Oligometastatic Lung Tumors Research Articles

Efficacy and prognostic factors of stereotactic body radiotherapy combined with immunotherapy for pulmonary oligometastases: a preliminary retrospective cohort study.

Stereotactic body radiotherapy (SBRT) combined immunotherapy has a synergistic effect on patients with stage IV tumors. However, the efficacy and prognostic factors analysis of SBRT combined immunotherapy for patients with pulmonary oligometastases have rarely been reported in the studies. The purpose of this study is to explore the efficacy and prognostic factors analysis of SBRT combined immunotherapy for patients with oligometastatic lung tumors. A retrospective analysis was conducted on 43 patients with advanced tumors who received SBRT combined with immunotherapy for pulmonary oligometastases from October 2018 to October 2021. Local control (LC), progression-free survival (PFS), and overall survival (OS) were assessed using the Kaplan-Meier method. Univariate and multivariate analyses of OS were performed using the Cox regression model, and the P value <0.05 was considered statistically significant. The receiver operating characteristic (ROC) curve of neutrophil-to-lymphocyte ratio (NLR) after SBRT was generated. Spearman correlation analysis was used to determine the relationship of planning target volume (PTV) with absolute lymphocyte count (ALC) before and after SBRT and with neutrophil count (NE) after SBRT. Additionally, linear regression was used to examine the relationship between ALC after SBRT and clinical factors. A total of 43 patients with pulmonary oligometastases receiving SBRT combined with immunotherapy were included in the study. The change in NLR after SBRT was statistically significant (P<0.001). At 1 and 2 years, respectively, the LC rates were 90.3% and 87.5%, the OS rates were 83.46% and 60.99%, and the PFS rates were 69.92% and 54.25%, with a median PFS of 27.00 (17.84-36.13) months. Univariate and multivariate Cox regression analyses showed that a shorter interval between radiotherapy and immunization [≤21 days; hazard ratio (HR) =1.10, 95% confidence interval (CI): 0.06-0.89; P=0.02] and a low NLR after SBRT (HR =0.24, 95% CI: 1.01-1.9; P=0.03) were associated with improved OS. The ROC curve identified 4.12 as the cutoff value for predicting OS based on NLR after SBRT. NLR after SBRT ≤4.12 significantly extended OS compared to NLR after SBRT >4.12 (log-rank P=0.001). Spearman correlation analysis and linear regression analysis showed that PTV was negatively correlated with ALC after SBRT. Our preliminary research shows that SBRT combined with immunotherapy has a good effect, and NLR after SBRT is a poor prognostic factor for OS. Larger PTV volume is associated with decreased ALC after SBRT.

Stereotactic body radiotherapy in ultracentrally located lung tumors

Stereotactic body radiotherapy (SBRT) is a highly conformal radiotherapy technique that delivers high doses of radiation per fraction, typically in 1 &amp;ndash; 5 fractions. It is a standard treatment option for patients with early-stage non-small cell lung cancer that is peripherally located, for those who are medically inoperable, or for patients who do not opt for surgery. Similarly, SBRT is considered an effective treatment option for oligometastatic lung tumors. However, in the case of ultracentrally located lung tumors&amp;mdash;tumors situated close to the central airway and mediastinal region&amp;mdash;there is an increased risk of severe toxicities (grade 4 &amp;ndash; 5) due to the dose tolerances of the surrounding organs at risk. The definition of ultracentrally located lung tumors remains unclear. Some studies define an ultracentral lung tumor as one in which the gross tumor volume directly involves the proximal bronchial tree or trachea, while others define it as the planning target volume (PTV) that includes the trachea or main bronchial system. In addition, some studies consider tumors whose PTV touches or overlaps with the central bronchial tree, esophagus, pulmonary vein, or pulmonary artery as ultracentral. In addition, the optimal SBRT regime and organ-at-risk dose limitations for ultracentral tumors have yet to be clearly established. The aim of this review is to explore and discuss the role of SBRT in the treatment of ultracentrally located lung tumors.

