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Schietroma F, Bensi M, Calegari MA, Pozzo C, Basso M, Valente G, Caira G, Trovato G, Spring A, Beccia V, Ceccarelli A, Perazzo S, Chiofalo L, Barbaro B, Tatulli G, Alfieri S, De Sio D, Lorenzon L, Persiani R, Lococo F, Nachira D, Giuliante F, Ardito F, Cellini F, Panza G, Cozza V, Giovinazzo F, Pafundi DP, Sofo L, Santullo F, Tondolo V, Tortora G, Salvatore L. The Impact of a Multidisciplinary Tumor Board (MDTB) in the Management of Colorectal Cancer (CRC). Clin Colorectal Cancer 2025; 24:231-238. [PMID: 39893137 DOI: 10.1016/j.clcc.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 01/05/2025] [Accepted: 01/07/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND The management of colorectal cancer (CRC) is a complex process. Defining the disease burden, assessing the radiological response and identifying the right time for surgery or other locoregional treatments are crucial factors which can require the involvement of a multidisciplinary tumor board (MDTB) comprising several specialists. This study investigates the impact of MDTB on management of CRC in our institution. METHODS We retrospectively assessed all cases discussed by our MDTB between September 2019 and April 2023. In particular, we collected data concerning radiology, surgery and radiotherapy indication before and after MDTB meetings. The primary endpoint was the overall rate of discrepancy between pre- and post-discussion evaluations. RESULTS Our analysis involved 1150 cases. Median age was 64 years (16-90), 629 patients (54.7%) were male and 915 (79.5%) had metastatic disease at the time of the relevant MDTB discussion. After the meetings, 325 treatment decisions were modified, producing an overall discrepancy rate of 28.3%. In particular: (1) of 648 cases discussed for radiological assessment, 156 decisions (24.1%) were altered after a central imaging review; (2) of 327 cases considered for surgical approach, treatment strategy changed in 118 (36.1%); and (3) of the 160 cases discussed regarding radiotherapy, the treatment strategy changed in 51 of them (31.9%). CONCLUSIONS Our analysis shows significant discrepancies between the radiology and locoregional evaluations from both before and after the MDTB meetings. Our results highlight that the discussions of a MDTB can considerably change the management of CRC, maximizing the treatment strategy.
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Affiliation(s)
- Francesco Schietroma
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Bensi
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Alessandra Calegari
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michele Basso
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giustina Valente
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Caira
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Trovato
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexia Spring
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Viria Beccia
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Ceccarelli
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Perazzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Chiofalo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Brunella Barbaro
- Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Tatulli
- Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Alfieri
- Chirurgia Digestiva, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide De Sio
- Chirurgia Digestiva, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Laura Lorenzon
- Chirurgia Generale, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Roberto Persiani
- Chirurgia Generale, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Lococo
- Chirurgia Toracica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dania Nachira
- Chirurgia Toracica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Felice Giuliante
- Chirurgia Generale ed Epato-Biliare, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ardito
- Chirurgia Generale ed Epato-Biliare, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cellini
- Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Panza
- Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Valerio Cozza
- Chirurgia d'Urgenza e del Trauma, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Francesco Giovinazzo
- Chirurgia Generale e dei Trapianti di Organo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Donato Paolo Pafundi
- Chirurgia Generale 2, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Luigi Sofo
- Chirurgia Addominale, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Santullo
- Chirurgia del Peritoneo e Retroperitone, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Tondolo
- Chirurgia Digestiva e del Colon Retto, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lisa Salvatore
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy.
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Leng B, Wang H, Ge Y, Sun X, Dong P, Dong X, Duan X, Wang Q, Xia Y, Ding L, Dai H, Liu T, Shi F, Zhang X, Yue J. Maintaining First-Line Therapy Plus Radiation Therapy May Prolong Progression-Free Survival and Delay Second-Line Therapy for Oligoprogressive Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2025; 122:325-338. [PMID: 39824367 DOI: 10.1016/j.ijrobp.2024.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 12/01/2024] [Accepted: 12/31/2024] [Indexed: 01/20/2025]
Abstract
PURPOSE Optimal treatment strategies for patients with hepatocellular carcinoma with oligoprogression after first-line systemic therapy (FLST) remain undefined. We aimed to determine whether maintaining (ie, continuing) FLST plus radiation therapy (RT) for oligoprogressive lesions (m-FLST + RT) would result in progression-free survival (PFS) equal to or greater than that of second-line systemic therapy (s-SLST), either alone or with RT (s-SLST + RT). METHODS AND MATERIALS From October 2018 to February 2024, 154 patients from 7 medical centers who developed oligoprogression after FLST were enrolled and assigned to 1 of 3 groups based on post-oligoprogression treatment strategy: m-FLST + RT, s-SLST + RT, or s-SLST-only. The primary outcome was PFS, and early patterns of recurrence were noted. RESULTS At a median follow-up time of 8.4 months, the median PFS time was longer in the m-FLST + RT group (8.6 months) compared with the s-SLS-only group (3.1 months) (hazard ratio, 3.163; 95% CI, 2.133-4.690; P < .001) and the s-SLST + RT group (5.8 months) (hazard ratio, 2.183; 95% CI, 1.110-4.293; P = .006). Multivariate Cox analysis demonstrated that albumin-bilirubin (ALBI) grade and postoligoprogression treatment strategy were independent prognostic factors for PFS. Stratified analysis by ALBI grade showed that m-FLST + RT resulted in significantly longer median PFS in patients with both ALBI-1 and ALBI-2 compared with s-SLST-only (P < .001). Regarding subsequent patterns of relapse, the m-FLST + RT group had a lower rate of re-enlargement of recently oligoprogressive lesions (27.6%) than the s-SLST + RT (31.8%) and s-SLST-only (50.0%) groups. It also had the lowest rate of re-enlargement of previously identified metastases that did not progress during FLST (13.8%) compared with s-SLRT + RT (27.3%) and s-SLST-only (24.4%). CONCLUSIONS Our study suggests a potential clinical benefit of m-FLST + RT without the need for s-SLST and provides insights to optimize treatment strategies for oligoprogressive hepatocellular carcinoma.
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Affiliation(s)
- Boyu Leng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Haohua Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China; Cheeloo College of Medicine, Shandong University Cancer Center, Jinan, Shandong, China
| | - Yunfan Ge
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China; Clinical Medical College, Shandong Second Medical University, Jinan, Shandong, China
| | - Xiaoli Sun
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pingping Dong
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinzhe Dong
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xuezhang Duan
- Department of Radiation Oncology, Senior Department of Oncology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Quan Wang
- Department of Radiation Oncology, Senior Department of Oncology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yaoxiong Xia
- Department of Radiation Oncology, Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Lijuan Ding
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Honghai Dai
- Department of Radiation Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Tianxing Liu
- Department of Radiation Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China; Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Fang Shi
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiang Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
| | - Jinbo Yue
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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Sun X, Shu P, Shen Y, Li Z, Liu N, Ouyang G, Tang Y, Huang M, Wang X. Targeted therapy acts to sensitize stereotactic body radiotherapy for pulmonary oligometastases from colorectal cancer. Front Oncol 2025; 15:1464707. [PMID: 40406266 PMCID: PMC12095014 DOI: 10.3389/fonc.2025.1464707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 04/14/2025] [Indexed: 05/26/2025] Open
Abstract
Background Stereotactic body radiation therapy (SBRT) is used to manage lung metastases arising from colorectal cancer (CRC), but its effectiveness is constrained by the radioresistance of CRCs. Here, we explored whether concurrent therapy with cetuximab or bevacizumab could improve the prognosis of CRC patients with pulmonary oligometastases. Materials and methods CRC patients with oligometastatic lung tumors (OLTs) treated with concurrent chemoradiotherapy from March 2011 to March 2023 were retrospectively analyzed. Treatment outcomes for local control rate (LCR), progression-free survival (PFS), overall survival (OS), and toxicities were assessed. Results Sixty-nine patients were included, with a median follow-up of 34 months. The 1-year LCRs for SBRT + chemotherapy, SBRT + chemotherapy + bevacizumab, and SBRT + chemotherapy + cetuximab were 63.3%, 96.2%, and 94.4%, respectively. Incorporating bevacizumab or cetuximab significantly prolonged median OS compared to chemotherapy (61 vs. 46 vs. 24 months). Substantial differences in median PFS were noted, with durations of 5, 23, and 8 months for SBRT + chemotherapy, SBRT + chemotherapy + bevacizumab, and SBRT + chemotherapy + cetuximab, respectively. Our univariate analysis revealed that patients under targeted therapy of bevacizumab or cetuximab were linked to prolonged OS and PFS (p < 0.05). Tumor size <2 cm and median biologically effective dose (BED10) ≥100 Gy were correlated with higher local control rates (p < 0.05). Furthermore, comprehensive multivariate analysis confirmed that tumor sizes of <2 cm were linked to better local control (p < 0.05). All three combination regimens were well tolerated, and the occurrence of toxicities was higher in treatments involving targeted therapy. Conclusion Combining concurrent chemoradiotherapy with cetuximab or bevacizumab improves treatment outcomes, with manageable toxicity. Given the limited sample size of this study, larger studies such as prospective trials are needed.
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Affiliation(s)
- Xiye Sun
- Division of Thoracic Tumor Multimodality Treatment and Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Pei Shu
- Division of Abdominal Tumor Multimodality Treatment, Department of Radiation Oncology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Clinical Trial Center, National Medical Products Administration Key Laboratory for Clinical Research and Evaluation of Innovative Drugs, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yali Shen
- Division of Abdominal Tumor Multimodality Treatment, Department of Radiation Oncology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiping Li
- Division of Abdominal Tumor Multimodality Treatment, Department of Radiation Oncology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ning Liu
- Division of Thoracic Tumor Multimodality Treatment and Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ganlu Ouyang
- Division of Abdominal Tumor Multimodality Treatment, Department of Radiation Oncology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuanling Tang
- Division of Abdominal Tumor Multimodality Treatment, Department of Radiation Oncology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meijuan Huang
- Division of Thoracic Tumor Multimodality Treatment and Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wang
- Division of Abdominal Tumor Multimodality Treatment, Department of Radiation Oncology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Gooijer SA, Gazendam ASM, Torensma B, Tuynman JB, Dahele M, Heineman DJ, Braun J, Dickhoff C, Senan S, Schreurs WH, Schneiders FL, van Dorp M. Metastasectomy versus stereotactic body radiotherapy for patients with oligometastatic colorectal lung metastases: a systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:110056. [PMID: 40300380 DOI: 10.1016/j.ejso.2025.110056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 03/27/2025] [Accepted: 04/12/2025] [Indexed: 05/01/2025]
Abstract
Metastasectomy and stereotactic body radiotherapy (SBRT) are both guideline-recommended treatment modalities for patients with oligometastatic colorectal lung metastases (CLM). Few evidence is available comparing different local therapies in an oligometastatic population. This systematic review aimed to compare the efficacy of metastasectomy with SBRT for patients with oligometastatic CLM. A systematic literature search was performed according to the PRISMA guidelines to identify studies on metastasectomy and SBRT for patients with oligometastatic CLM. Studies published between 2000 and 2023 were identified through Medline, Embase, and the Cochrane databases. Overall survival (OS), progression-free survival (PFS), and local recurrence rate (LRR) were assessed and compared between both groups. The risk of bias was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. A total of 141 studies on metastasectomy (n = 29932) and 16 studies on SBRT (n = 1381) were included in the final analysis. The pooled five-year OS was 52.2 % (CI: 49.8-54.5) and 45.0 % (CI: 31.2-58.9) following metastasectomy and SBRT, respectively (p = 0.213). The pooled five-year PFS was 35.1 % (CI: 32.2-38.1) following metastasectomy and 11.7 % (CI: 0-38.2) following SBRT (p < 0.001). The pooled LRR was 10.5 % (CI: 5.5-15.5) following metastasectomy and 28.1 % (CI: 20.8-35.4) following SBRT (p < 0.001). The average GRADE score of the included studies was low. The data suggest that patients with oligometastatic CLM have a comparable OS rate after metastasectomy or SBRT, but PFS and LRR favour a surgical approach. This systematic review supports initiating a randomized controlled trial comparing surgery and SBRT in operable patients with oligometastatic CLM.
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Affiliation(s)
- Simone A Gooijer
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
| | | | - Bart Torensma
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - David J Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Martijn van Dorp
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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Romero-Zoghbi SE, Krumina E, López-Campos F, Couñago F. Current and future perspectives in the management and treatment of colorectal cancer. World J Clin Oncol 2025; 16:100807. [PMID: 39995555 PMCID: PMC11686563 DOI: 10.5306/wjco.v16.i2.100807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 09/30/2024] [Accepted: 10/23/2024] [Indexed: 12/11/2024] Open
Abstract
In this editorial, we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology. The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer (CRC), one of the leading causes of cancer-related morbidity and mortality worldwide. The article analyzed the therapeutic modalities and their sequencing, focusing on total neoadjuvant therapy for locally advanced rectal cancer. It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair, addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC. Innovations in surgical techniques, advanced radiotherapy, and systemic agents targeting specific mutational profiles are also discussed, reflecting on how they revolutionized clinical management. Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease, prognosis, and therapeutic monitoring, solidifying its role in precision oncology. This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.
