Observation on the Clinical Effect of Stereotactic Body Radiotherapy in Patients with Oligometastatic Tumors
PDF

Keywords

Stereotactic body radiotherapy
Extracranial oligometastases
Efficacy
Adverse reactions

DOI

10.26689/jcnr.v6i6.4429

Abstract

Objective: To observe the efficacy and safety of stereotactic body radiotherapy (SBRT) in the treatment of extracranial oligometastases. Method: A retrospective analysis of 70 patients with extracranial oligometastasis of malignant tumors who underwent SBRT in our hospital (Shaanxi Provincial People’s Hospital) from January 2019 to December 2021 with ? 5 metastases, ?3 metastatic organs, and metastases with diameters of ? 5 cm. According to the clinical data of patients, the dose-fractionation mode of SBRT is mainly determined according to the pathology of the primary tumor, the location of the metastatic tumor, and the important structures around the tumor. The local control, survival and adverse reactions were observed. Results: A total of 219 oligometastatic lesions in 70 patients were treated with SBRT. The median follow-up time was 24 months (12–40 months). The local control rate (LCR) of all target lesions assessed 3 months after radiotherapy was 94.1%; the 1-, 2-, and 3-year LCRs were 88.6%, 74.6%, and 64.9%, respectively. The median progression-free survival (PFS) was 11.8 months (95% CI, 8.9–14.7 months), and the 1- and 2-year PFS rates were 48.6% and 32.6%, respectively; the median overall survival (OS) was 31.9 month (95% CI 26.0-37.8 months), the 1-year OS rate was 84.3%. The local control time, PFS, and OS of patients with metastases ? 3 cm were significantly better than those with metastases > 3 cm, and the differences were statistically significant (P < 0.05). Acute adverse reactions after SBRT treatment in oligometastatic patients were mainly bone marrow suppression and gastrointestinal reactions, with incidence rates of 48.98% and 30.61%, respectively; chronic adverse reactions were mainly pain (bone, muscle), radiation enteritis, and radiation pneumonitis, with incidence rates of 38.57%, 30.00%, and 24.29%, respectively. The treatment-related adverse reactions were mainly grade 1, which were all improved after symptomatic treatment, except for one patient with bone metastases from lung cancer who had grade 4 myelosuppression. No grade 4 or 5 adverse events occurred in the other patients. Conclusion: The application of SBRT in the treatment of extracranial oligometastases is safe, effective, and has high tolerability.

References

Hellman S, Weichselbaum RR, 1995, Oligometastases. J Clin Oncol, 13(1): 8–10.

Dawood S, Broglio K, Gonzalez-Angulo AM, et al., 2008, Trends in Survival Over the Past Two Decades Among White and Black Patients with Newly Diagnosed Stage IV Breast Cancer. J Clin Oncol, 2008, 26(30): 4891–4898.

Mehta N, Mauer AM, Hellman S, et al., 2004, Analysis of Further Disease Progression in Metastatic Non-Small Cell Lung Cancer: Implications for Locoregional Treatment. Int J Oncol, 25(6): 1677-1683.

Tosoian JJ, Gorin MA, Ross AE, et al., 2017, Oligometastatic Prostate Cancer: Definitions, Clinical Outcomes, and Treatment Consideration. Nat Rev Urol, 14(1):15-25.

Loh J, Davis ID, Martin JM, et al., 2014, Extracranial Oligometastatic Renal Cell Carcinoma: Current Management and Future Directions. Future Oncol, 10(5): 761–774.

Milano MT, Katz AW, Zhang H, et al., 2012, Oligometastases Treated with Stereotactic Body Radiotherapy: Long-Term Follow-Up of Prospective Study. Int J Radiat Oncol Biol Phys, 83(3): 878–886.

Palma DA, Salama JK, Lo SS, et al., 2014, The Oligometastatic State-Separating Truth From Wishful Thinking. Nat Rev Clin Oncol, 11(9): 549–557.

Ahmed KA, Caudell JJ, El-Haddad G, et al., 2016, Radiosensitivity Differences Between Liver Metastases Based on Primary Histology Suggest Implications for Clinical Outcomes After Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys, 95(5):1399-1404.

Torok JA, Gu L, Tandberg DJ, et al., 2016, Patterns of Distant Metastases After Surgical Management of Non-Small-Cell Lung Cancer. Clinical Lung Cancer, 18(1): 57–70.

Dorn P, Meriwether A, Lemieux M, et al., 2011, Patterns of Distant Failure and Progression in Breast Cancer: Implications for the Treatment of Oligmetastatic Disease. Fuel and Energy Abstracts, 81(2): 643.