Clinical Outcomes of Synchronous Lung Stereotactic Body Radiation Therapy Lesions via Single-Isocenter/Multi-Lesion Treatments

Lung cancer patients with synchronous primary or oligometastatic (< 5 lesions) with associated co-morbidities may not retain their treatment position for the extended stereotactic body radiotherapy (SBRT) treatment times with individual isocenter plans for each lesion due to discomfort or shortness of breath. SBRT using a single-isocenter/multi-lesion (SIML) volumetric arc therapy (VMAT) plan with flattening filter free (FFF) beam could significantly shorten overall treatment time, improve patient comfort and compliance and clinic efficiency. We report clinical results of treating multiple lung metastases or synchronous primary lung cancers with SIML lung SBRT. Eighty patients with synchronous primary lung cancers or oligometastatic lung tumors (two, n = 61; three, n = 10; four, n = 4; five n = 5; total treated lesions, n = 193) were simulated with abdominal compression and/or 4D-CT MIP images and treated with a highly-conformal SIML VMAT lung SBRT plans via 3-4 non-coplanar arcs. Common prescriptions were 50-55 Gy/5 fractions and 54 Gy/3 fractions prescribed 70-80% isodose line to the each PTV. Acuros dose calculation for 6MV-FFF beam was used for tissue heterogeneity corrections. RTOG-0618/0813 criteria were used to dose constraints to organs at risk (OAR) and target conformality. Treatment was delivered every other day or twice weekly with CBCT-guidance, adjustments made with 6DOF couch corrections on a medical linear accelerator, and treatment delivery time within 15 minutes. Local control rates and toxicity profile was evaluated using CTCAE v. 5.0 grading for pneumonitis, rib fracture and chest wall pain. All plans met RTOG-0618/0813 requirements for each tumor coverage, dose to OAR including normal lung and ribs. Mean follow up after last fraction of treatment was 16.9 months (range, 1.0-54.2 months). PTV volume ranged from 2.17 to 167.8 cc with mean volume of 16.1 cc. Of the 80 patients treated, 71 had adequate post-treatment thoracic CT imaging to assess local control. Local control was achieved in 167/175 (95.4%) of treated and followed lesions. CTCAE grade 1 asymptomatic pneumonitis was noted on thoracic CT scans in 42/71 (59.2%) of patients and occurred, on average 4.8 months after SBRT. Symptomatic pneumonitis and rib fracture did not occur in any patient. CTCAE grade 2 chest wall pain occurred in 4/80 (5.0%) treated patients and was managed conservatively with over-the-counter NSAIDS or acetaminophen. SIML lung SBRT for synchronous primary lung cancers or multiple lung metastases can be used as a variant to traditional multiple isocenter SBRT or chronologically separate treatment courses, and has excellent local control rates and low toxicity profile in our patient population. It can help improve comfort and compliance of the patients who have difficulty lying still for an extended treatment course, and significantly reduces treatment time via isocenter shifts/repeated CBCTs for image guidance, thus improving clinic efficiency.

Comparison of Diagnostic PET and 4D CT-Based Tumor Delineation for Oligometastatic Lung Tumors

<h3>Purpose/Objective(s)</h3> Stereotactic body raiation therapy (SBRT) is increasingly used to treat oligometastatic tumors. To account for internal motion, 4D-CT is commonly used for lung SBRT. Biology-guided radiotherapy (BgRT) is an emerging concept that may allow for reduction of treatment volumes using positron emission tomography (PET) signal guidance. Benchtop testing of BgRT technology suggests target delineation on a single respiratory phase with 5 mm biology-guided margin may be sufficient, however this has not been clinically validated. We tested our hypothesis that PET-based tumor delineation would result in smaller target volumes than 4D-CT. <h3>Materials/Methods</h3> We retrospectively reviewed a single-institution lung radiotherapy database to identify patients with oligometastatic lung tumors treated with ablative doses of biologically effective dose (BED10) >=100 Gy. We included patients treated from 2015-2020 with a diagnostic PET performed within 30 days of CT simulation. Tumors were contoured on the diagnostic PET using an auto-threshold of 40% of the lesion SUVmax, followed by manual editing to include CT-based tumor accounting for possible PET signal misregistration. A 5 mm isotropic expansion was applied to generate the planning target volume (PTV). We compared these to existing 4D CT-based tumor volumes accounting for internal motion and their associated PTVs. <h3>Results</h3> Of 102 patients with oligometastatic lung tumors, we included 13 patients with 15 lung tumors. There were 7 female and 6 male patients, with a median age of 72 (range 52 – 89) at the time of treatment. Primary tumor types included 4 colorectal, 2 head and neck, 1 non-small cell lung cancer, 1 melanoma, and 5 other cancer types. Patients were treated to 50 to 54 Gy in 3 to 5 fractions. Median time from diagnostic PET scan to CT simulation was 17 days (range 0 – 27). Median lesion diameter was 1.2 cm (IQR 0.9 – 1.7) with median SUVmax of 5.4 (IQR 4.0 – 7.7). Diagnostic PET-based tumor contours had a median volume of 2.5 cc (IQR 1.7 – 3.1 cc), whereas 4D CT-based tumor contours had a median volume of 3.0 cc (IQR 2.4 – 9.9 cc). Diagnostic PET-based PTV had a median volume of 10.4 cc (IQR 8.4 – 12.6 cc), whereas 4D CT-based PTV had a median volume of 11.8 cc (IQR 10.8 – 31.5). <h3>Conclusion</h3> Diagnostic PET-based tumor delineation resulted in smaller tumor and planning target volumes compared to 4D-based tumor delineation. This data will serve as a benchmark for future research focusing on imaging modality concordance and clinical impact of reduced biology-guided margins in BgRT for oligometastatic patients undergoing lung SBRT.

