Abstract
BackgroundIn limited metastatic burden of disease, stereotactic body radiotherapy (SBRT) has been shown to achieve high local control rates. It has been hypothesized that SBRT may translate to a better quality of life by delaying the need for systemic chemotherapy and possibly increasing survival. There is limited published literature on the efficacy of SBRT in limited nodal metastases. The primary aim is to review institutional outcomes of patients with solitary or oligometastatic lymph nodes treated with SBRT.MethodsA retrospective study of patients treated with SBRT to metastatic lymph nodes (March 2010–June 2015) was conducted. Endpoints of this study were local control (LC), chemotherapy-free survival (CFS) following SBRT, toxicities, progression free survival (PFS), and overall survival (OS).ResultsEighteen patients with a mean age of 65 years underwent SBRT to metastatic lymph nodes. Median follow-up was 33.6 months. There were four hepatocellular carcinoma, seven colorectal, four pancreatic, one esophageal, one gallbladder and one lung primary. Eleven (61%) patients had lymph node metastases at initial presentation of metastatic disease. Seven patients (39%) had systemic therapy prior to SBRT, with five patients receiving two lines of chemotherapy. Eight patients had solitary metastatic disease at the time of radiotherapy. All patients had <5 metastases. Median size of lymph node metastases was 1.95 cm (range: 0.8–6.2 cm). RT doses were 31 to 60 Gy in four to ten fractions, with 44% of patients receiving 35 Gy in 5 fractions. At 1 year, LC was 94% and CFS from SBRT was 60%. One-year PFS and OS were 39% and 89% respectively. There were no grade 3 or higher toxicities.ConclusionsIn this single institution study, SBRT to oligometastatic lymph nodes provided excellent LC and a moderate chemotherapy-free interval with minimal toxicities. Disease progression remains prominent in these patients and larger studies are warranted to identify those who benefit most from SBRT.
Highlights
The concept of metastatic disease in cancer treatment has evolved over the past decades
In 1995, the concept of oligometastases was introduced as a distinct clinical entity of limited metastatic disease; this is an intermediate stage of cancer spread between localized and disseminated disease [1]
Local control of limited metastatic disease is believed to improve systemic control and achieve potential cure as it is hypothesized that the cancer has not yet acquired the genetic variation required for widespread dissemination [1,2,3]
Summary
The concept of metastatic disease in cancer treatment has evolved over the past decades. The presence of metastases has been regarded as a clinical manifestation of widespread microscopic disseminated disease. From this historical perspective, local treatment to metastatic lesions cannot eradicate all cancer cells, and systemic therapies prolonging survival, cannot offer a cure [1, 2]. Local control of limited metastatic disease is believed to improve systemic control and achieve potential cure as it is hypothesized that the cancer has not yet acquired the genetic variation required for widespread dissemination [1,2,3]. It has been hypothesized that local treatment of limited metastases may delay the need for systemic therapies, thereby improving quality of life in the short term and providing more lines of cytotoxic therapy in the long term [4].
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