Abstract
Aim: Lung metastases from an extra-pulmonary origin occasionally present with a limited metastatic disease burden. In cases where metastatectomy is not feasible, stereotactic body radiation therapy (SBRT) represents a non-invasive, efficacious option. We report the outcomes of patients treated with lung SBRT in cases of limited metastatic disease.Methods: We retrospectively reviewed outcomes in 44 patients with 50 lung nodules from various extra-pulmonary malignancies treated with SBRT. Fifty percent of the patients were male and median age was 64. The median number of nodules was 1 and 90% of patients had oligometastatic disease. Thirty-four percent of patients had extra-thoracic disease.Results: Fifty lung nodules were treated with SBRT in 44 patients. Median dose was 48 Gy in 5 fractions with a median biological effective dose (BED) of 100 Gy10. Follow-up imaging was available for review in 96% of nodules. Median follow-up was 17.5 months. One year local control was 82%. BED >72 Gy10 predicted improved local control (90 vs. 57% at 1 year). One year overall survival following SBRT was 66%. There was no difference in overall survival if patients had extra-thoracic disease.Conclusion: Lung SBRT is a safe, effective tool for treatment of limited lung metastases. Dose selection remains important for local control.
Highlights
Lung metastases from an extrapulmonic origin signified widespread tumor dissemination and overall poor prognosis
Though systemic therapy remains the primary treatment modality in these cases, aggressive local therapy has been utilized with moderate success [1]
We retrospectively reviewed the records of patients with known or suspected metastatic extra-pulmonary disease treated with stereotactic body radiotherapy (SBRT) between 2008 and 2017 in this institutional review board (IRB) approved study
Summary
Lung metastases from an extrapulmonic origin signified widespread tumor dissemination and overall poor prognosis. Though systemic therapy remains the primary treatment modality in these cases, aggressive local therapy has been utilized with moderate success [1]. Surgical resection (i.e., metastatectomy) represents the preferred local treatment strategy when technically feasible [2, 3]. A subset of patients will not be operative candidates due to medical co-morbidities, anatomic limitations, or even patient refusal. In these cases of inoperable disease, alternative approaches are often utilized; with stereotactic body radiotherapy (SBRT) representing a non-invasive, efficacious option
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