Role of Consolidative Stereotactic Body Radiation Therapy in Oligoresistant/Oligoprogressive Pulmonary Parenchymal Metastases.

AimTo extend the survival of patients by providing local control of metastases in oligoresistance/oligoprogressive disease.MethodsWe retrospectively evaluated the efficacy of stereotactic body radiotherapy (SBRT) applied to 30 lesions in the lungs of 19 patients who were considered inoperable by the tumor board upon the development of oligoresistance/oligoprogressive lung metastasis while undergoing chemotherapy between January 2016 and December 2017. Each patient had one to five metastases in their lungs. The median SBRT biologic effective dose at α/β of 10 (BED10) was 180.0 (IQR: 115.5–180.0) Gy.ResultsWe obtained effective, low-toxicity results. The rates of local control were 89.4%, 84.2%, and 78.9% for the 1st, 2nd, and 3rd years, respectively. The median local control time was 4 (IQR: 3–6) months. The median overall survival (OS) was 36.3 (IQR: 29.7–42.9) months. The rates of OS for the 1st, 2nd, and 3rd years were 89.5%, 73.7%, and 61.4%, respectively. Despite the nonoccurrence of grade 4–5 toxicity in the lungs, six (31.6%) patients had grade 1–3 pulmonary pneumonia, one patient had a grade 4 skin ulceration, and two patients had increased chronic obstructive pulmonary disease in the follow-up period.DiscussionIn patients with oligometastatic lung tumors, SBRT is very effective in terms of progression-free survival and OS.

Past, present, and future perspectives of pulmonary metastasectomy for patients with advanced colorectal cancer.

Over a half-century has passed since Thomford et al. proposed the selection criteria for pulmonary metastasectomy, and several prognostic factors have been identified. Although screening modalities and operations have changed dramatically, the important concepts of the selection criteria remain unchanged. Recent improvements in the survival outcomes of colorectal cancer patients undergoing pulmonary metastasectomy may be the result of strict adherence to the selection criteria for oligometastatic lung tumors, which can mimic local disease. Pulmonary metastasectomy has become an important option for selected patients with oligometastasis, based mainly on a large amount of retrospective data, but its effect on survival remains unclear. Curable pulmonary metastasis might be regarded as a "semi-local disease" under the spontaneous control of an acquired alteration in host immune status. The current practice of pulmonary metastasectomy for colorectal cancer focuses on selecting the most appropriate operation for selected patients. However, in the rapidly evolving era of immunotherapy, treatment-naïve patients for whom surgery is not suitable might be pre-conditioned by immunotherapy so that they may be considered for salvage surgery.

Adoption of Biologically Effective Dose of the Non-Target Lung Volume to Predict Symptomatic Radiation Pneumonitis After Stereotactic Body Radiation Therapy With Variable Fractionations for Lung Cancer.

Background: This study aims to establish lung biologically effective dose (BED)–based uniform dosimetric constraints for minimizing the risk of symptomatic radiation pneumonitis (SRP) from stereotactic body radiation therapy (SBRT) using variable fractionations in patients with lung tumors.Materials and Methods: A total of 102 patients with primary or oligometastatic lung tumors treated with SBRT in our institution were enrolled into this study. The associations between the clinical and dosimetric parameters and the incidences of SRP were analyzed using univariate and multivariate Cox regression hazard models. The receiver operating characteristic (ROC) curve was generated to evaluate the predictive performance of lung BED on the SRP risk compared with the physical dose.Results: SRP occurred in 11 patients (10.8%). In univariate analysis, the mean lung dose (p = 0.002), V5 (p = 0.005), V20 (p < 0.001), and the percentage of non-target normal lung volume receiving more than a BED of 5–170 Gy (VBED5−170, p < 0.05) were associated with SRP. Multivariate logistic regression analysis showed that there existed a significant statistical correlation between SRP and VBED70 (p < 0.001), which performed better than V5 or V20 on the ROC curves, resulting in an optimal cut-off value of lung VBED70 of 2.22%.Conclusions: This retrospective study indicated that non-target lung BED may better predict SRP from patients with SBRT-treated lung cancer. Limiting the lung VBED70 below 2.22% may be favorable to reduce the incidence of SRP, which warranted further prospective validation.

