Abstract
PurposeThe aim of this study was to evaluate the safety and long-term tumor control after stereotactic radiotherapy (SRT) with 12 × 6 Gy of patients with primary bronchial carcinoma (BC) or with pulmonary metastases (MET) of various solid tumors. Local progression-free survival (LPFS), progression-free survival (PFS), overall survival (OS), and prognostic factors were compared.MethodsBetween May 2012 and January 2020, 168 patients with 206 pulmonary lesions (170 MET and 36 primary BC) were treated with 12 × 6 Gy (BED10 116 Gy). The irradiated pulmonary MET were from the following cancers: 47 (27.6%) head and neck, 37 (21.8%) rectum or colon, 30 (17.6%) bronchial, 13 (7.6%) malignant melanoma, 9 (5.3%) esophageal, 9 (5.3%) sarcoma, and 25 (14.8%) other.ResultsThe median follow-up was 16.26 months (range: 0.46–89.34) for BC and 19.18 months (0.89–91.11) for MET. Survival rates at 3 years were: OS 43% for BC and 35% for MET; LPFS BC 96% and MET 85%; PFS BC 35% and MET 29%. The most frequently observed grade 3 adverse events (AEs) were pneumonitis (5.9% BC, 4.8% MET), pulmonary fibrosis (2.9% BC, 4% MET), and pulmonary embolism (2.9% BC, 0.8% MET). The favorable prognostic effects on overall survival of patients with MET were female gender (log-rank: p < 0.001), no systemic progression (log-rank; p = 0.048, multivariate COX regression p = 0.039), and malignant melanoma histology (log-rank; p = 0.015, multivariate COX regression p = 0.020). For patients with BC, it was tumor location within the lower lobe (vs. upper lobe, log-rank p = 0.027). LPFS of patients with metastatic disease was beneficially influenced by female gender (log-rank: p = 0.049).ConclusionThe treatment concept of 12 × 6 Gy is associated with 96% local progression-free survival for BC and 85% for pulmonary metastases after 3 years. There was no difference in response after SRT of primary lung carcinoma or pulmonary metastases.
Highlights
Lung cancer is one of the most common cancers worldwide
Lung metastases are frequent in head and neck cancer, gastrointestinal tumors, malignant melanoma, renal carcinomas, different types of sarcomas, and bronchial carcinoma (BC) itself [1]
Our Local progression-free survival (LPFS) rate of 83% for patients with lung metastases was comparable with 81.3% (3 years) in one of the largest multicenter (68 centers) analyses consisting of 1547 cases by Yamamoto et al [16], and lower compared to 94.1% or 89% as seen in retrospective series consisting of 129 cases by Borm et al [8] or 61 cases by Ricardi et al [17], respectively
Summary
Lung cancer is one of the most common cancers worldwide. The lungs are the second most frequent site of metastasis of various types of solid cancer. Lung metastases are frequent in head and neck cancer, gastrointestinal tumors, malignant melanoma, renal carcinomas, different types of sarcomas, and bronchial carcinoma (BC) itself [1]. Surgery is the standard for treatment of medically operable K. Strahlenther Onkol results in terms of control of disease [7]. Successful local therapy for pulmonary lesions may lead to longer survival. Recent studies performing SRT of lung metastases showed high rates of local control and a low incidence of severe (grade 3–5) toxicities [8]
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