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Affiliation(s)
| | - Evita Krumina
- Department of Radiation Oncology, GenesisCare Guadalajara, Guadalajara 19004, Spain
| | - Fernando López-Campos
- Department of Radiation Oncology, Hospital Universitario Ramón Y Cajal, Madrid 28034, Spain
- Department of Radiation Oncology, GenesisCare-Hospital Universitario Vithas Madrid La Milagrosa, Madrid 28010, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, GenesisCare-San Francisco de Asís University Hospital, Madrid 28002, Spain
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Costa SPF, Sousa F, Leite-Silva P, Gomes D, Sousa O. Stereotactic body radiation therapy for lung metastases from colorectal cancer: outcomes and prognostic factors in a series of 109 patients. Rep Pract Oncol Radiother 2025; 29:700-709. [PMID: 40104661 PMCID: PMC11912891 DOI: 10.5603/rpor.103527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/12/2024] [Indexed: 03/20/2025] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) has been applied in the treatment of inoperable lung metastases. We retrospectively evaluated local control (LC) and prognostic factors in patients treated with SBRT for colorectal cancer (CRC) pulmonary metastases. Materials and methods Unicentric retrospective study of 109 patients with CRC lung metastases treated with SBRT between 2013 and 2020. The prescribed dose was 30-34 Gy in a single fraction or 40-50 Gy in 4-5 fractions. Primary end-point was LC. Secondary end-points included overall survival (OS), progression-free survival (PFS) and identification of prognostic factors that could influence survival and LC. Results Sixty-eight patients presented rectal cancer and 41 colon cancer as primary cancer. Local PFS (LPFS) at 2 years was 81.0%. The median OS was 51 months with a 2-year OS rate of 85.8%. For PFS, 2-year rate was 30.8% and the median PFS was 11.7 months. No patient experienced grade toxicity ≥ 3. Lesion diameter was the only variable marginally significant for LPFS. Metastases located centrally were associated with a worse OS. The volume (≥ 10 cc), the administration of systemic treatment before or after SBRT and the age (≥ 70 years) were predictive factors for PFS. The volume (≥ 10 cc) and the age (≥ 70 years) were predictive factors for regional progression. Extrapulmonary disease was the most important prognostic factor for distance progression. Conclusions SBRT proved to be a feasible, safe and effective option for the treatment of patients with CRC lung metastases, with a good LC. None of the prognostic factors studied showed a statistically significant impact on LC.
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Affiliation(s)
- Susana P F Costa
- Department of Radiation Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, Portugal
| | - Fausto Sousa
- Department of Radiation Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, Portugal
| | - Pedro Leite-Silva
- Cancer Epidemiology Group-Research Center. Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, Portugal
- Department of Epidemiology. Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, Portugal
| | - Dora Gomes
- Department of Radiation Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, Portugal
| | - Olga Sousa
- Department of Radiation Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, Portugal
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Deodato F, Pezzulla D, Cilla S, Romano C, Ferro M, Galietta E, Lancellotta V, Morganti AG, Macchia G. Stereotactic Radiosurgery with Volumetric Modulated Arc Radiotherapy: Final Results of a Multi-arm Phase I Trial (DESTROY-2). Clin Oncol (R Coll Radiol) 2024; 36:632-641. [PMID: 38971684 DOI: 10.1016/j.clon.2024.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/16/2024] [Accepted: 06/13/2024] [Indexed: 07/08/2024]
Abstract
AIMS To present the final results of a phase I trial on stereotactic radiosurgery (SRS) delivered using volumetric modulated arc therapy (VMAT) in patients with primary or metastatic tumors in different extracranial sites. MATERIALS AND METHODS The DESTROY-2 trial, planned as a prospective dose escalation study in oligometastatic (one to five lesions) cancer patients relied on the delivery of a single high dose of radiation utilizing high-precision technology. The primary study endpoint was the definition of the maximum tolerated dose (MTD) of SRS-VMAT. The secondary objectives of the study were the evaluation of safety, efficacy, and long-term outcomes. All patients consecutively observed at our radiotherapy unit matching the inclusion criteria were enrolled. Each enrolled subject was included in a different phase I study arm, depending on the tumor site and the disease stage (lung, liver, bone, other), and sequentially assigned to a particular dose level. RESULTS Two hundred twenty seven lesions in 164 consecutive patients (male/female: 97/67, median age: 68 years; range: 29-92) were treated. The main primary tumors were: prostate cancer (60 patients), colorectal cancer (47 patients), and breast cancer (39 patients). The maximum planned dose level was achieved in all study arms, and the MTD was not exceeded. 34 Gy, 32 Gy, 24 Gy, and 24 Gy were established as the single-fraction doses for treating lung, liver, bone, and other extracranial lesions, respectively. The prescribed BED 2Gyα/β:10 to the planning target volume ranged from 26.4 Gy to 149.6 Gy. Twenty-seven patients (16.5%) experienced grade 1-2 and only one grade 3 acute toxicity, which was a pulmonary one. In terms of late toxicity, we registered only 5 toxicity>G2: a G3 gastro-intestinal one, three G3 bone toxicity, and a G3 laryngeal toxicity. The overall response was available for 199 lesions: 107 complete response (53.8%), 50 partial response (25.1%), and 31 stable disease (15.6%), leading to an overall response rate of 94.5%. Progression was registered only in 11 cases (5.5%). The overall response rate in each arm ranged from 88.6% to 96.4%. The overall two-year local control, distant metastasis free survival, disease free survival, and overall survival were 81.7%, 33.0%, 25.4%, and 78.7% respectively. CONCLUSION In conclusion, the planned doses of 34 Gy, 32 Gy, 24 Gy, and 24 Gy were successfully administered as single-fractions for the treatment of lung, liver, bone, and other extracranial lesions, respectively, in a prospective SRS dose-escalation trial. No dose-limiting toxicities were registered, and minimal acute and late toxicity were reported. New indications for SRS are currently being studied in oligoprogressive patients receiving targeted drugs or in combination with immunotherapy. The DESTROY-2 trial represents, in our opinion, a credible starting point for future modern radiosurgery trials.
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Affiliation(s)
- F Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy; Radiology Institute, Università Cattolica del Sacro Cuore, Rome 00135, Italy
| | - D Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy.
| | - S Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - C Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - Mi Ferro
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - E Galietta
- Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna, University, Bologna, Italy; Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - V Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - A G Morganti
- Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna, University, Bologna, Italy; Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - G Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
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Jeong JU, Rim CH, Yoo GS, Cho WK, Chie EK, Ahn YC, Lee JH, on behalf of Korean Oligometastasis Working Group, Korean Cancer Association. The Clinical Efficacy of Colorectal Cancer Patients with Pulmonary Oligometastases by Sterotactic Body Ablative Radiotherapy: A Meta-Analysis. Cancer Res Treat 2024; 56:809-824. [PMID: 38097919 PMCID: PMC11261202 DOI: 10.4143/crt.2023.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 07/18/2024] Open
Abstract
PURPOSE There is increasing interest in the efficacy of stereotactic ablative radiotherapy (SABR) for treating colorectal cancer (CRC) patients with oligometastases (OM), recently. The purpose of this meta-analysis was to evaluate local control (LC), progression-free survival (PFS), and overall survival (OS) of CRC patients with pulmonary OM treated with SABR and toxicities. MATERIALS AND METHODS Studies that reported SABR for CRC patients with pulmonary OM were searched from MEDLINE and Embase. Treatment outcomes including LC, PFS, OS, and toxicities of grade 3 or higher were assessed. RESULTS A total of 19 studies with 1,668 patients were chosen for this meta-analysis. Pooled 1-, 2-, and 3-year LC rates were 83.1%, 69.3%, and 63.9%, respectively. PFS rates were 44.8%, 26.5%, and 21.5% at 1, 2, and 3 years, respectively. OS rates at 1-, 2-, and 3-year were 87.5%, 69.9%, and 60.5%, respectively. The toxicity rate of grade 3 or higher was 3.6%. The effect of dose escalation was meta-analyzed using available studies. CONCLUSION Application of SABR to CRC patients with pulmonary OM achieved modest local control with acceptable toxicity according to the present meta-analysis. Further studies establishing the clinical efficacy of SABR are guaranteed.
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Affiliation(s)
- Jae-Uk Jeong
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - on behalf of Korean Oligometastasis Working Group, Korean Cancer Association
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
- Department of Radiation Oncology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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9
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Choi SH, Lee BM, Kim J, Kim DY, Seong J. Efficacy of stereotactic ablative radiotherapy in patients with oligometastatic hepatocellular carcinoma: A phase II study. J Hepatol 2024; 81:84-92. [PMID: 38467379 DOI: 10.1016/j.jhep.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND & AIMS Stereotactic ablative radiotherapy (SABR) can extend survival and offers the potential for cure in some patients with oligometastatic disease (OMD). However, limited evidence exists regarding its use in oligometastatic hepatocellular carcinoma (HCC). We aimed to prospectively investigate the efficacy and safety of SABR in patients with oligometastatic HCC. METHODS We enrolled patients with controlled primary HCC and one to five metastatic lesions amenable to SABR. The primary endpoint was treatment efficacy defined as overall survival (OS) and progression-free survival (PFS). The secondary endpoints included time to local progression, objective response rate, disease control rate, toxicities, and quality of life (QOL), assessed using the EORTC QLQ-C30 before, and 0, 1, and 3 months after SABR. RESULTS Overall, 40 consecutive patients received SABR on 62 lesions between 2021 and 2022. The most common locations for OMD were the lungs (48.4%), lymph nodes (22.6%), and bone (17.7%). After a median follow-up of 15.5 months, the 2-year OS was 80%. Median PFS was 5.3 months, with 1- and 2-year PFS rates of 21.2% and 0%, respectively. A shorter time to OMD from the controlled primary independently correlated with PFS (p = 0.039, hazard ratio 2.127) alongside age, Child-Pugh class, and alpha-fetoprotein (p = 0.002, 0.004, 0.019, respectively). The 2-year time to local progression, objective response rate, and disease control rate were 91.1%, 75.8%, and 98.4%, respectively. Overall, 10% of patients experienced acute toxicity, and 7.5% experienced late toxicity, with no grade 3+ toxicity. All QOL scores remained stable, whereas the patients without systemic treatments had improved insomnia and social functioning scores. CONCLUSIONS SABR is an effective and feasible option for oligometastatic HCC that leads to excellent local tumor control and improves survival without adversely affecting QOL. IMPACT AND IMPLICATIONS Stereotactic ablative radiotherapy (SABR) is a non-invasive treatment approach capable of efficiently ablating the target lesion; however, neither the oligometastatic disease concept nor the potential benefits of SABR have been well-defined in hepatocellular carcinoma (HCC). According to this study, SABR is an effective and safe treatment option for oligometastatic HCC, yielding excellent local tumor control and survival improvement without worsening patients' quality of life, regardless of tumor sites. We also demonstrated that patients with a later presentation of OMD from the controlled primary and lower alpha-fetoprotein levels achieved better survival outcomes. This is the first prospective study of SABR in oligometastatic HCC, providing insights for the development of novel strategies to improve oncologic outcomes. CLINICAL TRIAL NUMBER NCT05173610.
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Affiliation(s)
- Seo Hee Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Min Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jina Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
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10
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Parvinian A, Thompson SM, Schmitz JJ, Welch BT, Hibbert R, Adamo DA, Kurup AN. Update on Percutaneous Ablation for Sarcoma. Curr Oncol Rep 2024; 26:601-613. [PMID: 38647995 DOI: 10.1007/s11912-024-01532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW To provide an update on the current state of percutaneous thermal ablation in the treatment of sarcoma. RECENT FINDINGS Data continue to accrue in support of ablation for local control and palliation of specific sarcoma subtypes such as extra-abdominal desmoid fibromatosis and for broader indications such as the treatment of oligometastatic disease. The synergistic possibilities of various combination therapies such as cryoablation and immunotherapy represent intriguing areas of active investigation. Histotripsy is an emerging non-invasive, non-thermal ablative modality that may further expand the therapeutic arsenal for sarcoma treatment. Percutaneous thermal ablation is a valuable tool in the multidisciplinary management of sarcoma, offering a minimally invasive adjunct to surgery and radiation therapy. Although there remains a paucity of high-level evidence specific to sarcomas, ablation techniques are demonstrably safe and effective for achieving local tumor control and providing pain relief in select patients and are of particular benefit in those with metastatic disease or requiring palliative care.
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Affiliation(s)
- Ahmad Parvinian
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Scott M Thompson
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Rebecca Hibbert
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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11
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Pan M. Metastasectomy and Stereotactic Body Radiotherapy for Colorectal Cancer With Liver and Lung Oligometastases: A Case Report of Complete Remission in a 96-Year-Old Patient. Cureus 2024; 16:e58135. [PMID: 38741816 PMCID: PMC11088955 DOI: 10.7759/cureus.58135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
We report a rare case of an extremely old colorectal cancer (CRC) patient who had complete remission after liver metastasectomy and stereotactic body radiotherapy (SBRT) to lung oligometastases (OM), with good quality of life and no evidence of recurrence 12 years after the initial diagnosis. An 83-year-old male patient had a right hemicolectomy for stage pT3 pN0 adenocarcinoma of the colon. Soon he was found to have liver metastasis treated with radiofrequency ablation and then liver metastasectomy with clear margins, followed by chemotherapy in the form of FOLFIRI for six months. Six years later, positron emission tomography (PET) showed 1.6 cm OM in the left upper lobe lung. He was not considered a good candidate for surgery. We offered him SBRT 48 Gy in four fractions every other day. The lesion disappeared with no recurrence in the same location on PET and serial computed tomography (CT) scans. Three years later, PET-CT found a new OM in the left lingular lung measuring 1.2 cm. A CT-guided lung biopsy confirmed invasive adenocarcinoma favoring OM from the CRC. SBRT planning failed due to its proximity to the heart. He accepted the longer course of conventional volumetric modulated arc therapy at 60 Gy in 15 fractions with daily cone-beam CT guidance. Again, he tolerated treatment very well with no significant side effects, despite his age. He did not require any chemotherapy or other systemic treatment in the last 11 years, so he did not experience any toxicities related to such treatment. This case is important to show that old age alone should not be considered a contraindication for metastasectomy and SBRT for CRC with liver and lung OM.