Metabolic Regression Velocity Post Lung SBRT - How Early Do We Get to See!

FDG PET-CT is a well-established cancer-imaging tool for diagnosis, staging, and response assessment. It is also well known that, post chemotherapy or radiotherapy, metabolic response precedes morphologic response based on size criteria. Normally PET-CT post SBRT is done at 3 months. However, earliest time needed when one would get maximum metabolic response following Lung SBRT was never known or assessed. Present study evaluates the metabolic regression velocity patterns post SBRT with serial FDG PET-CT scans in patients with oligo solitary lung metastases within first 3 months of the treatment. Five patients with oligometastatic lung tumors (Primaries: Colorectal cancer -2, Breast - 2 and Head and neck cancer- 1) were planned SBRT by Deep inspiratory breath hold technique using Active breath controller on 6 DOF C-arm Linac using body fix immobilization. A risk adapted multi-fractionated regimen (3-5 fractions) was used and doses delivered were in the range of 110-118gy BED. All patients underwent diagnostic pre- and post-treatment PET-CT scans. Post SBRT PET-CTs scans were timed serially at 48hrs, 10 days, 30 days and 60 and 90 days post treatment. PET-CT reports were reviewed in order to determine the pre- and post- treatment maximum standardized uptake value (m-SUV) of the lesion, including “complete resolution” of FDG-avidity. Corresponding Morphologic variations of the target lesions were studied on the CT images during the evaluation period (first 3 months). All 5 patients showed serial regression in metabolic activity, with maximum regression in metabolic activity occurring at 10 days post SBRT. The observed metabolic regression was between 40-54% (median – 50%) at 48 hours and 67-82% (median 80%) at 10 days post SBRT. 10 days after SBRT, there was no further decrease in metabolic activity. SUV thereupon remained constant ranging between 2.3 - 3.2 up to 3 months suggesting to fact that inflammation might have been initiated between 48hrs and 10 days. The earliest morphologic changes on CT in the form of ground glass appearance were detected at 60 days post SBRT scan uniformly in all patients. During the evaluation period (first 3 months) there was no significant change in size of the lesion. In cases of solitary lung oligomets the metabolic response precedes morphologic response with 50% median metabolic regression within 48hrs and 80% median metabolic regression by 10th day post SBRT. To the best of our knowledge, this is the first study reported in literature, which looked into the metabolic regression velocity patterns within the first 3 months post SBRT.

A matched-pair analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer versus early stage non-small cell lung cancer

BackgroundThe use of stereotactic body radiotherapy (SBRT) for early-stage primary non-small cell lung cancer (NSCLC) reported excellent local control rates. But the optimal SBRT dose for oligometastatic lung tumors (OLTs) from colorectal cancer (CRC) has not yet been determined. This study aimed to evaluate whether SBRT to a dose of 48–60 Gy in 4–5 fractions could result in similar local outcomes for OLTs from CRC as compared to early-stage NSCLC, and to examine potential dose-response relationships for OLTs from CRC.MethodsOLTs from CRC and primary NSCLCs treated with SBRT to 48–60 Gy in 4–5 fractions at a single institution were evaluated, and a matched-pair analysis was performed. Local recurrence-free survival (LRFS) was estimated by the Kaplan-Meier method. Univariate Cox regression was performed to identify significant predictors.ResultsThere were 72 lung lesions in 61 patients (24 OLTs from CRC in 15 patients and 48 NSCLCs in 46 patients) were analyzed with a median follow-up of 30 months. LRFS for OLTs from CRC was significantly worse than that of NSCLC when treated with 48–60 Gy/4–5 fx (p = 0.006). The 1, 3 and 5-year LRFS of OLTs from CRC vs NSCLC were 80.6% vs. 100%, 68.6% vs. 97.2%, and 68.6% vs. 81.0%, respectively. On univariate analysis, OLTs from CRC treated with higher dose (BED10 = 132 Gy) exhibited significantly better local recurrence-free survival than those treated to lower doses (BED10 ≤ 105.6 Gy) (p = 0.0022). The 1 and 3-year LRFS rates for OLTs treated to a higher dose (BED10 = 132 Gy) were 88.9% and 81.5%, vs 33.3%, and not achieved for lower doses (BED10 ≤ 105.6 Gy).ConclusionThe LRFS of OLTs from CRC after SBRT of 48–60 Gy/4–5 fx was significantly worse than that of primary NSCLC. Lower dose SBRT appeared to have inferior control for OLTs of CRC in this cohort. Further studies with larger sample sizes are needed.

