Stereotactic Body Radiotherapy for Lymph Node Oligometastases: Real-World Evidence From 90 Consecutive Patients

Overview

Journal Front Oncol

Specialty Oncology

Date 2021 Feb 22

PMID 33614499

Citations 4

Authors

Petr Burkon

Iveta Selingerova

Marek Slavik

Petr Pospisil

Lukas Bobek

Libor Kominek

Pavel Osmera

Tomas Prochazka

Miroslav Vrzal

Tomas Kazda

Pavel Slampa

Affiliations

Soon will be listed here.

Abstract

Aims: To evaluate the efficacy and toxicity of extracranial stereotactic body radiotherapy (SBRT) in the treatment of oligometastatic lymph node involvement in the mediastinum, retroperitoneum, or pelvis, in a consecutive group of patients from real clinical practice outside clinical trials.

Methods: A retrospective analysis of 90 patients with a maximum of four oligometastases and various primary tumors (the most common being colorectal cancers). The endpoints were local control of treated metastases (LC), freedom from widespread dissemination (FFWD), progression-free survival (PFS), overall survival (OS), and freedom from systemic treatment (FFST). Acute and delayed toxicities were also evaluated.

Results: The median follow-up after SBRT was 34.9 months. The LC rate at three and five years was 68.4 and 56.3%, respectively. The observed median FFWD was 14.6 months, with a five-year FFWD rate of 33.7%. The median PFS was 9.4 months; the three-year PFS rate was 19.8%. The median FFST was 14.0 months; the five-year FFST rate was 23.5%. The OS rate at three and five years was 61.8 and 39.3%, respectively. Median OS was 53.1 months. The initial dissemination significantly shortened the time to relapse, death, or activation of systemic treatment-LC (HR 4.8, p < 0.001), FFWD (HR 2.8, p = 0.001), PFS (HR 2.1, p = 0.011), FFST (HR 2.4, p = 0.005), OS (HR 2.2, p = 0.034). Patients classified as having radioresistant tumors noticed significantly higher risk in terms of LC (HR 13.8, p = 0.010), FFWD (HR 3.1, p = 0.006), PFS (HR 3.5, p < 0.001), FFST (HR 3.2, p = 0.003). The multivariable analysis detected statistically significantly worse survival outcomes for initially disseminated patients as well as separately in groups divided according to radiosensitivity. No grade III or IV toxicity was reported.

Conclusion: Our study shows that targeted SBRT is a very effective and low toxic treatment for oligometastatic lymph node involvement. It can delay the indication of cytotoxic chemotherapy and thus improve and maintain patient quality of life. The aim of further studies should focus on identifying patients who benefit most from SBRT, as well as the correct timing and dosage of SBRT in treatment strategy.

Citing Articles

Stereotactic body radiation therapy on abdominal-pelvic lymph node oligometastases: a systematic review on toxicity.

van Werkhoven L, Cammareri E, Hoogeman M, Nout R, Milder M, Nuyttens J Acta Oncol. 2024; 63:822-832.

PMID: 39473177 PMC: 11541805. DOI: 10.2340/1651-226X.2024.40681.

Stereotactic body radiation therapy for the treatment of lymph node metastases: a retrospective mono-institutional study in a large cohort of patients.

Caivano D, Bonome P, Pezzulla D, Rotondi M, Sigillo R, De Sanctis V Front Oncol. 2023; 13:1163213.

PMID: 37601675 PMC: 10435736. DOI: 10.3389/fonc.2023.1163213.

Intra-fraction motion of pelvic oligometastases and feasibility of PTV margin reduction using MRI guided adaptive radiotherapy.

Snyder J, Smith B, St-Aubin J, Dunkerley D, Shepard A, Caster J Front Oncol. 2023; 13:1098593.

PMID: 37152034 PMC: 10154517. DOI: 10.3389/fonc.2023.1098593.

Multi-Institutional Outcomes of Stereotactic Magnetic Resonance Image Guided Adaptive Radiation Therapy With a Median Biologically Effective Dose of 100 Gy for Non-bone Oligometastases.

Kutuk T, Herrera R, Mustafayev T, Gungor G, Ugurluer G, Atalar B Adv Radiat Oncol. 2022; 7(6):100978.

PMID: 35647412 PMC: 9130084. DOI: 10.1016/j.adro.2022.100978.