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Affiliation(s)
- Ming Pan
- Radiation Oncology, Windsor Regional Hospital Cancer Program, Windsor, CAN
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12
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Song M, Zhou X, Hou R, Sigdel M, Liu Y, Zhang C, Xu K, Han X, Jiao D. CT-guided radioactive 125I seeds brachytherapy for lung oligometastases from colorectal cancer: initial results. BMC Cancer 2024; 24:265. [PMID: 38403626 PMCID: PMC10895717 DOI: 10.1186/s12885-024-12013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/16/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVES To evaluate the safety and effectiveness of computed tomography (CT)-guided radioactive 125I seeds brachytherapy (RISB) for lung oligometastases (LO) from colorectal cancer (CRC). METHODS Data for 144 LOs from 70 CRC patients who underwent CT-guided RISB were retrospectively analyzed. The primary endpoints were progression-free survival (PFS) and overall survival (OS), and the secondary endpoints were technical success, local control rate (LCR), and complications. Kaplan-Meier method was used for survival analysis. Cox model was used to identify the independent predictors of poor prognosis. RESULTS The RISB procedures were successfully performed in all patients, and the success rate was 100%. The median follow-up was 27.8 months. The median PFS was 10.0 months (95% CI: 8.9-11.1) and the 1- and 2-year PFS rates were 32.9% and 5.9%, respectively. On multivariate analysis, serum carcinoembryonic antigen (CEA) ≤ 15 ng/ml (P = 0.048), middle-high differentiated pathological classification (P = 0.015), primary TNM stages I-III (P = 0.001), LO number ≤ 2 (P < 0.001) and cumulative gross tumor volume (GTV) ≤ 40 cm3 (P < 0.001) showed superior PFS. The median OS was 30.8 months (95% CI: 27.1-34.4) and the 1-, 2-, and 3-year OS rates were 95.7%, 67.4%, and 42.5%, respectively. On multivariate analysis, serum CEA ≤ 15 ng/ml (P = 0.004), middle-high differentiated pathological classification (P < 0.001), primary TNM stages I-III (P < 0.001), LO number ≤ 2 (P < 0.001), cumulative GTV ≤ 40 cm3 (P < 0.001) and system treatments combined with chemotherapy and target therapy (P < 0.001) showed superior OS. The LCR for 3, 6, and 12 months was 97.9%, 91.0%, and 83.6%, respectively. There were 4 cases of pneumothorax at 5.7% that required drainage. CONCLUSIONS RISB for LO from CRC is safe and effective, and serum CEA, TNM stage, LO number, cumulative GTV, and system treatments should be emphasized for long OS.
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Affiliation(s)
- Mengyao Song
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xueliang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Rongna Hou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Milan Sigdel
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yiming Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Chengzhi Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Kaihao Xu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China.
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Bourbonne V, Lévy A, Khalifa J, Antoni D, Blais E, Darréon J, Le Péchoux C, Lerouge D, Giraud P, Marguerit A, Pourel N, Riet FG, Thureau S. Radiotherapy in the management of lung oligometastases. Cancer Radiother 2024; 28:36-48. [PMID: 38228422 DOI: 10.1016/j.canrad.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/07/2023] [Accepted: 06/29/2023] [Indexed: 01/18/2024]
Abstract
In recent years, the development of both medical imaging and new systemic agents (targeted therapy and immunotherapy) have revolutionized the field of oncology, leading to a new entity: oligometastatic disease. Adding local treatment of oligometastases to systemic treatment could lead to prolonged survival with no significant impact on quality of life. Given the high prevalence of lung oligometastases and the new systemic agents coming with increased pulmonary toxicity, this article provides a comprehensive review of the current state-of-art for radiotherapy of lung oligometastases. After reviewing pretreatment workup, the authors define several radiotherapy regimen based on the localization and size of the oligometastases. A comment on the synergistic combination of medical treatment and radiotherapy is also made, projecting on future steps in this specific clinical setting.
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Affiliation(s)
- V Bourbonne
- Radiation Oncology Department, CHU de Brest, Brest, France; LaTim, Inserm, UMR 1101, université de Bretagne occidentale, Brest, France
| | - A Lévy
- Department of Radiation Oncology, Centre international des cancers thoraciques (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud, institut universitaire du cancer Toulouse-Oncopôle, Toulouse, France
| | - D Antoni
- Department of Radiation Oncology, Institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - E Blais
- Department of Radiation Oncology, polyclinique Marzet, Pau, France
| | - J Darréon
- Department of Radiation Oncology, institut Paoli-Calmettes, Marseille, France
| | - C Le Péchoux
- Department of Radiation Oncology, Centre international des cancers thoraciques (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - D Lerouge
- Department of Radiation Oncology, centre François-Baclesse, Caen, France
| | - P Giraud
- Department of Radiation Oncology, hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Paris, France
| | - A Marguerit
- Department of Radiation Oncology, Institut de cancérologie de Montpellier, Montpellier, France
| | - N Pourel
- Department of Radiation Oncology, institut Sainte-Catherine, Avignon, France
| | - F-G Riet
- Department of Radiation Oncology, centre hospitalier privé Saint-Grégoire, 35760 Saint-Grégoire, France
| | - S Thureau
- Radiotherapy Department, centre Henri-Becquerel, Rouen, France; QuantIF-Litis EA4108, université de Rouen, Rouen, France.
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Chang ATC, Ng CSH, Nezami N. Treatment strategies for malignant pulmonary nodule: beyond lobectomy. Point-counterpoint. Curr Opin Pulm Med 2024; 30:35-47. [PMID: 37916619 DOI: 10.1097/mcp.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW Technological advancement in low-dose computed tomography resulted in an increased incidental discovery of early-stage lung cancer and multifocal ground glass opacity. The demand for parenchyma-preserving treatment strategies is greater now than ever. Pulmonary ablative therapy is a groundbreaking technique to offer local ablative treatment in a lung-sparing manner. It has become a promising technique in lung cancer management with its diverse applicability. In this article, we will review the current development of ablative therapy in lung and look into the future of this innovative technique. RECENT FINDINGS Current literature suggests that ablative therapy offers comparable local disease control to other local therapies and stereotactic body radiation therapy (SBRT), with a low risk of complications. In particular, bronchoscopic microwave ablation (BMWA) has considerably fewer pleural-based complications due to the avoidance of pleural puncture. BMWA can be considered in the multidisciplinary treatment pathway as it allows re-ablation and allows SBRT after BMWA. SUMMARY With the benefits which ablative therapy offers and its ability to incorporate into the multidisciplinary management pathway, we foresee ablative therapy, especially BMWA gaining significance in lung cancer treatment. Future directions on developing novel automated navigation platforms and the latest form of ablative energy would further enhance clinical outcomes for our patients.
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Affiliation(s)
- Aliss Tsz Ching Chang
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore
- The Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, University of Maryland, Colleague Park, , Maryland, USA
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Fu MX, Carvalho C, Milan-Chhatrisha B, Gadi N. Stereotactic Body Radiotherapy for Management of Pulmonary Oligometastases in Stage IV Colorectal Cancer: A Perspective. Clin Colorectal Cancer 2023; 22:402-410. [PMID: 37748936 DOI: 10.1016/j.clcc.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 02/05/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
In pulmonary oligometastases from colorectal cancer (POM-CRC), metastasectomy is the primarily recommended treatment. Stereotactic body radiotherapy (SBRT) has been suggested as a viable alternative therapy. SBRT efficacy for POM-CRC is poorly delineated compared to selected non-CRC primaries. This perspective article aims to critically summarize the existing evidence regarding efficacy of SBRT in terms of overall survival (OS) and local control (LC), and factors modulating this, in the treatment of POM-CRC. Overall, reasonable LC and OS rates were observed. The wide range of expansions in planning target volume margins introduced variation in pretreatment protocols. Dose-fractionation schedules varied according to patient and tumor characteristics, though leverage of BED10 in select studies enabled standardization. An association between SBRT dose and improved OS and LC was observed across multiple studies. Prognostic factors that were associated with improved LC included: fewer oligometastases, absence of extra-pulmonary metastases, primary tumor histology, and smaller gross tumor volume. Differences in SBRT modality and techniques over time further confounded results. Many studies included patients receiving additional systemic therapies; preprotocol and adjuvant chemotherapies were identified as prognostic factors for LC. SBRT compared with metastasectomy showed no differences in short-term OS and LC outcomes. In conclusion, SBRT is an efficacious treatment for POM-CRC, in terms of OS and LC. Heterogeneity in study design, particularly pertaining to dose protocols, patient selection, and additional therapies should be controlled for future randomized studies to further validate SBRT efficacy.
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Affiliation(s)
- Michael X Fu
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom.
| | - Catarina Carvalho
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Bella Milan-Chhatrisha
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Nishita Gadi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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16
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Lee BM, Chang JS, Koom WS, Byun HK, Kim HS, Beom SH, Oh C, Suh YJ, Ahn JB, Shin SJ, Park BJ, Park SY. Importance of Local Ablative Therapies for Lung Metastases in Patients With Colorectal Cancer. Ann Surg 2023; 278:e173-e178. [PMID: 35837890 DOI: 10.1097/sla.0000000000005466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effect of local ablative therapy (LAT) on overall survival in patients with lung metastases from colorectal cancer (CRC) compared with patients treated with systemic therapy. SUMMARY BACKGROUND DATA CRC affects approximately 1.4 million individuals worldwide every year. The lungs are commonly affected by CRC, and there is no treatment standard for a secondary lung metastasis from CRC. METHODS This longitudinal, retrospective cohort study (2010-2018) quantified the pulmonary and extrapulmonary tumor burden of 1143 patients by retrospectively reviewing computed tomography images captured at diagnosis. A comprehensive multidisciplinary approach informed how and when surgery and/or stereotactic body radiotherapy was administered. RESULTS Among 1143 patients, 473 patients (41%) received LAT, with surgery first (n = 421) or stereotactic ablative radiation therapy first (n = 52) either at the time of diagnosis (n = 288), within 1 year (n = 132), or after 1 year (n = 53). LAT was repeated in 158 patients (33.4%, 384 total sessions) when new lung metastases were detected. The 5- and 10-year survival rates for patients treated with LAT (71.2% and 64.0%, respectively) were significantly higher than those of patients treated with systemic therapy alone (14.2% and 10.0%, respectively; P <0.001). The overall survival of patients who received LAT intervention increased as the total tumor burden decreased. CONCLUSIONS A high long-term survival rate was achievable in a significant portion of patients with lung metastasis from CRC by the timely administrations of LAT to standard systemic therapy. The tumor burden and LAT feasibility should be included in a discussion during the follow-up period.
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Affiliation(s)
- Byung Min Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Gyeonggi-do, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Han Sang Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hoon Beom
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Caleb Oh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Suh
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joong Bae Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Mayinger M, Kotecha R, Sahgal A, Kim MS, Lo SS, Louie AV, Scorsetti M, Slotman B, Guckenberger M. Stereotactic Body Radiotherapy for Lung Oligo-metastases: Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines. Lung Cancer 2023; 182:107284. [PMID: 37390723 DOI: 10.1016/j.lungcan.2023.107284] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE A systematic review of treatment characteristics, outcomes, and treatment-related toxicities of stereotactic body radiation therapy (SBRT) for pulmonary oligometastases served as the basis for development of this International Stereotactic Radiosurgery Society (ISRS) practice guideline. METHODS In accordance with PRISMA guidelines, a systematic review was performed of retrospective series with ≥50 patients/lung metastases, prospective trials with ≥25 patients/lung metastases, analyses of specific high-risk situations, and all randomized trials published between 2012 and July 2022 in the MEDLINE or Embase database using the key words "lung oligometastases", "lung metastases", "pulmonary metastases", "pulmonary oligometastases", "stereotactic body radiation therapy (SBRT)" and "stereotactic ablative body radiotherapy (SBRT)". Weighted random effects models were used to calculate pooled outcomes estimates. RESULTS Of the 1884 articles screened, 35 analyses (27 retrospective-, 5 prospective, and 3 randomized trials) reporting on treatment of >3600 patients and >4650 metastases were included. The median local control was 90 % (Range: 57-100 %) at 1 year and 79 % (R: 70-96 %) at 5 years. Acute toxicity ≥3 was reported for 0.5 % and late toxicity ≥3 for 1.8 % of patients. A total of 21 practice recommendations covering the areas of staging & patient selection (n = 10), SBRT treatment (n = 10), and follow-up (n = 1) were developed, with agreements rates of 100 %, except for recommendation 13 (83 %). CONCLUSION SBRT represents an effective definitive local treatment modality combining high local control rates with low risk of radiation-induced toxicities.