Successful recanalization of acute extensive portal vein thrombosis by aspiration thrombectomy and thrombolysis via an operatively placed mesenteric catheter: a case report.

Portal vein thrombosis (PVT) after hepatobiliary surgery is rare but can cause lethal and severe complications. If early diagnosis and recanalization can be achieved, the PVT is expected to be eliminated. A 70-year-old male was diagnosed as having hepatocellular carcinoma occupying the right lobe of the liver. As oligometastatic lung tumors were simultaneously detected on contrast-enhanced CT (CECT), hepatectomy was not indicated. However, the primary tumor was very large, and as large tumor size can be associated with an unfavorable prognosis, and owing to the strong desire of the patient, he underwent right lobe hepatectomy. Jaundice appeared on post-operative Day (POD) 2 and CECT displayed slight intraheptatic bile duct dilation. However, a PVT did not exist at this time. Percutaneous transhepatic biliary drainage was performed and Doppler echo displayed intrahepatic and extrahepatic PVT on post-operative Day 5. Emergent thrombectomy was performed using a Vasplyser PlusTM thrombus aspiration catheter (Johnson & Johnson K.K. Medical Company, Tokyo, Japan) via the ileocolic vein under laparotomy. The mesenteric catheter was placed at the distal point of the residual PVT. Thrombolysis and anticoagulant therapy were performed using heparin and urokinase. In the CECT performed 16 days after the additional operation, the PVT had disappeared and the portal vein was completely recanalized. The mesenteric catheter was removed on the same day and oral anticoagulant therapy was continued. At the time of writing, 14 months have passed with no recurrence of PVT. Early diagnosis of PVT enables treatment with emergent thrombectomy, thrombolysis, and anticoagulant therapy. These treatments result in the improvement of portal vein flow and the complete disappearance of PVT.

Stereotactic body radiotherapy for lung tumors: Dosimetric analysis and clinical outcome.

Stereotactic body radiotherapy (SBRT) has emerged as an important modality in malignant lung tumor treatment both in early localized primary and oligometastatic setting. This study aims to present the results of lung SBRT both in terms of dosimetry and clinical outcome. Twenty-seven patients were assessed from 2012 to 2016. Both the primary and oligometastatic lung tumors were evaluated. Respiratory motion management was done employing ANZAI (Siemens, Germany) based four-dimensional computed tomography (CT). Commonly used fractionations were 60 Gy/5 fractions for peripheral tumors and 48 Gy/6 fractions for central tumors. Radiation Therapy Oncology Group toxicity criteria were used for toxicity and whole-body positron emission tomography-CT scan was done at follow-up for response evaluation. Twenty-seven patients were evaluated, 18 (66.7%) patients had a primary, and 9 (33.3%) patients had metastatic lung tumors. The male-to-female ratio for the entire cohort was 2:1. The median age at diagnosis was 65.8 years. Mean planning target volume (PTV) D2cc was 54.9 ± 9.04 Gy and mean internal target volume diameter was 3.0 ± 1.07 cm. Mean V20 Gy, V10 Gy, and V5 Gy of (lungs total-PTV) and (Lung ipsilateral - PTV) were 5.4 ± 4% and 10.9 ± 7.9%, 11.7 ± 5.8% and 24.2 ± 14.0%, and 22.05 ± 12.4% and 33.2 ± 15.3%, respectively. In total 21 (84%) patients and 4 patients (16%) showed a complete and partial response, respectively. One (3%) patient developed Gr 3 radiation pneumonitis. One year local control was in 18 (81%) patients whereas 4 (14%) patients progressed and three patients did not report. A higher prescribed dose significantly correlated with 1 year tumor control (P = 0.036). This study infers the feasibility and a favorable outcome for lung cancer amenable to SBRT in addition to being one of the largest clinical experiences for lung stereotactic treatment in our country.