Thariat J, Marcy PY, Lagrange JL, 2010, Trends in Radiation Therapy for the Treatment of Metastatic and Oligometastatie Disease in 2010. Bull Cancer, 97(12): 1467–1476.

Hasselle MD, Haraf DJ, Rusthoven KE, et al., 2012, Hypofractionated Image-Guided Radiation Therapy for Patients with Limited Volume Metastatic Non-Small Cell Lung Cancer. J Thor Oncol, 7(2): 376–381?

Fumagalli I, Bibault JE, Dewas S, et al., 2012, A Single-Institution Study of Stereotactic Body Radiotherapy for Patients with Unresectable Visceral Pulmonary or Hepatic Oligometastases. Radiat Oncol, 7(1): 164?

Lussier YA, Xing HR, Salama JK, e t al., 2011, MicroRNA Expression Characterizes Oligometastasis (es). PLOS One, 6(12): e28650.

Pawlik TM, Scoggins CR, Zorzi D, et al., 2005, Effect of Surgical Margin Status on Survival and Site of Recurrence After Hepatic Resection for Colorectal Metastases. Ann Surg, 241(5): 715–722.

Pastorino U, Buyse M, Friedel G, et al., 1997, Long-term Results of Lung Metastasectomy: Prognostic Analyses Based on 5206 Cases. J Thorac Cardiovasc Surg, 113(1): 37–49.

Strong VE, D’angelica M, Tang L, et al., 2007, Laparoscopic Adrenalectomy for Isolated Adrenal Metastasis. Ann Surg Oncol, 14(12): 3392–3400.

Lewis SL, Porceddu S, Nakamura N, et al., 2017, Definitive Stereotactic Body Radiotherapy (SBRT) for Extracranial Oligometastases: An International Survey of >1000 Radiation Oncologists. Am J Clin Oncol, 40(4): 418–422.

Iyengar P, Kavanagh BD, Wardak Z, et al., 2014, Phase? trial of Stereotactic Body Radiation Therapy Combined with Erlotinib for Patients with Limited but Progressive Metastatic Non-Small-Cell Lung Cancer. J Clin Oncol, 32(34): 3824–3830?

Hasselle MD, Haraf DJ, Rusthoven KE, et al., 2012, Hypofractionated Image-Guided Radiation Therapy for Patients with Limited Volume Metastatic Non-Small Cell Lung Cancer. J Thor Oncol, 7(2): 376-381?

Fanetti G, Marvaso G, Ciardo D, et al., 2018, Stereotactic Body Radiotherapy or Castration-Sensitive Prostate Cancer Bone Oligometastases. Med Oncol, 35(5): 75.

Dohopolski MJ, Horne Z, Clump D, et al., 2018, Stereotactic Body Radiation Therapy for Pulmonary Oligometastases Arising from Non-Lung Primaries in Patients without Extrapulmonary disease. Cureus, 10(2): e2167.

Gomez DR, Blumenschein GR Jr, Lee JJ, et al., 2016, Local Consolidative Therapy Versus Maintenance Therapy or Observation for Patients with Oligometastatic Non-Small-Cell Lung Cancer Without Progression After First-Line Systemic Therapy: A Multicentre, Randomised, Controlled, Phase 2 Study. Lancet Oncol, 17(12): 1672–1682.

Palma DA, Olson R, Harrow S, et al., 2019, Stereotactic Ablative Radiotherapy Versus Standard of Care Palliative Treatment in Patients with Oligometastatic Cancers (SABR-COMET): A Randomised, Phase 2, Open-Label Trial. Lancet, 393(10185): 2051–2058.

Hong JC, Ayala-Peacock DN, Lee J, et al., 2018, Classification for Long-Term Survival in Oligometastatic Patients Treated with Ablative Radiotherapy: A Multi-Institutional Pooled Analysis. PLOS One. 13(4): e0195149.

Oh D, Ahn YC, Seo JM, et al., 2012, Potentially Curative Stereotactic Body Radiation Therapy (SBRT) for Single or Oligometastasis to the Lung. Acta Oncol, 51(5): 596–602.

Andrews DW, Scott CB, Sperduto PW, et al., 2004, Whole Brain Radiation Therapy with or Without Stereotactic Radiosurgery Boost for Patients with One to Three Brain Metastases: Phase III Results of the RTOG 9508 Randomised Trial. Lancet, 363(9422): 1665–1672.