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Affiliation(s)
- Michael Mayinger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Nowon-gu, Seoul, South Korea
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano 20089, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Ben Slotman
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
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18
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Ho CB, Tsai JT, Chen CY, Shiah HS, Chen HY, Ting LL, Kuo CC, Lai IC, Lai HY, Chung CL, Lee KL, Tzeng HE, Lee KH, Lee HL, Chen SW, Chiou JF. Effectiveness of Stereotactic Ablative Radiotherapy for Systemic Therapy Respondents with Inoperable Pulmonary Oligometastases and Oligoprogression. Diagnostics (Basel) 2023; 13:diagnostics13091597. [PMID: 37174988 PMCID: PMC10177978 DOI: 10.3390/diagnostics13091597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/15/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Stereotactic ablative radiotherapy (SABR) may improve survival in patients with inoperable pulmonary oligometastases. However, the impact of pulmonary oligometastatic status after systemic therapy on SABR outcomes remains unclear. Hence, we investigated the outcomes of SABR in 45 patients with 77 lung tumors and the prognostic value of pulmonary oligoprogression. Eligibility criteria were pulmonary oligometastases (defined as ≤5 metastatic lung tumors), controlled extrapulmonary disease (EPD) after front-line systemic therapy, SABR as primary local treatment for inoperable pulmonary metastases, and consecutive imaging follow-up. Oligometastatic lung tumor was classified into controlled or oligoprogressive status. Overall survival (OS), in-field progression-free survival (IFPFS), out-field progression-free survival (OFPFS), and prognostic variables were evaluated. With 21.8 months median follow-up, the median OS, IFPFS, and OFPFS were 28.3, not reached, and 6.5 months, respectively. Two-year OS, IFPFS, and OFPFS rates were 56.0%, 74.2%, and 17.3%, respectively. Oligoprogressive status (p = 0.003), disease-free interval < 24 months (p = 0.041), and biologically effective dose (BED10) < 100 Gy (p = 0.006) were independently associated with inferior OS. BED10 ≥ 100 Gy (p = 0.029) was independently correlated with longer IFPFS. Oligoprogressive status (p = 0.017) and EPD (p = 0.019) were significantly associated with inferior OFPFS. Grade ≥ 2 radiation pneumonitis occurred in four (8.9%) patients. Conclusively, SABR with BED10 ≥ 100 Gy could provide substantial in-field tumor control and longer OS for systemic therapy respondents with inoperable pulmonary oligometastases. Oligoprogressive lung tumors exhibited a higher risk of out-field treatment failure and shorter OS. Hence, systemic therapy should be tailored for patients with oligoprogression to reduce the risk of out-field treatment failure. However, in the absence of effective systemic therapy, SABR is a reasonable alternative to reduce resistant tumor burden.
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Affiliation(s)
- Chin-Beng Ho
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei 110301, Taiwan
- Department of Radiation Oncology, Camillian Saint Mary's Hospital Luodong, Yilan 265502, Taiwan
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Jo-Ting Tsai
- Department of Radiation Oncology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Chun-You Chen
- Taipei Cancer Center, Taipei Medical University, Taipei 110301, Taiwan
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 116079, Taiwan
| | - Her-Shyong Shiah
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231016, Taiwan
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 110301, Taiwan
| | - Hsuan-Yu Chen
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei 110301, Taiwan
- Institute of Statistical Science, Academia Sinica, Taipei 115201, Taiwan
- Department of Heavy Particles and Radiation Oncology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Lai-Lei Ting
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Chia-Chun Kuo
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei 110301, Taiwan
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei 110301, Taiwan
| | - I-Chun Lai
- Department of Heavy Particles and Radiation Oncology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Hsin-Yi Lai
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei Medical University, Taipei 110301, Taiwan
| | - Chi-Li Chung
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei 110301, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Division of Thoracic Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Kai-Ling Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei 110301, Taiwan
| | - Huey-En Tzeng
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 110301, Taiwan
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Kuen-Haur Lee
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei 110301, Taiwan
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 110301, Taiwan
| | - Hsin-Lun Lee
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei 110301, Taiwan
| | - Shang-Wen Chen
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Department of Radiation Oncology, China Medical University Hospital, Taichung 404327, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Jeng-Fong Chiou
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei 110301, Taiwan
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
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Nezami N, Khorshidi F, Mansur A, Habibollahi P, Camacho JC. Primary and Metastatic Lung Cancer: Rationale, Indications, and Outcomes of Thermal Ablation. Clin Lung Cancer 2023:S1525-7304(23)00055-4. [PMID: 37127487 DOI: 10.1016/j.cllc.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
The widespread use of imaging as well as the efforts conducted through screening campaigns has dramatically increased the early detection rate of lung cancer. Historically, the management of lung cancer has heavily relied on surgery. However, the increased proportion of patients with comorbidities has given significance to less invasive therapeutic options like minimally invasive surgery and image-guided thermal ablation, which could precisely target the tumor without requiring general anesthesia or a thoracotomy. Thermal ablation is considered low-risk for lung tumors smaller than 3 cm that are located in peripheral lung and do not involve major blood vessels or airways. The rationale for ablative therapies relies on the fact that focused delivery of energy induces cell death and pathologic necrosis. Image-guided percutaneous thermal ablation therapies are established techniques in the local treatment of hepatic, renal, bone, thyroid and uterine lesions. In the lung, and specifically in the setting of metastatic disease, the 3 main indications for lung ablation are to serve as (1) curative intent, (2) as a strategy to achieve a chemo-holiday in oligometastatic disease, and (3) in oligoprogressive disease. Following these premises, the current paper aims to review the rationale, indications, and outcomes of thermal ablation as a form of local therapy in the treatment of primary and metastatic lung disease.
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20
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Garcia-Exposito N, Ramos R, Navarro-Perez V, Molina K, Arnaiz MD, Padrones S, Ruffinelli JC, Santos C, Guedea F, Navarro-Martin A. Stereotactic Body Radiotherapy versus Surgery for Lung Metastases from Colorectal Cancer: Single-Institution Results. Cancers (Basel) 2023; 15:cancers15041195. [PMID: 36831537 PMCID: PMC9954242 DOI: 10.3390/cancers15041195] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Surgery and stereotactic body radiotherapy (SBRT) are two of the options available as local treatments for pulmonary oligometastases from colorectal cancer (CRC). We hypothesized that SBRT would have, at least, a similar local control rate to surgery. METHODS We identified an initial cohort of 100 patients with CRC who received SBRT or surgery for lung metastases. This was then narrowed down to 75 patients: those who underwent surgery (n = 50) or SBRT (n = 25) as their first local thoracic treatment between 1 January 2004 and 29 December 2017. The Kaplan-Meier method was used to calculate lung-progression-free survival (L-PFS) and overall survival (OS). RESULTS The 1 and 2-year L-PFS was 85% and 70% in the surgical group and 87% and 71% in the SBRT group, respectively (p = 0.809). No significant differences were found between the two groups in terms of OS. The biologically effective dose (BED), age and initial CRC stage did not have a significant effect on local control or survival. No grade 3 or above acute- or late-toxicity events were reported. CONCLUSIONS These results add retrospective evidence that SBRT and surgery have similar results in terms of OS and local control in patients with lung oligometastases from CRC.
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Affiliation(s)
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDI-BELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Valentin Navarro-Perez
- Clinical Research Unit, Institut Català d’Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Kevin Molina
- Medical Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Maria Dolores Arnaiz
- Radiation Oncology Department, Institut Català d’Oncologia, 08908 Barcelona, Spain
| | - Susana Padrones
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Jose Carlos Ruffinelli
- Medical Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Cristina Santos
- Medical Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d’Oncologia, 08908 Barcelona, Spain
| | - Arturo Navarro-Martin
- Radiation Oncology Department, Institut Català d’Oncologia, 08908 Barcelona, Spain
- Correspondence:
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21
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Stereotactic body radiation therapy for metastatic lung metastases. Jpn J Radiol 2022; 40:995-1005. [PMID: 36097233 PMCID: PMC9529709 DOI: 10.1007/s11604-022-01323-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022]
Abstract
Although systemic therapy is standard management for patients with metastatic disease, several recent reports have indicated that an addition of local therapies including stereotactic body radiation therapy (SBRT) for patients with oligometastatic disease (OMD) could improve survival. The lung is the most common site of distant metastasis from many solid tumors, and the strategy of SBRT, such as dose-fraction schedules, timing, etc., would be different depending on the type of primary tumor, location, and patterns of OMD. This review describes the role of SBRT with curative-intent for patients with pulmonary OMD for each of these variables. First, differences according to the type of primary tumor, for which many studies suggest that SBRT-mediated local control (LC) for patients with pulmonary OMD from colorectal cancer (CRC) is less successful than for those from non-CRC tumors. In addition, higher dose-fraction schedules seemed to correlate with higher LC; hence, different SBRT treatment strategies may be needed for patients with pulmonary OMD from CRC relative to other tumors. Second, differences according to location, where the safety of SBRT for peripheral pulmonary tumors has been relatively well established, but safety for central pulmonary tumors including pulmonary OMD is still considered controversial. To determine the optimal dose-fraction schedules, further data from prospective studies are still needed. Third, differences according to the patterns of OMD, the number of metastases and the timing of SBRT whereby 1–5 lesions in most patients and patients with synchronous or metachronous OMD are considered good candidates for SBRT. We conclude that there are still several problems in defining suitable indications for local therapy including SBRT, and that further prospective studies are required to resolve these issues.
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22
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Predicting the benefit of stereotactic body radiotherapy of colorectal cancer metastases. Clin Transl Radiat Oncol 2022; 36:91-98. [PMID: 35942398 PMCID: PMC9356237 DOI: 10.1016/j.ctro.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
Predicting the benefit from Stereotactic body radiotherapy (SBRT) of colorectal cancer metastases. CLInical Categorical Algorithm (CLICAL©) – a predictive algorithm applied to SBRT. The benefit from SBRT varies among patients with metastatic colorectal cancer. CLICAL© may be used as a screening tool for SBRT referrals. Aim Methods Results Conclusion
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23
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Han Y, Yan X, Zhi W, Liu Y, Xu F, Yan D. Long-term outcome following microwave ablation of lung metastases from colorectal cancer. Front Oncol 2022; 12:943715. [PMID: 35936731 PMCID: PMC9354679 DOI: 10.3389/fonc.2022.943715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/27/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To retrospectively evaluate the safety and efficacy of percutaneous computed tomography (CT)-guided microwave ablation (MWA) in colorectal cancer (CRC) lung metastases, and to analyze prognostic factors. Materials and methods Data were collected from 31 patients with CRC lung metastases from May 2013 to September 2017. They had removed the CRC, no extrapulmonary metastases, no more than three metastases in the lung, the maximum diameter of the lesions was ≤3 cm, and all the lung metastases could be completely ablated. The ablation procedures were performed using a KY-2000 microwave multifunctional therapeutic apparatus. Efficacy is assessed two to four weeks after ablation, and follow-up are performed every three months for two years. The primary outcome was overall survival (OS). The secondary outcomes were progression-free survival (PFS), and complications. Cox regression analysis was used for the evaluation of the statistical significance of factors affecting the end result of MWA therapy. The Kaplan–Meier method was used for estimation of survival rates. Results A total of 45 metastatic lung lesions from CRC in 31 patients were treated with CT-guided MWA procedures. The median OS was 76 months. The one, two, three, and five-year survival rates were 93.5%, 80.6%, 61.3%, and 51.6%, respectively. Multivariate analysis showed that the primary tumor from the rectum (P = 0.009) and liver metastases at the diagnosis of lung metastases (P = 0.043) were risk factors affecting OS, while PFS was a protective factor. The median PFS was 13 months. The maximum diameter of lung metastases lesions (P = 0.004) was a risk factor. The interval between pulmonary metastases and MWA (P=0.031) was the protective factor. Pneumothorax was observed in 13 out of 36 procedures. Four patients developed pneumothorax requiring drainage tube insertion. No patient deaths occurred within 30 days of ablation. Three out of 31 patients (9.67%) were found to have local recurrence of the original lung metastatic ablation foci. Conclusion MWA therapy may be safely and effectively used as a therapeutic tool for the treatment of selected CRC pulmonary metastases, and the prognosis is better in patients without liver metastases at the diagnosis of lung metastases.
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Affiliation(s)
- Yue Han
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yue Han,
| | - Xue Yan
- Department of General Surgery, Cancer Hospital of Huanxing, Beijing, China
| | - Weihua Zhi
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Liu
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Fei Xu
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yan
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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24
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Debbi K, Loganadane G, To NH, Kinj R, Husain ZA, Chapet S, Nguyen NP, Barillot I, Benezery K, Belkacemi Y, Calais G. Curative intent Stereotactic Ablative Radiation Therapy (SABR) for treatment of lung oligometastases from head and neck squamous cell carcinoma (HNSCC): a multi-institutional retrospective study. Br J Radiol 2022; 95:20210033. [PMID: 35143326 PMCID: PMC10993965 DOI: 10.1259/bjr.20210033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The aim of this retrospective study was to assess outcomes of SABR for metachronous isolated lung oligometastases from HNSCC. METHODS For patients who developed isolated, 1 or 2 lungs lesions (<5cm) consistent with metastases from HNSCC, the indication of SABR was validated in a multidisciplinary tumor board. All patients were monitored by CT or PET CT after SABR (Stereotactic Ablative Body Radiation) for HNSCC. RESULTS Between November 2007 and February 2018, 52 patients were treated with SABR for metachronous lung metastases. The median time from the treatment of the primary HNSCC to the development of lung metastases was 18 months (3-93). The cohort's median age was 65.5 years old (50-83). The vast majority (94.2%) received 60 Gy in three fractions. Forty-one patients (78.5%) presented a solitary lung metastasis, while 11 patients (21.5%) had two lung metastases. With a median follow-up of 45.3 months, crude local and metastatic control rates were 74 and 38%, respectively. 1 year and 2 year Overall Survival (OS) were 85.8 and 65.9%, respectively. The median OS was 46.8 months. About one-fourth of patients were retreated by SABR for distant pulmonary recurrence. The treatment was well tolerated with only one patient who reported ≥ grade 3 toxicity (1.9%). CONCLUSION In selected metastatic HNSCC patients, early detection and treatment of lung metastases with SABR is effective and safe. Prospective studies are required to validate this potential shift. ADVANCES IN KNOWLEDGE Patients with oligometastases and controlled primary HNSCC seem to benefit from metastasis directed therapies.