Clinical efficacy and prognostic factors of stereotactic body radiotherapy for pulmonary oligometastases

Objective To evaluate the clinical efficacy and prognostic factors of stereotactic body radiotherapy (SBRT) for pulmonary oligometastases, and to further explore the patients most suitable for SBRT. Methods From 2012 to 2105, 51 patients with 76 oligometastatic lung tumors were treated with SBRT. In those patients, 27 had primary lung tumors and the others had extrapulmonary tumors. Seven patients had squamous cell carcinoma, thirty-five had adenocarcinoma, and the rest had other types of cancer. The patients received radiotherapy at a dose of 50 Gy in five fractions or 60 Gy in three fractions. Survival analysis was made by the Kaplan-Meier method. A multivariate analysis was made by the Cox model. Results The 1-and 2-year local control rates were 86%(65/76) and 80%(61/76), respectively. The 1-and 2-year overall survival (OS) rates were 80%(41/51) and 55%(28/51), respectively. The median survival time was 30(2-57) months, while the median progression-free survival time was 8(1-32) months. Twenty-one patients had grade 1 radiation pneumonitis (RP), while one patient had grade 2 RP. The multivariate analysis revealed that no more than 2 oligometastatic lung tumors, progression-free interval (PFI), and a performance score (PS) no higher than 1 were independent factors for OS (all P<0.05). Conclusions SBRT is effective and safe for treating pulmonary oligometastases. The number of oligometastatic lung tumors, PFI, and PS are independent prognostic factors for OS. Suitable patients and the appropriate timing of treatment are key to the efficacy of SBRT. Key words: Pulmonary oligometastases/stereotactic body radiotherapy; Prognosis

Clinical outcome of stereotactic body radiotherapy for primary and oligometastatic lung tumors: a single institutional study with almost uniform dose with different five treatment schedules.

BackgroundTo evaluate clinical outcomes of stereotactic body radiotherapy (SBRT) for localized primary and oligometastatic lung tumors by assessing efficacy and safety of 5 regimens of varying fraction size and number.MethodsOne-hundred patients with primary lung cancer (n = 69) or oligometastatic lung tumors (n = 31), who underwent SBRT between May 2003 and August 2010, were included. The median age was 75 years (range, 45–88). Of them, 98 were judged to have medically inoperable disease, predominantly due to chronic illness or advanced age. SBRT was performed using 3 coplanar and 3 non-coplanar fixed beams with a standard linear accelerator. Fraction sizes were escalated by 1 Gy, and number of fractions given was decreased by 1 for every 20 included patients. Total target doses were between 50 and 56 Gy, administered as 5–9 fractions. The prescribed dose was defined at the isocenter, and median overall treatment duration was 10 days (range, 5–22).ResultsThe median follow-up was 51.1 months for survivors. The 3-year local recurrence rates for primary lung cancer and oligometastasis was 6 % and 3 %, respectively. The 3-year local recurrence rates for tumor sizes ≤3 cm and >3 cm were 3 % and 14 %, respectively (p = 0.124). Additionally, other factors (fraction size, total target dose, and BED10) were not significant predictors of local control. Radiation pneumonia (≥ grade 2) was observed in 2 patients. Radiation-induced rib fractures were observed in 22 patients. Other late adverse events of greater than grade 2 were not observed.ConclusionWithin this dataset, we did not observe a dose response in BED10 values between 86.4 and 102.6 Gy. SBRT with doses between 50 and 56 Gy, administered over 5–9 fractions achieved acceptable tumor control without severe complications.

PET-CT Response Characteristics Following SBRT for Early-Stage and Oligometastatic Lung Tumors

PET-CT Response Characteristics Following SBRT for Early-Stage and Oligometastatic Lung Tumors

Stereotactic Body Radiation Therapy for Central Lung Tumors: Outcomes and Toxicity: Treatment Toxicity

