann?

Correction to: Comparison of 3D and 4D Monte Carlo optimization in robotic tracking stereotactic body radiotherapy of lung cancer