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Affiliation(s)
- Kamel Debbi
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | | | - Nhu Hanh To
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | - Remy Kinj
- Department of Radiation Oncology, Centre
Antoine-Lacassagne, Nice,
France
| | - Zain A Husain
- Department of Radiation Oncology, Odette Cancer Center,
Sunnybrook Health Sciences Centre, Toronto,
Ontario, Canada
| | - Sophie Chapet
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
| | - Nam P Nguyen
- Department of Radiation Oncology, Howard
University, Washington, DC,
USA
| | - Isabelle Barillot
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
| | - Karen Benezery
- Department of Radiation Oncology, Centre
Antoine-Lacassagne, Nice,
France
| | - Yazid Belkacemi
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | - Gilles Calais
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
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Nicosia L, Franceschini D, Perrone-Congedi F, Casamassima F, Gerardi MA, Rigo M, Mazzola R, Perna M, Scotti V, Fodor A, Iurato A, Pasqualetti F, Gadducci G, Chiesa S, Niespolo RM, Bruni A, Alicino G, Frassinelli L, Borghetti P, Di Marzo A, Ravasio A, De Bari B, Sepulcri M, Aiello D, Mortellaro G, Sangalli C, Franceschini M, Montesi G, Aquilanti FM, Lunardi G, Valdagni R, Fazio I, Corti L, Vavassori V, Maranzano E, Magrini SM, Arcangeli S, Valentini V, Paiar F, Ramella S, Di Muzio NG, Livi L, Jereczek-Fossa BA, Osti MF, Scorsetti M, Alongi F. A multicenter LArge retrospectIve daTabase on the personalization of Stereotactic ABlative Radiotherapy use in lung metastases from colon-rectal cancer: the LaIT-SABR study. Radiother Oncol 2021; 166:92-99. [PMID: 34748855 DOI: 10.1016/j.radonc.2021.10.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/14/2021] [Accepted: 10/31/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION stereotactic ablative radiotherapy (SABR) has been shown to increase survival in oligometastatic disease, but local control of colorectal metastases remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate the progression to the polymetastatic disease (PMD). MATERIAL AND METHODS the study involved 23 centers, and was approved by the Ethical Committee (Prot. Negrar 2019-ZT). 1033 lung metastases were reported. Clinical and biological parameters were evaluated as predictive for local progression-free survival (FLP). Secondary end-point was the time to the polymetastatic conversion (tPMC). RESULTS Two-year FLP was 75.4%. Two-year FLP for lesions treated with a BED <100 Gy, 100-124 Gy, and ≥125 Gy was 76.1%, 70.6%, and 94% (p=0.000). Two-year FLP for lesion measuring ≤10 mm, 10-20 mm, and >20 mm was 79.7%, 77.1%, and 66.6% (p=0.027). At the multivariate analysis a BED ≥125 Gy significantly reduced the risk of local progression (HR 0.24, 95%CI 0.11-0.51; p=0.000). Median tPMC was 26.8 months. Lesions treated with BED ≥125 Gy reported a significantly longer tPMC as compared to lower BED. The median tPMC for patients treated to 1, 2-3 or 4-5 simultaneous oligometastases was 28.5, 25.4, and 9.8 months (p=0.035). CONCLUSION The present is the largest series of lung colorectal metastases treated with SABR. The results support the use of SBRT in lung oligometastatic colorectal cancer patients as it might delay the transition to PMD or offer relatively long disease-free period in selected cases. Predictive factors were identified for treatment personalization.
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Affiliation(s)
- L Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center.
| | - D Franceschini
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - F Perrone-Congedi
- Department of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | | | - M A Gerardi
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - M Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center
| | - R Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center
| | - M Perna
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - V Scotti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - A Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Iurato
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - F Pasqualetti
- Radiation Oncology Unit, Pisa University Hospital, Via Roma 67, 56123, Pisa, Italy
| | - G Gadducci
- Radiation Oncology Unit, Pisa University Hospital, Via Roma 67, 56123, Pisa, Italy
| | - S Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - R M Niespolo
- Department of Radiation Oncology, Azienda Ospedaliera S. Gerardo, Monza, Italy
| | - A Bruni
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - G Alicino
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - L Frassinelli
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - P Borghetti
- Radiation Oncology Department, ASST Spedali Civili di Brescia - Brescia University, Brescia, Italy
| | - A Di Marzo
- Radiation Oncology Centre, S. Maria Hospital, Terni, Italy
| | - A Ravasio
- Radiotherapy Unit, Humanitas Gavazzeni, Bergamo
| | - B De Bari
- Radiation Oncology Department, University Hospital of Besançon, Besançon, France; Radiation Oncology Department, Neuchâtel Hospital Network, la Chaux-de-Fonds, Switzerland
| | - M Sepulcri
- Radiation Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - D Aiello
- Radiotherapy Unit, Casa di Cura Macchiarella, Palermo, Italy
| | - G Mortellaro
- Department of Radiation Oncology, ARNAS Ospedale Civico, Palermo, Italy
| | - C Sangalli
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Franceschini
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Montesi
- Radiotherapy Unit ULSS5, Rovigo, Italy
| | - F M Aquilanti
- Radiotherapy Marrelli Hospital, Marrelli Hospital, Crotone, Italy
| | - G Lunardi
- Medical Analysis Laboratory, IRCCS Sacro Cuore Don Calabria Hospital
| | - R Valdagni
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Haematology-Oncology, University of Milan
| | - I Fazio
- Radiotherapy Unit, Casa di Cura Macchiarella, Palermo, Italy
| | - L Corti
- Radiation Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - V Vavassori
- Radiotherapy Unit, Humanitas Gavazzeni, Bergamo
| | - E Maranzano
- Radiation Oncology Centre, S. Maria Hospital, Terni, Italy
| | - S M Magrini
- Radiation Oncology Department, ASST Spedali Civili di Brescia - Brescia University, Brescia, Italy
| | - S Arcangeli
- Department of Radiation Oncology, Azienda Ospedaliera S. Gerardo, Monza, Italy
| | - V Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Paiar
- Radiation Oncology Unit, Pisa University Hospital, Via Roma 67, 56123, Pisa, Italy
| | - S Ramella
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - N G Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - L Livi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - B A Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - M F Osti
- Department of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - M Scorsetti
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy
| | - F Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center; University of Brescia, Brescia, Italy
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Huang X, Cui J, Li X, Liu C, Sun J, Yue J. The decreased platelet-to-lymphocyte ratio could predict a good prognosis in patients with oligometastatic colorectal cancer: a single-center cohort retrospective study. World J Surg Oncol 2021; 19:297. [PMID: 34645481 PMCID: PMC8513170 DOI: 10.1186/s12957-021-02406-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Inflammation markers have an important effect on tumor proliferation, invasion, and metastasis. Oligometastatic disease (OMD) is an intermediate state between widespread metastases and locally confined disease, where curative strategies may be effective for some patients. We aimed to explore the predictive value of inflammatory markers in patients with oligometastatic colorectal cancer (OMCC) and build a nomogram to predict the prognosis of these patients. METHODS Two hundred nine patients with OMCC were retrospectively collected in this study. The Kaplan-Meier survival curves and Cox regression analysis were used to estimate overall survival (OS) and progression-free survival (PFS). A multivariate Cox analysis model was utilized to establish the nomogram. The concordance index (C-index), calibration curve, and receiver operating characteristics (ROC) were established to verify the validity and accuracy of the prediction model. RESULTS According to the multivariate analysis, decreased platelet-to-lymphocyte ratio (PLR) might independently improve OS in patients with OMCC (HR = 2.396, 95% CI 1.391-4.126, P = 0.002). Metastases of extra-regional lymph nodes indicated poor OS (HR = 2.472, 95% CI 1.247-4.903, P = 0.010). While the patients with early N stage had better OS (HR = 4.602, 95% CI 2.055-10.305, P = 0.001) and PFS (HR = 2.100, 95% CI 1.364-3.231, P = 0.007). Primary tumor resection (HR = 0.367, 95% CI 0.148-0.908, P = 0.030) and lower fibrinogen (HR = 2.254, 95% CI 1.246-4.078, P = 0.007) could significantly prolong the OS in patients with OMCC. PLR, metastases of extra-regional lymph nodes, N stage, primary tumor resection, and fibrinogen were used to make up the nomogram. The C-index and area under the curve (AUC) of the ROC in nomogram were 0.721 and 0.772 respectively for OS, showed good consistency between predictive probability of OS and actual survival. CONCLUSIONS Decreased PLR could predict a good prognosis in patients with OMCC. The nomogram including inflammatory factors and clinicopathological markers was credible and accurate to predict survivals in patients with OMCC.
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Affiliation(s)
- Xiaojuan Huang
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Jin Cui
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiaohui Li
- Department of Radiation Oncology, Shandong Cancer Hospital, and Institute, Cheeloo College of Medicine, Shandong University, and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Chao Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jujie Sun
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
| | - Jinbo Yue
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China.
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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Lucia F, Rehn M, Blanc-Béguin F, Le Roux PY. Radiation Therapy Planning of Thoracic Tumors: A Review of Challenges Associated With Lung Toxicities and Potential Perspectives of Gallium-68 Lung PET/CT Imaging. Front Med (Lausanne) 2021; 8:723748. [PMID: 34513884 PMCID: PMC8429617 DOI: 10.3389/fmed.2021.723748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/09/2021] [Indexed: 12/13/2022] Open
Abstract
Despite the introduction of new radiotherapy techniques, such as intensity modulated radiation therapy or stereotactic body radiation therapy, radiation induced lung injury remains a significant treatment related adverse event of thoracic radiation therapy. Functional lung avoidance radiation therapy is an emerging concept in the treatment of lung disease to better preserve lung function and to reduce pulmonary toxicity. While conventional ventilation/perfusion (V/Q) lung scintigraphy is limited by a relatively low spatial and temporal resolution, the recent advent of 68Gallium V/Q lung PET/CT imaging offers a potential to increase the accuracy of lung functional mapping and to better tailor lung radiation therapy plans to the individual's lung function. Lung PET/CT imaging may also improve our understanding of radiation induced lung injury compared to the current anatomical based dose–volume constraints. In this review, recent advances in radiation therapy for the management of primary and secondary lung tumors and in V/Q PET/CT imaging for the assessment of functional lung volumes are reviewed. The new opportunities and challenges arising from the integration of V/Q PET/CT imaging in radiation therapy planning are also discussed.
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Affiliation(s)
- François Lucia
- Radiation Oncology Department, University Hospital, Brest, France
| | - Martin Rehn
- Radiation Oncology Department, University Hospital, Brest, France
| | - Frédérique Blanc-Béguin
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
| | - Pierre-Yves Le Roux
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
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Chen X, Chen H, Poon I, Erler D, Badellino S, Biswas T, Dagan R, Foote M, Louie AV, Ricardi U, Sahgal A, Redmond KJ. Late metastatic presentation is associated with improved survival and delayed wide-spread progression after ablative stereotactic body radiotherapy for oligometastasis. Cancer Med 2021; 10:6189-6198. [PMID: 34432390 PMCID: PMC8446561 DOI: 10.1002/cam4.4133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/25/2022] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is increasingly used to treat oligometastatic disease (OMD), but the effect of metastasis timing on patient outcomes remains uncertain. Methods An international database of patients with OMD treated with SBRT was assembled with rigorous quality assurance. Early versus late metastases were defined as those diagnosed ≤24 versus >24 months from the primary tumor. Overall survival (OS), progression‐free survival (PFS), and incidences of wide‐spread progression (WSP) were estimated using multivariable Cox proportional hazard models stratified by primary tumor types. Results The database consists of 1033 patients with median follow‐up of 24.1 months (0.3–104.7). Late metastatic presentation (N = 427) was associated with improved OS compared to early metastasis (median survival 53.6 vs. 33.0 months, hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.47–0.72, p < 0.0001). Patients with non‐small cell lung cancer (NSCLC, N = 255, HR 0.49, 95% CI: 0.33–0.74, p = 0.0005) and colorectal cancer (N = 235, HR 0.50, 95% CI: 0.30–0.84, p = 0.008) had better OS if presenting with late metastasis. Late metastasis correlated with longer PFS (median 17.1 vs. 9.0 months, HR 0.71, 95% CI: 0.61–0.83, p < 0.0001) and lower 2‐year incidence of WSP (26.1% vs. 43.6%, HR 0.60, 95% CI: 0.49–0.74, p < 0.0001). Fewer WSP were observed in patients with NSCLC (HR 0.52, 95% CI: 0.33–0.83, p = 0.006) and kidney cancer (N = 63, HR 0.37, 95% CI: 0.14–0.97, p = 0.044) with late metastases. Across cancer types, greater SBRT target size was a significant predictor for worse OS. Conclusion Late metastatic presentation is associated with improved survival and delayed progression in patients with OMD treated with SBRT.