Stereotactic body radiation therapy (SBRT) is increasingly employed for the treatment of primary, recurrent, and oligometastatic lung tumors. The outcomes and toxicities of SBRT for central lung tumors are not well defined. We investigated our institutional experience using SBRT for central lung tumors. Our institutional SBRT database prospectively collects demographic and treatment-related data from all patients treated at our center. We retrospectively analyzed all patients with central lung tumors treated with SBRT between April 2008 and May 2013. The most common radiation dose was 50 Gy in 5 fractions delivered over consecutive days using coplanar plans. Dose constraints for organs at risk followed the recommendations of the American Association of Physicists in Medicine Task Group 101 report. Local control (LC) and overall survival (OS) were calculated using Kaplan-Meier estimates. Toxicity was graded using the Radiation Therapy Oncology Group Common Terminology Criteria. Tumor response was scored using Response Evaluation Criteria in Solid Tumors, version1.1. Predictors for toxicity, LC, and OS were analyzed using Cox proportional hazard regression models. A total of 142 central lung tumors from 132 patients were identified and included for analysis. Median age was 71 years (range, 24-91 years) and median follow up was 31.0 months (range, 2.5-62.5 months). There were 55 primary, 33 recurrent, and 54 metastatic tumors. Median tumor size was 2.1 cm (range, 0.5-5.5 cm). Overall, there were 13 local failures resulting in 3-year LC rates of 94.2%, 91.7%, and 58.3%, in primary, recurrent, and metastatic lung tumors, respectively. There were 19 patients (14.4%) with grade 3 or higher pneumonitis including 1 grade 4 and 1 grade 5 toxicity. There were no grade 3 or higher acute toxicities. Rates of complete response, partial response, stable disease, and progressive disease were 34% (n=48), 45% (n=64), 20% (n=29), and 1% (n=1), respectively. The median survival for primary, recurrent, and metastatic lung tumors was 46.1, 43.6, and 16.5 months, respectively. Toxicity, LC, and OS were not associated with tumor size, radiation dose, or previous local therapy on univariate or multivariate analysis. SBRT for central lung tumors offers high rates of local control and acceptable toxicity rates comparable to published data for peripheral tumors. Patients with primary or recurrent lung tumors had comparable LC and OS which were better than patients with metastatic lung tumors. Appropriate patient selection and dose fractionation remains critical while outcomes from prospective trials mature.

Stereotactic Body Radiation Therapy for Central Lung Tumors: Outcomes and Toxicity

Stereotactic body radiation therapy (SBRT) is increasingly employed for the treatment of primary, recurrent, and oligometastatic lung tumors. The outcomes and toxicities of SBRT for central lung tumors are not well defined. We investigated our institutional experience using SBRT for central lung tumors. Our institutional SBRT database prospectively collects demographic and treatment-related data from all patients treated at our center. We retrospectively analyzed all patients with central lung tumors treated with SBRT between April 2008 and May 2013. The most common radiation dose was 50 Gy in five fractions delivered over consecutive days using coplanar plans. Dose constraints for organs at risk followed the recommendations of the American Association of Physicists in Medicine Task Group 101 report. Local control (LC) and overall survival (OS) were calculated using Kaplan-Meier estimates. Toxicity was graded using the Radiation Therapy Oncology Group Common Toxicity Criteria. Tumor response was scored using Response Evaluation Criteria in Solid Tumors v1.1. Predictors for toxicity, LC, and OS were analyzed using Cox proportional hazard regression models. A total of 142 central lung tumors from 132 patients were identified and included for analysis. Median age was 71 years (range, 24-91) and median follow up was 31.0 months (range, 2.5-62.5). There were 55 primary, 33 recurrent, and 54 metastatic tumors. Median tumor size was 2.1 cm (range, 0.5-5.5). Overall, there were 13 local failures resulting in 3-year LC rates of 94.2%, 91.7%, and 58.3%, in primary, recurrent, and metastatic lung tumors, respectively. There were 19 patients (14.4%) with grade 3 or higher pneumonitis including one grade 4 and one grade 5 toxicity. There were no grade 3 or higher acute toxicities. Rates of complete response, partial response, stable disease, and progressive disease were 34% (n = 48), 45% (n = 64), 20% (n = 29), and 1% (n = 1), respectively. The median survival for primary, recurrent, and metastatic lung tumors was 46.1, 43.6, and 16.5 months, respectively. Toxicity, LC, and OS were not associated with tumor size, radiation dose, or previous local therapy on univariate or multivariate analysis. SBRT for central lung tumors offers high rates of local control and acceptable toxicity rates comparable to published data for peripheral tumors. Patients with primary or recurrent lung tumors had comparable LC and OS which were better than patients with metastatic lung tumors. Appropriate patient selection and dose fractionation remains critical while outcomes from prospective trials mature.

Maladie oligométastatique dans le cancer bronchique non à petites cellules

Non-small cell lung cancers are diagnosed at a widespread metastatic stage in about half of cases. Prognosis remains poor with a median overall survival around one year. Oligometastatic non-small cell lung cancers are an infrequent feature comprising 1 to 5 metastatic sites only which may be synchrones (diagnosed within 6 months after primary site) or metachrones. The major sites which have been studied, mainly as case reports, are adrenal glands, brain, and lung in which bifocal surgery and/or stereotactic radiation therapy have been proposed associated in most instances with systemic treatment. Long term survival may be observed essentially if there is no mediastinal lymph nodes involvement. Even more infrequently, oligometastatic lung tumors involving bone, skin, liver, kidney… have been reported as being amenable to radical treatment. In those cases also, the main prognostic factor is the involvement of mediastinal nodes. The exact role of systemic treatment remains to be established as only isolated cases have been reported. It is more than probable that these oligometastatic non-small cell lung cancers which do not progress toward a polymetastatic form have a special biological profile as some studies, especially about microRNAs, suggested it recently.