References

Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2008; 45(2):228-47. DOI: 10.1016/j.ejca.2008.10.026. View

Spratt D, Beeler W, de Moraes F, Rhines L, Gemmete J, Chaudhary N . An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report. Lancet Oncol. 2017; 18(12):e720-e730. DOI: 10.1016/S1470-2045(17)30612-5. View

Burkon P, Kazda T, Pospisil P, Slavik M, Kominek L, Selingerova I . Ablative dose stereotactic body radiation therapy for oligometastatic disease: a prospective single institution study. Neoplasma. 2018; 66(2):315-325. DOI: 10.4149/neo_2018_180731N558. View

Hellman S, Weichselbaum R . Oligometastases. J Clin Oncol. 1995; 13(1):8-10. DOI: 10.1200/JCO.1995.13.1.8. View

Wang Z, Wang J, Zhuang H, Wang P, Yuan Z . Stereotactic body radiation therapy induces fast tumor control and symptom relief in patients with iliac lymph node metastasis. Sci Rep. 2016; 6:37987. PMC: 5126556. DOI: 10.1038/srep37987. View

Shibata D, Paty P, Guillem J, Wong W, Cohen A . Surgical management of isolated retroperitoneal recurrences of colorectal carcinoma. Dis Colon Rectum. 2002; 45(6):795-801. DOI: 10.1007/s10350-004-6300-3. View

Weichselbaum R, Hellman S . Oligometastases revisited. Nat Rev Clin Oncol. 2011; 8(6):378-82. DOI: 10.1038/nrclinonc.2011.44. View

Werensteijn-Honingh A, Kroon P, Winkel D, Aalbers E, van Asselen B, Bol G . Feasibility of stereotactic radiotherapy using a 1.5 T MR-linac: Multi-fraction treatment of pelvic lymph node oligometastases. Radiother Oncol. 2019; 134:50-54. DOI: 10.1016/j.radonc.2019.01.024. View

Palma D, Olson R, Harrow S, Gaede S, Louie A, Haasbeek C . Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. J Clin Oncol. 2020; 38(25):2830-2838. PMC: 7460150. DOI: 10.1200/JCO.20.00818. View

10.

Matsushita H, Jingu K, Umezawa R, Yamamoto T, Ishikawa Y, Takahashi N . Stereotactic Radiotherapy for Oligometastases in Lymph Nodes-A Review. Technol Cancer Res Treat. 2018; 17:1533033818803597. PMC: 6201169. DOI: 10.1177/1533033818803597. View

11.

Gregoire V, Mackie T . State of the art on dose prescription, reporting and recording in Intensity-Modulated Radiation Therapy (ICRU report No. 83). Cancer Radiother. 2011; 15(6-7):555-9. DOI: 10.1016/j.canrad.2011.04.003. View

12.

Purdie T, Bissonnette J, Franks K, Bezjak A, Payne D, Sie F . Cone-beam computed tomography for on-line image guidance of lung stereotactic radiotherapy: localization, verification, and intrafraction tumor position. Int J Radiat Oncol Biol Phys. 2007; 68(1):243-52. DOI: 10.1016/j.ijrobp.2006.12.022. View

13.

Winkel D, Bol G, Werensteijn-Honingh A, Intven M, Eppinga W, Hes J . Target coverage and dose criteria based evaluation of the first clinical 1.5T MR-linac SBRT treatments of lymph node oligometastases compared with conventional CBCT-linac treatment. Radiother Oncol. 2020; 146:118-125. DOI: 10.1016/j.radonc.2020.02.011. View

14.

Videtic G, Donington J, Giuliani M, Heinzerling J, Karas T, Kelsey C . Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol. 2017; 7(5):295-301. DOI: 10.1016/j.prro.2017.04.014. View

15.

Jereczek-Fossa B, Piperno G, Ronchi S, Catalano G, Fodor C, Cambria R . Linac-based stereotactic body radiotherapy for oligometastatic patients with single abdominal lymph node recurrent cancer. Am J Clin Oncol. 2012; 37(3):227-33. DOI: 10.1097/COC.0b013e3182610878. View

16.

Heinzerling J, Anderson J, Papiez L, Boike T, Chien S, Zhang G . Four-dimensional computed tomography scan analysis of tumor and organ motion at varying levels of abdominal compression during stereotactic treatment of lung and liver. Int J Radiat Oncol Biol Phys. 2008; 70(5):1571-8. DOI: 10.1016/j.ijrobp.2007.12.023. View

17.

Winkel D, Bol G, Werensteijn-Honingh A, Kiekebosch I, van Asselen B, Intven M . Evaluation of plan adaptation strategies for stereotactic radiotherapy of lymph node oligometastases using online magnetic resonance image guidance. Phys Imaging Radiat Oncol. 2021; 9:58-64. PMC: 7807584. DOI: 10.1016/j.phro.2019.02.003. View

18.

Josipovic M, Persson G, Bangsgaard J, Specht L, Aznar M . Deep inspiration breath-hold radiotherapy for lung cancer: impact on image quality and registration uncertainty in cone beam CT image guidance. Br J Radiol. 2016; 89(1068):20160544. PMC: 5604920. DOI: 10.1259/bjr.20160544. View

19.

van Gestel Y, de Hingh I, van Herk-Sukel M, van Erning F, Beerepoot L, Wijsman J . Patterns of metachronous metastases after curative treatment of colorectal cancer. Cancer Epidemiol. 2014; 38(4):448-54. DOI: 10.1016/j.canep.2014.04.004. View

20.

Postmus P, Kerr K, Oudkerk M, Senan S, Waller D, Vansteenkiste J . Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017; 28(suppl_4):iv1-iv21. DOI: 10.1093/annonc/mdx222. View