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Affiliation(s)
- Xuguang Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Darby Erler
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | | | - Tithi Biswas
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA
| | - Matthew Foote
- Department of Radiation Oncology, University of Queensland, Princess Alexandra Hospital, Queensland, Australia
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | | | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
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Ottaiano A, Petito A, Santorsola M, Gigantino V, Capuozzo M, Fontanella D, Di Franco R, Borzillo V, Buonopane S, Ravo V, Scipilliti E, Totaro G, Serra M, Ametrano G, Penta R, Tatangelo F, Scognamiglio G, Di Mauro A, Di Bonito M, Napolitano M, Scala S, Rea G, Santagata S, Lombardi A, Grimaldi A, Caputo C, Crispo A, Celentano E, De Feo G, Circelli L, Savarese G, Ruggiero R, Perri F, Granata V, Botti G, Caraglia M, Nasti G, Muto P. Prospective Evaluation of Radiotherapy-Induced Immunologic and Genetic Effects in Colorectal Cancer Oligo-Metastatic Patients with Lung-Limited Disease: The PRELUDE-1 Study. Cancers (Basel) 2021; 13:4236. [PMID: 34439390 PMCID: PMC8394588 DOI: 10.3390/cancers13164236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND in recent years, the management of advanced colorectal cancer (CRC) has been greatly improved with integrated strategies including stereotactic radiation therapy (SRT). The administration of SRT has been demonstrated, particularly in oligo-metastatic (om) CRC, to be a safe and effective option. Interestingly, it has been demonstrated that SRT can induce regression of tumors in non-irradiated regions ("abscopal effect") through stimulation of anti-tumor immune effects ("radiation-induced immunity"). We have recently shown that lung-limited omCRC is characterized by regression of tumor clones bearing specific key driver gene mutations. AIMS to assess the genetic evolution on tumor cancer cells induced by SRT in lung-limited omCRC. Secondary objectives included descriptions of the abscopal effect, responses' duration, toxicity, and progression-free survival. A translational research will be performed to evaluate tumor genetic evolution (through liquid biopsies and Next Generation Sequencing), HLA class I repertoire, peripheral immune cells, and cytokine dynamics. METHODS PRELUDE-1 is a prospective translational study. SRT will be administered only to the largest nodule (with a maximum diameter ≤ 25 mm) in omCRC with two or three radiologically evident lesions. The sample size is based on the innovative hypothesis that radiation-induced immunity could induce regression of tumor clones bearing KRAS oncogene mutations. According to the binomial test, considering the frequency of KRAS mutations and assuming a probability of mutant KRAS→wild type KRAS of p0 = 0.0077, with α = 0.05 and 1-β = 0.60, the final sample size is 25 patients.
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Affiliation(s)
- Alessandro Ottaiano
- SSD—Innovative Therapies for Abdominal Metastases Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (M.S.); (G.N.)
| | - Angela Petito
- Radiotherapy Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.P.); (R.D.F.); (V.B.); (S.B.); (V.R.); (E.S.); (G.T.); (M.S.); (G.A.); (P.M.)
| | - Mariachiara Santorsola
- SSD—Innovative Therapies for Abdominal Metastases Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (M.S.); (G.N.)
| | - Valerio Gigantino
- Innovalab Scarl, Molecular Biology, Centro Direzionale, Isola A2, 80143 Naples, Italy; (V.G.); (M.C.); (D.F.)
| | - Maurizio Capuozzo
- Innovalab Scarl, Molecular Biology, Centro Direzionale, Isola A2, 80143 Naples, Italy; (V.G.); (M.C.); (D.F.)
| | - Daniela Fontanella
- Innovalab Scarl, Molecular Biology, Centro Direzionale, Isola A2, 80143 Naples, Italy; (V.G.); (M.C.); (D.F.)
| | - Rossella Di Franco
- Radiotherapy Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.P.); (R.D.F.); (V.B.); (S.B.); (V.R.); (E.S.); (G.T.); (M.S.); (G.A.); (P.M.)
| | - Valentina Borzillo
- Radiotherapy Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.P.); (R.D.F.); (V.B.); (S.B.); (V.R.); (E.S.); (G.T.); (M.S.); (G.A.); (P.M.)
| | - Sergio Buonopane
- Radiotherapy Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.P.); (R.D.F.); (V.B.); (S.B.); (V.R.); (E.S.); (G.T.); (M.S.); (G.A.); (P.M.)
| | - Vincenzo Ravo
- Radiotherapy Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.P.); (R.D.F.); (V.B.); (S.B.); (V.R.); (E.S.); (G.T.); (M.S.); (G.A.); (P.M.)
| | - Esmeralda Scipilliti
- Radiotherapy Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.P.); (R.D.F.); (V.B.); (S.B.); (V.R.); (E.S.); (G.T.); (M.S.); (G.A.); (P.M.)
| | - Giuseppe Totaro
- Radiotherapy Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.P.); (R.D.F.); (V.B.); (S.B.); (V.R.); (E.S.); (G.T.); (M.S.); (G.A.); (P.M.)
| | - Marcello Serra
- Radiotherapy Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.P.); (R.D.F.); (V.B.); (S.B.); (V.R.); (E.S.); (G.T.); (M.S.); (G.A.); (P.M.)
| | - Gianluca Ametrano
- Radiotherapy Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.P.); (R.D.F.); (V.B.); (S.B.); (V.R.); (E.S.); (G.T.); (M.S.); (G.A.); (P.M.)
| | - Roberta Penta
- Oncohaematology Department, A.O.R.N. Santobono-Pausilipon di Napoli, 80123 Naples, Italy;
| | - Fabiana Tatangelo
- Pathology Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (F.T.); (G.S.); (A.D.M.); (M.D.B.)
| | - Giosuè Scognamiglio
- Pathology Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (F.T.); (G.S.); (A.D.M.); (M.D.B.)
| | - Annabella Di Mauro
- Pathology Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (F.T.); (G.S.); (A.D.M.); (M.D.B.)
| | - Maurizio Di Bonito
- Pathology Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (F.T.); (G.S.); (A.D.M.); (M.D.B.)
| | - Maria Napolitano
- Functional Genomics, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (M.N.); (S.S.); (G.R.); (S.S.)
| | - Stefania Scala
- Functional Genomics, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (M.N.); (S.S.); (G.R.); (S.S.)
| | - Giuseppina Rea
- Functional Genomics, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (M.N.); (S.S.); (G.R.); (S.S.)
| | - Sara Santagata
- Functional Genomics, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (M.N.); (S.S.); (G.R.); (S.S.)
| | - Angela Lombardi
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, via de Crecchio 7, 80138 Naples, Italy; (A.L.); (A.G.); (C.C.); (M.C.)
| | - Anna Grimaldi
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, via de Crecchio 7, 80138 Naples, Italy; (A.L.); (A.G.); (C.C.); (M.C.)
| | - Carlo Caputo
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, via de Crecchio 7, 80138 Naples, Italy; (A.L.); (A.G.); (C.C.); (M.C.)
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.C.); (E.C.)
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.C.); (E.C.)
| | - Gianfranco De Feo
- Scientific Directorate, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (G.D.F.); (G.B.)
| | - Luisa Circelli
- AMES, Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (L.C.); (G.S.); (R.R.)
| | - Giovanni Savarese
- AMES, Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (L.C.); (G.S.); (R.R.)
| | - Raffaella Ruggiero
- AMES, Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (L.C.); (G.S.); (R.R.)
| | - Francesco Perri
- Head&Neck Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy;
| | - Vincenza Granata
- Radiology Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy;
| | - Gerardo Botti
- Scientific Directorate, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (G.D.F.); (G.B.)
| | - Michele Caraglia
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, via de Crecchio 7, 80138 Naples, Italy; (A.L.); (A.G.); (C.C.); (M.C.)
| | - Guglielmo Nasti
- SSD—Innovative Therapies for Abdominal Metastases Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (M.S.); (G.N.)
| | - Paolo Muto
- Radiotherapy Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131 Naples, Italy; (A.P.); (R.D.F.); (V.B.); (S.B.); (V.R.); (E.S.); (G.T.); (M.S.); (G.A.); (P.M.)
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De Baère T, Woodrum D, Tselikas L, Abtin F, Littrup P, Deschamps F, Suh R, Aoun HD, Callstrom M. The ECLIPSE Study: Efficacy of cryoablation on metastatic lung tumors with a 5-year follow-up. J Thorac Oncol 2021; 16:1840-1849. [PMID: 34384914 DOI: 10.1016/j.jtho.2021.07.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The ECLIPSE study aimed to assess the feasibility and efficacy of cryoablation for local tumor control in patients with pulmonary metastatic disease over five years of follow-up. METHODS ECLIPSE was a prospective, multicenter, single-arm study which included patients treated with cryoablation if they had 1-5 metastatic lung tumors, each with a diameter of ≤ 3.5 cm. Patients were followed up over the course of five years. The primary endpoint was local tumor control, both per tumor and per patient; secondary endpoints included cancer-specific survival, overall survival (OS), and quality of life. Quality of life was assessed using the Karnofsky Performance Score, the Eastern Cooperative Oncology Group Performance Score, and the Short Form-12 health survey. RESULTS The study included 40 patients across 4 sites (3 US and 1 European). A total of 60 metastatic pulmonary tumors were treated with 48 cryoablation procedures. Overall local tumor control rates were 87.9% (29/33) and 79.2% (19/24) per tumor, and 83.3% (20/24) and 75.0% (15/20) per patient, at 3 and 5 years respectively. A total of 5 treated patients demonstrated local progression throughout the duration of the study. Disease specific survival rate was of 74.8% at 3 years and 55.3% at 5 years while overall survival at 3 and 5 years were of 63.2% and 46.7% respectively. Patient quality of life scores did not reach statistical significance. CONCLUSIONS Cryoablation is an effective means of long-term local tumor control in patients with metastatic pulmonary tumors.
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Affiliation(s)
- Thierry De Baère
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy-Cancer Campus, Villejuif, France;.
| | - David Woodrum
- Department of Radiology, Mayo Clinic and Mayo Medical School, Rochester, Minnesota
| | - Lambros Tselikas
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy-Cancer Campus, Villejuif, France
| | - Fereidoun Abtin
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Peter Littrup
- Department of Radiology, Karmanos Cancer Institute, Detroit, Michigan
| | - Frederic Deschamps
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy-Cancer Campus, Villejuif, France
| | - Robert Suh
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Hussein D Aoun
- Department of Radiology, Karmanos Cancer Institute, Detroit, Michigan
| | - Matthew Callstrom
- Department of Radiology, Mayo Clinic and Mayo Medical School, Rochester, Minnesota
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Virbel G, Le Fèvre C, Noël G, Antoni D. Stereotactic Body Radiotherapy for Patients with Lung Oligometastatic Disease: A Five-Year Systematic Review. Cancers (Basel) 2021; 13:3623. [PMID: 34298836 PMCID: PMC8303507 DOI: 10.3390/cancers13143623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 12/25/2022] Open
Abstract
For several years, oligometastatic disease has represented an intermediate state between localized disease accessible to local treatment and multimetastatic disease requiring systemic therapy. The lung represents one of the most common metastatic locations. Stereotactic body radiation therapy (SBRT) appears to be the treatment of choice for these patients. There are few data defining the place of radiotherapy and reporting outcome after SBRT in lung metastases. This 5-year review aimed to determine areas of SBRT usefulness and methods for the management of pulmonary metastasis in oligometastatic patients. A search for articles on PubMed allowed selection of the most relevant studies. Eighteen articles were selected according to pre-established criteria for this purpose. The analysis concludes that SBRT is an effective and safe treatment in selected patients when the disease remains localized from one to three organs.
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Affiliation(s)
| | | | - Georges Noël
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033 Strasbourg, France; (G.V.); (C.L.F.); (D.A.)
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Response to Is Cryoablation Really Safe and Efficacious: Analyzing Results Within SOLSTICE Trial. J Thorac Oncol 2021; 16:e6-e7. [PMID: 33384060 DOI: 10.1016/j.jtho.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
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Donkor M, Jones HP. The Proposition of the Pulmonary Route as an Attractive Drug Delivery Approach of Nano-Based Immune Therapies and Cancer Vaccines to Treat Lung Tumors. FRONTIERS IN NANOTECHNOLOGY 2021. [DOI: 10.3389/fnano.2021.635194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lung cancer is the leading cause of cancer related deaths globally, making it a major health concern. The lung’s permissive rich microenvironment is ideal for supporting outgrowth of disseminated tumors from pre-existing extra-pulmonary malignancies usually resulting in high mortality. Tumors occurring in the lungs are difficult to treat, necessitating the need for the development of advanced treatment modalities against primary tumors and secondary lung metastasis. In this review, we explore the pulmonary route as an attractive drug delivery approach to treat lung tumors. We also discuss the potential of pulmonary delivery of cancer vaccine vectors to induce mucosal immunity capable of preventing the seeding of tumors in the lung.