Clinical Outcomes of Single Dose Stereotactic Radiotherapy for Lung Metastases

IntroductionStereotactic body radiation therapy is an emerging noninvasive technique for the treatment of oligometastatic cancer. The use of small numbers of large doses achieve a high percentage of local control. The aim of this study was to evaluate the efficacy and tolerability of SBRT for the treatment of lung metastases in a cohort of patients treated between 2008 and 2012 at our institution. Patients and MethodsA total of 66 patients with oligometastatic lung tumors (single pulmonary nodules in 40 patients; 61%) were included in the study. SBRT was performed with a stereotactic body frame and a 3-D conformal technique. Forty-nine central tumors received 23 Gy in a single fraction and 54 peripheral tumors received a dose of 30 Gy in a single fraction. The primary end point was local control; secondary end points were survival and toxicity. ResultsMedian follow-up was 15 months (range, 3-45 months). Local control rates at 1 and 2 years were 89.1% and 82.1%, overall survival rates were 76.4% and 31.2%, cancer-specific survival rates were 78.5% and 35.4%, and progression-free survival rates were 53.9% and 22%, respectively. Median survival time was 12 months, and median progression-free survival time was 10 months. Toxicity profiles were good, with 2 cases of Grade 3 toxicity (pneumonitis). ConclusionSBRT is an effective and safe local treatment option for patients with lung metastases, although it remains investigational; longer follow-up to confirm results is required.

Clinical outcomes of stereotactic body radiotherapy for patients with lung tumors in the state of oligo-recurrence.

We retrospectively evaluated the clinical outcomes of patients with oligometastatic lung tumors who underwent stereotactic body radiotherapy (SBRT). Twenty-two patients with one or two oligometastatic lung tumors were treated with SBRT at our institution between 1999 and 2009. With a median follow-up period of 25 months from the date of SBRT to the detection of oligometastatic lung tumors, the patients' 3- and 5-year overall survival (OS) and progression-free survival (PFS) rates were 72% and 54%, respectively. The median disease-free interval (DFI) between the treatment of the primary site and SBRT to oligometastatic lung tumors was 41 months. The OS of patients with a DFI ≥ 36 months was significantly longer than that of the patients with a DFI < 36 months by the log-rank test (P = 0.02). For patients with a DFI ≥ 36 months, the 3- and 5-year OS rates were both 88%, compared to 50% for the patients with a DFI < 36 months. The primary tumor of all patients was locally controlled when SBRT to oligometastatic lung tumors was performed, and thus they were in the state of “oligo-recurrence.” Patients with oligometastatic lung lesions treated by SBRT had good prognoses. This was especially true of the patients with a long DFI and in the state of “oligo-recurrence.”

Stereotactic body radiation therapy for lung metastases

IntroductionStereotactic body radiation therapy (SBRT) has an emerging role in patients affected with pulmonary metastases. Purpose of this study was to evaluate efficacy and tolerability of SBRT in a cohort of patients treated between 2003 and 2009 at our institution. MethodsA total of 61 patients with oligometastatic lung tumors (single pulmonary nodules in 73.7%) were included in the study. SBRT was performed with a stereotactic body frame and a 3D-conformal technique. Fifty-one patients received 26Gy in 1 fraction, 22 a dose of 45Gy in 3 fractions and 3 a dose of 36Gy in 4 fractions. Primary tumor was lung cancer in 45.7% of patients, colorectal cancer in 21.3% and a variety of other origins in 33%. The primary endpoint was local control, secondary endpoints were survival and toxicity. ResultsAfter a median follow-up interval of 20.4 months, local control rates at 2 and 3 years were 89% and 83.5%, overall survival 66.5% and 52.5%, cancer-specific survival 75.4% and 67%, progression-free survival 32.4% and 22.3%. Tumor volume was significantly associated to survival, with highest rates in patients with single small tumors. Median survival time was 42.8 months, while median progression-free survival time was 11.9 months. Toxicity profiles were good, with just one case of grade III toxicity (pneumonitis). ConclusionThis study shows that SBRT is an effective and safe local treatment option for patients with lung metastases. Definitive results are strictly correlated to clinical selection of patients.