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Pellini B, Pejovic N, Feng W, Earland N, Harris PK, Usmani A, Szymanski JJ, Qaium F, Mudd J, Petty M, Jiang Y, Singh A, Maher CA, Henke LE, Park H, Ciorba MA, Kim H, Mutch MG, Pedersen KS, Tan BR, Hawkins WG, Fields RC, Chaudhuri AA. ctDNA MRD Detection and Personalized Oncogenomic Analysis in Oligometastatic Colorectal Cancer From Plasma and Urine. JCO Precis Oncol 2021; 5:PO.20.00276. [PMID: 34250420 PMCID: PMC8232837 DOI: 10.1200/po.20.00276] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/14/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
We hypothesized that circulating tumor DNA (ctDNA) molecular residual disease (MRD) analysis without prior mutational knowledge could be performed after neoadjuvant chemotherapy to assess oligometastatic colorectal cancer (CRC) treated surgically with curative intent. We also investigated urine as an alternative analyte for ctDNA MRD detection in this nongenitourinary setting. PATIENTS AND METHODS We applied AVENIO targeted next-generation sequencing to plasma, tumor, and urine samples acquired on the day of curative-intent surgery from 24 prospectively enrolled patients with oligometastatic CRC. Age-related clonal hematopoiesis was accounted for by removing variants also present in white blood cells. Plasma and urine ctDNA MRD were correlated with tumor cells detected in the surgical specimen, and adjuvant treatment strategies were proposed based on ctDNA-inferred tumor mutational burden (iTMB) and targetable alterations. RESULTS Seventy-one percent of patients were treated with neoadjuvant chemotherapy. Tumor-naive plasma ctDNA analysis detected MRD at a median level of 0.62% with 95% sensitivity and 100% specificity, and 94% and 77% sensitivity when only considering patients treated with neoadjuvant chemotherapy and putative driver mutations, respectively. In urine, ctDNA MRD detection specificity remained high at 100%, but sensitivity decreased to 64% with median levels being 11-fold lower than in plasma (P < .0001). Personalized ctDNA MRD oncogenomic analysis revealed 81% of patients might have been candidates for adjuvant immunotherapy based on high iTMB or targeted therapy based on actionable PIK3CA mutations. CONCLUSION Tumor-naive plasma ctDNA analysis can sensitively and specifically detect MRD in patients with oligometastatic CRC after neoadjuvant chemotherapy. Urine-based ctDNA MRD detection is also feasible; however, it is less sensitive than plasma because of significantly lower levels. Oligometastatic patients with detectable MRD may benefit from additional personalized treatment based on ctDNA-derived oncogenomic profiling.
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Affiliation(s)
- Bruna Pellini
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Nadja Pejovic
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Wenjia Feng
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Noah Earland
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Peter K. Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Abul Usmani
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Jeffrey J. Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Faridi Qaium
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Jacqueline Mudd
- Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Marvin Petty
- Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | | | | | - Christopher A. Maher
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
- Department of Biomedical Engineering, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St Louis, MO
| | - Lauren E. Henke
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Haeseong Park
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Matthew A. Ciorba
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Hyun Kim
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Matthew G. Mutch
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
- Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Katrina S. Pedersen
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Benjamin R. Tan
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - William G. Hawkins
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
- Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Ryan C. Fields
- Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Aadel A. Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Department of Biomedical Engineering, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
- Department of Genetics, Washington University School of Medicine, St Louis, MO
- Department of Computer Science and Engineering, Washington University in St Louis, St Louis, MO
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Ito K, Yamaguchi T, Ogawa H, Nakajima Y, Karasawa K. Stereotactic body radiotherapy for bone metastases in patients with colorectal cancer. Jpn J Clin Oncol 2021; 50:1442-1446. [PMID: 32719860 DOI: 10.1093/jjco/hyaa128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/29/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To clarify the clinical outcomes of stereotactic body radiotherapy for colorectal cancer-derived bone metastases and identify factors predicting treatment failure. METHODS Patients treated with stereotactic body radiotherapy for bone metastases from colorectal cancer between September 2013 and June 2019 were retrospectively reviewed. The prescribed dose for spine and non-spine bone metastases was 24 Gy in two fractions and 35 Gy in five fractions, respectively. The end point was local failure, which was defined as tumour progression on imaging evaluations. In addition, various treatment- and tumour-specific factors were evaluated to determine predictors of local failure. RESULTS This study included 43 lesions in 38 patients, with solitary bone metastases in 18 lesions (42%), re-irradiation stereotactic body radiotherapy in 28 lesions (65%) and postoperative stereotactic body radiotherapy due to spinal cord compression in 10 lesions (23%). The median follow-up after stereotactic body radiotherapy was 12 (range, 2-60) months. The 1-year LF rate was 44%. In the univariate analysis, sacral metastases (P = 0.02) were found to be significantly correlated with LF, and multiple-course systemic therapy before stereotactic body radiotherapy (P= 0.06) and large target volume (P = 0.07) showed a trend towards an association with LF. However, these factors were not independent predictors of LF in the multivariate analysis. CONCLUSION More than 40% of the lesions treated with stereotactic body radiotherapy for bone metastases from colorectal cancer showed LF within 1 year. No poor prognostic factors could be identified statistically. The poor outcomes in all groups indicate that the treatment intensity of the stereotactic body radiotherapy was insufficient to control colorectal cancer bone metastases.
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Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo
| | - Tatsuro Yamaguchi
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiroaki Ogawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo
| | - Yujiro Nakajima
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo
| | - Katsuyuki Karasawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo
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Yamamoto T, Niibe Y, Matsumoto Y, Onishi H, Aoki M, Nishikawa A, Oh RJ, Shintani T, Yahara K, Ozaki M, Manabe Y, Jingu K. Analyses of local control and survival after stereotactic body radiotherapy for pulmonary oligometastases from colorectal adenocarcinoma. JOURNAL OF RADIATION RESEARCH 2020; 61:935-944. [PMID: 32940330 PMCID: PMC7674693 DOI: 10.1093/jrr/rraa071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/30/2020] [Indexed: 06/11/2023]
Abstract
This study is a subset analysis of a retrospective multicenter study performed in Japan and its purpose was to investigate the effectiveness of stereotactic body radiotherapy (SBRT) for pulmonary oligometastases from colorectal cancer. Local control (LC), freedom from further metastases, relapse-free survival and overall survival (OS) after SBRT were retrospectively analyzed. The Kaplan-Meier method was used to estimate lifetime data and the log-rank test was performed as univariate analyses. The Cox proportional hazards model was applied in multivariate analyses. Data for 330 patients with 371 tumors were used for analyses. The median follow-up period was 25.0 months. The 3-year LC, freedom from further metastases, relapse-free survival and OS rates were 64.9, 34.9, 24.9 and 63.4%, respectively. The results of multivariate analyses showed that a higher LC rate was associated with no history of local therapy for oligometastases (P = 0.01), SBRT without concurrent chemotherapy (P < 0.01), type B calculation algorithm (P < 0.01) and higher biological effective radiation doses (≥115 Gy, P = 0.04). A longer OS was associated with no history of local therapy for oligometastases (P = 0.04), a more recent period of SBRT (2010-15, P = 0.02), tumor located in the upper or middle lobe (P < 0.01) and higher biological effective radiation doses (≥115 Gy, P = 0.01). In conclusion, OS after SBRT was good, but LC rate was relatively low. The use of high biological effective radiation doses can improve both LC and OS outcomes.
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Affiliation(s)
- Takaya Yamamoto
- Corresponding author. Department of Radiation Oncology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. Tel: +81-22-717-7312; Fax: +81-22-717-7316;
| | - Yuzuru Niibe
- Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
- Department of Public Health, Kurume University School of Medicine, Kurume, Japan
| | - Yasuo Matsumoto
- Department of Radiation Oncology, Niigata Cancer Center, Niigata, Japan
| | - Hiroshi Onishi
- Department of Radiology, Yamanashi University, Chuo, Japan
| | - Masahiko Aoki
- Department of Radiation Oncology, Hirosaki University, Hirosaki, Japan
| | - Atsushi Nishikawa
- Department of Radiation Oncology, Shikoku Cancer Center, Matsuyama, Japan
| | - Ryoong-Jin Oh
- Department of Radiology, Miyakojima IGRT Clinic, Osaka, Japan
| | - Takashi Shintani
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsuya Yahara
- Department of Radiology, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Masatoki Ozaki
- Department of Radiation Oncology, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | | | - Keiichi Jingu
- Department of Radiation Oncology, Graduate School of Medicine, Tohoku University, Sendai, Japan
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Choi HS, Jeong BK, Kang KM, Jeong H, Song JH, Ha IB, Kwon OY. Tumor Control and Overall Survival after Stereotactic Body Radiotherapy for Pulmonary Oligometastases from Colorectal Cancer: A Meta-Analysis. Cancer Res Treat 2020; 52:1188-1198. [PMID: 32718145 PMCID: PMC7577807 DOI: 10.4143/crt.2020.402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/19/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE In pulmonary oligometastases from colorectal cancer (POM-CRC), the primarily recommended local therapy is metastasectomy. Stereotactic body radiotherapy (SBRT) is another local therapy modality that is considered as an alternative option in patients who cannot undergo surgery. The purpose of this meta-analysis is to demonstrate the effects of SBRT on POM-CRC by integrating the relevant studies. MATERIALS AND METHODS The authors explored MEDLINE, EMBASE, Cochrane Library, Web of Science, and SCOPUS, and selected studies including patients treated with SBRT for POM-CRC and availability of local control (LC) or overall survival (OS) rate. In this meta-analysis, the effect of SBRT was presented in the form of the LC and OS rates for 1, 2, 3, and 5 years after SBRT as pooled estimates, and the frequency of pulmonary toxicity of grade 3 or higher after SBRT (PTG3-SBRT). RESULTS Fourteen full texts among the searched 4,984 studies were the objects of this meta-analysis. The overall number of POM-CRC patients was 495 as per the integration of 14 studies. The pooled estimate LC rate at 1, 2, 3, and 5 years after SBRT was 81.0%, 71.5%, 56.0%, and 61.8%, and the OS rate was 86.9%, 70.1%, 57.9%, and 43.0%, respectively. The LC and OS rates gradually declined until 3 years after SBRT in a similar pattern. Among the 14 studies, only two studies reported PTG3-SBRT as 2.2% and 10.8%, respectively. CONCLUSION For POM-CRC, SBRT is an ablative therapy with a benefit on LC and OS rates and less adverse effects on the lung.
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Affiliation(s)
- Hoon Sik Choi
- Department of Radiation Oncology and Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ki Mun Kang
- Department of Radiation Oncology and Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Hojin Jeong
- Department of Radiation Oncology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Bong Ha
- Department of Radiation Oncology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Oh-Young Kwon
- Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
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Kobayashi N, Abe T, Noda SE, Kumazaki YU, Hirai R, Igari M, Aoshika T, Saito S, Ryuno Y, Kato S. Stereotactic Body Radiotherapy for Pulmonary Oligometastasis from Colorectal Cancer. In Vivo 2020; 34:2991-2996. [PMID: 32871842 DOI: 10.21873/invivo.12130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIM A retrospective study was conducted to evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) for pulmonary oligometastasis from colorectal cancer (CRC). PATIENTS AND METHODS Patients with pulmonary oligometastasis from CRC who were treated with SBRT between April 2010 and October 2018 were enrolled in this study. All patients underwent SBRT using Cyberknife® with a dose of 54-60 Gy in 3 fractions to 99% of the clinical target volume. The treatment efficacy was evaluated by the local control (LC) and overall survival (OS) rates. The toxicity was evaluated using the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.0. RESULTS Twenty-six lesions in 20 patients were treated with SBRT. The median follow-up duration was 19 months (range=6-98 months). Local recurrence occurred in 6 of 26 lesions with a median follow-up of 12 months. The 2-year LC and OS rates were 65.8% and 88.6%, respectively. No patient developed ≥ grade 2 toxicity in the lung and other sites. CONCLUSION Although very high doses were delivered to the tumors with SBRT, the LC of pulmonary metastasis from CRC was not satisfactory when compared to that for stage I primary non-small cell lung cancer reported in the literature.
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Affiliation(s)
- Nao Kobayashi
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan.,Department of Radiation Oncology, Gunma University Hospital, Gunma, Japan
| | - Takanori Abe
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Y U Kumazaki
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
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Taylor M, Abah U, Shah R. A review of interventional treatments for colorectal lung metastases: is it time for a change in practice? Quant Imaging Med Surg 2020; 10:1413-1417. [PMID: 32550147 DOI: 10.21037/qims-2020-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Udo Abah
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
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Nicosia L, Cuccia F, Mazzola R, Ricchetti F, Figlia V, Giaj-Levra N, Rigo M, Tomasini D, Pasinetti N, Corradini S, Ruggieri R, Alongi F. Disease course of lung oligometastatic colorectal cancer treated with stereotactic body radiotherapy. Strahlenther Onkol 2020; 196:813-820. [PMID: 32399637 DOI: 10.1007/s00066-020-01627-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/25/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR) has been shown to increase survival rates in oligometastatic disease (OMD), but local control of colorectal metastases remains poor. We aimed to explore the natural course of oligometastatic colorectal cancer and to investigate how SBRT of lung metastases can delay the progression to polymetastatic disease (PMD). METHODS 107 lung oligometastases in 38 patients were treated with SBRT at a single institution. The median number of treated lesions was 2 (range 1-5). Time to PMD (ttPMD) was defined as the time from SBRT to the occurrence of >5 new metastases. Genetic biomarkers such as EGFR, KRAS, NRAS, BRAF, and microsatellite instability were investigated as predictive factors for response rates. RESULTS Median follow-up was 28 months. At median follow-up, 7 patients were free from disease and 31 had progression: 18 patients had sequential oligometastatic disease (SOMD) and 13 polymetastatic progression. All SOMD cases received a second SBRT course. Median progression-free survival (PFS) was 7 months (range 4-9 months); median ttPMD was 25.8 months (range 12-39 months) with 1‑ and 2‑year PFS rates of 62.5% and 53.4%, respectively. 1‑ and 2‑year local PFS (LPFS) rates were 91.5% and 80%, respectively. At univariate analysis, BRAF wildtype correlated with better LPFS (p = 0.003), SOMD after primary SBRT was associated with longer cancer-specific survival (p = 0.031). Median overall survival (OS) was 39.5 months (range 26-64 months) and 2‑year OS was 71.1%. CONCLUSION The present results support local ablative treatment of lung metastases using SBRT in oligometastatic colorectal cancer patients, as it can delay the transition to PMD. Patients who progressed as SOMD maintained a survival advantage compared to those who developed PMD.
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Affiliation(s)
- Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy.
| | - Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Davide Tomasini
- Radiation Oncology Department, ASST Spedali Civili di Brescia, Brescia University, Brescia, Italy
| | - Nadia Pasinetti
- Department of Radiation Oncology, Ospedale di Esine, ASL Valle Camonica-Sebino Esine, Esine, Italy
| | - Stefanie Corradini
- Radiation Oncology Department, University Hospital, LMU Munich, Munich, Germany
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy.,University of Brescia, Brescia, Italy
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Kalinauskaite GG, Tinhofer II, Kufeld MM, Kluge AA, Grün AA, Budach VV, Senger CC, Stromberger CC. Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases. BMC Cancer 2020; 20:404. [PMID: 32393261 PMCID: PMC7216666 DOI: 10.1186/s12885-020-06892-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 04/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with oligometastatic disease can potentially be cured by using an ablative therapy for all active lesions. Stereotactic body radiotherapy (SBRT) is a non-invasive treatment option that lately proved to be as effective and safe as surgery in treating lung metastases (LM). However, it is not clear which patients benefit most and what are the most suitable fractionation regimens. The aim of this study was to analyze treatment outcomes after single fraction radiosurgery (SFRS) and fractionated SBRT (fSBRT) in patients with lung oligometastases and identify prognostic clinical features for better survival outcomes. METHODS Fifty-two patients with 94 LM treated with SFRS or fSBRT between 2010 and 2016 were analyzed. The characteristics of primary tumor, LM, treatment, toxicity profiles and outcomes were assessed. Kaplan-Meier and Cox regression analyses were used for estimation of local control (LC), overall survival (OS) and progression-free survival. RESULTS Ninety-four LM in 52 patients were treated using SFRS/fSBRT with a median of 2 lesions per patient (range: 1-5). The median planning target volume (PTV)-encompassing dose for SFRS was 24 Gy (range: 17-26) compared to 45 Gy (range: 20-60) in 2-12 fractions with fSBRT. The median follow-up time was 21 months (range: 3-68). LC rates at 1 and 2 years for SFSR vs. fSBRT were 89 and 83% vs. 75 and 59%, respectively (p = 0.026). LM treated with SFSR were significantly smaller (p = 0.001). The 1 and 2-year OS rates for all patients were 84 and 71%, respectively. In univariate analysis treatment with SFRS, an interval of ≥12 months between diagnosis of LM and treatment, non-colorectal cancer histology and BED < 100 Gy were significantly associated with better LC. However, none of these parameters remained significant in the multivariate Cox regression model. OS was significantly better in patients with negative lymph nodes (N0), Karnofsky performance status (KPS) > 70% and time to first metastasis ≥12 months. There was no grade 3 acute or late toxicity. CONCLUSIONS Longer time to first metastasis, good KPS and N0 predicted better OS. Good LC and low toxicity rates were achieved after short SBRT schedules.
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Affiliation(s)
- Goda G. Kalinauskaite
- Department of Radiation Oncology and Radiotherapy, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Ingeborg I. Tinhofer
- Department of Radiation Oncology and Radiotherapy, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- The Translational Radiooncology and Radiobiology Research Laboratory, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus M. Kufeld
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anne A. Kluge
- Department of Radiation Oncology and Radiotherapy, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Arne A. Grün
- Department of Radiation Oncology and Radiotherapy, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Volker V. Budach
- Department of Radiation Oncology and Radiotherapy, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Carolin C. Senger
- Department of Radiation Oncology and Radiotherapy, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Carmen C. Stromberger
- Department of Radiation Oncology and Radiotherapy, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Berkovic P, Gulyban A, Defraene G, Swenen L, Dechambre D, Nguyen PV, Jansen N, Mievis C, Lovinfosse P, Janvary L, Lambrecht M, De Meerleer G. Stereotactic robotic body radiotherapy for patients with oligorecurrent pulmonary metastases. BMC Cancer 2020; 20:402. [PMID: 32384918 PMCID: PMC7206759 DOI: 10.1186/s12885-020-06906-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 04/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Our aim is to report treatment efficacy and toxicity of patients treated by robotic (Cyberknife®) stereotactic body radiotherapy (SBRT) for oligorecurrent lung metastases (ORLM). Additionally we wanted to evaluate influence of tumor, patient and treatment related parameters on local control (LC), lung and distant progression free- (lung PFS/Di-PFS) and overall survival (OS). METHODS Consecutive patients with up to 5 ORLM (confirmed by FDG PET/CT) were included in this study. Intended dose was 60Gy in 3 fractions (prescribed to the 80% isodose volume). Patients were followed at regular intervals and tumor control and toxicity was prospectively scored. Tumor, patient and treatment data were analysed using competing risk- and Cox regression. RESULTS Between May 2010 and March 2016, 104 patients with 132 lesions were irradiated from primary lung carcinoma (47%), gastro-intestinal (34%) and mixed primary histologies (19%). The mean tumor volume was 7.9 cc. After a median follow up of 22 months, the 1, 2 and 3 year LC rate (per lesion) was 89.3, 80.0 and 77.8% respectively. The corresponding (per patient) 1, 2 and 3 years lung PFS were 66.3, 50.0, 42.6%, Di-PFS were 80.5, 64.4, 60.6% and OS rates were 92.2, 80.9 and 72.0% respectively. On univariable analysis, gastro-intestinal (GI) as primary tumor site showed a significant superior local control versus the other primary tumor sites. For OS, significant variables were primary histology and primary tumor site with a superior OS for patients with metastases of primary GI origin. LC was significantly affected by the tumor volume, physical and biologically effective dose coverage. Significant variables in multivariable analysis were BED prescription dose for LC and GI as primary site for OS. The vast majority of patients developed no toxicity or grade 1 acute and late toxicity. Acute and late grade 3 radiation pneumonitis (RP) was observed in 1 and 2 patients respectively. One patient with a centrally located lesion developed grade 4 RP and died due to possible RT-induced pulmonary hemorrhage. CONCLUSIONS SBRT is a highly effective local therapy for oligorecurrent lung metastases and could achieve long term survival in patients with favourable prognostic features.
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Affiliation(s)
- Patrick Berkovic
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Akos Gulyban
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
- Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000 Brussels, Belgium
| | - Gilles Defraene
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Laurie Swenen
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - David Dechambre
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Paul Viet Nguyen
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Nicolas Jansen
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Carole Mievis
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Pierre Lovinfosse
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Levente Janvary
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Maarten Lambrecht
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Franzese C, Comito T, Franceschini D, Loi M, Clerici E, Navarria P, De Rose F, Di Brina L, Mancosu P, Reggiori G, Tomatis S, Scorsetti M. Recursive partitioning model-based analysis for survival of colorectal cancer patients with lung and liver oligometastases treated with stereotactic body radiation therapy. J Cancer Res Clin Oncol 2020; 146:1227-1234. [PMID: 32056005 DOI: 10.1007/s00432-020-03148-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/04/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Liver and lung are common sites of metastases from colorectal cancer (CRC). Stereotactic body radiation therapy (SBRT) represents a valid treatment, with high rates of local control (LC). In this study, we applied recursive partitioning model-based analysis (RPA) to define class risks for overall survival (OS) and progression free survival (PFS) in oligometastatic CRC patients. MATERIALS AND METHODS In this monocentric analysis, we included patients with lung or liver metastases. Patients were candidate to SBRT if a maximum of 5 metastases. End points of the present analysis were LC, PFS, and OS. The binary classification tree approach with RPA was applied to stratify the patients into risk groups based on OS and PFS. RESULTS 218 patients were treated with SBRT on 371 metastases. Majority of patients (56%) was treated on single lesion, followed by 2 (26.1%) and 3 lesions (14.7%). Median follow-up was 22.7 months. Rates of LC were 84.2% at 1 year and 73.8% at 3 years. Rates of PFS at 1 and 3 years were 42.2% and 14.9%, respectively. RPA identified 3 classes for PFS, according to age and number of metastases with 3-year PFS of 30.6%, 13.5% and 8.4%. Overall survival was 87.2% at 1 year, 51.9% at 3 years, and 36.8% at 5 years. RPA identified 3 nodes. Class 1 included patients with liver metastases (3-year OS 35.2%). Class 2 included patients with lung metastases and DFI ≤ 48 months (3-year OS 65%). Class 3 included patients with lung metastases and DFI > 48 months (3-year OS 73.5%). CONCLUSIONS Stereotactic body radiation therapy can be considered an effective treatment for the management of liver and lung metastases from CRC. With RPA, we identified prognostic risk class to define patients who could benefit the most from SBRT.
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Affiliation(s)
- Ciro Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy.
- Department of Biomedical Sciences, Humanitas University, Rozzano, MI, Italy.
| | - Tiziana Comito
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
| | - Mauro Loi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
| | - Fiorenza De Rose
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
| | - Lucia Di Brina
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
| | - Pietro Mancosu
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
| | - Giacomo Reggiori
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
| | - Stefano Tomatis
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, MI, Italy
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Agolli L, Nicosia L. Recent prospective data regarding good survival outcome after radiofrequency ablation of lung metastases from colorectal cancer: the radiation oncologist point of view. Quant Imaging Med Surg 2020; 10:1182-1185. [PMID: 32489944 DOI: 10.21037/qims-2020-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Linda Agolli
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Verona, Italy
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Lau DK, Burge M, Roy A, Chau I, Haller DG, Shapiro JD, Peeters M, Pavlakis N, Karapetis CS, Tebbutt NC, Segelov E, Price TJ. Update on optimal treatment for metastatic colorectal cancer from the AGITG expert meeting: ESMO congress 2019. Expert Rev Anticancer Ther 2020; 20:251-270. [PMID: 32186929 DOI: 10.1080/14737140.2020.1744439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Outcomes in metastatic colorectal cancer are improving, due to the tailoring of therapy enabled by better understanding of clinical behavior according to molecular subtype.Areas covered: A review of the literature and recent conference presentations was undertaken on the topic of systemic treatment of metastatic colorectal cancer. This review summarizes expert discussion of the current evidence for therapies in metastatic colorectal cancer (mCRC) based on molecular subgrouping.Expert opinion: EGFR-targeted and VEGF-targeted antibodies are now routinely incorporated into treatment strategies for mCRC. EGFR-targeted antibodies are restricted to patients with extended RAS wild-type profiles, with evidence that they should be further restricted to patients with left-sided tumors. Clinically distinct treatment pathways based on tumor RAS, BRAF, HER2 and MMR status, are now clinically applicable. Evidence suggests therapy for additional subgroups will soon be defined; the most advanced being for patients with KRAS G12 C mutation and gene TRK fusion defects.
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Affiliation(s)
- David K Lau
- GI and Lymphoma Unit, Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Matthew Burge
- Medical Oncology, Royal Brisbane Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Amitesh Roy
- Medical Oncology, Flinders Centre for Innovation in Cancer, Bedford Park, Australia
| | - Ian Chau
- GI and Lymphoma Unit, Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Daniel G Haller
- Abramson Cancer Center at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy D Shapiro
- Monash University, Melbourne, Australia.,Medical Oncology, Cabrini Medical Centre, Melbourne, Australia
| | - Marc Peeters
- Medical Oncology, University Hospital Antwerp, Edegem, Belgium
| | - Nick Pavlakis
- Medical Oncology, Royal North Shore Hospital, St Leonards, Australia.,Sydney University, Camperdown, Sydney, Australia
| | | | - Niall C Tebbutt
- Medical Oncology, Austin Health, Heidelberg, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Eva Segelov
- Monash University, Melbourne, Australia.,Medical Oncology, Monash Medical Centre, Clayton, Australia
| | - Timothy J Price
- Medical Oncology, The Queen Elizabeth Hospital, Woodville, Australia
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Jethwa KR, Jang S, Mullikin TC, Harmsen WS, Petersen MM, Olivier KR, Park SS, Neben-Wittich MA, Hubbard JM, Sandhyavenu H, Whitaker TJ, Waltman LA, Kipp BR, Merrell KW, Haddock MG, Hallemeier CL. Association of tumor genomic factors and efficacy for metastasis-directed stereotactic body radiotherapy for oligometastatic colorectal cancer. Radiother Oncol 2020; 146:29-36. [PMID: 32114263 DOI: 10.1016/j.radonc.2020.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report tumor genomic factors associated with overall survival (OS) and local failure (LF) for patients with colorectal cancer (CRC) who received metastasis-directed stereotactic body radiation therapy (SBRT). MATERIALS/METHODS This was a retrospective review of patients with CRC who received metastasis-directed SBRT. Tumor genomic alterations were identified through KRAS, BRAF, or a 50-gene next generation sequencing panel. OS and LF were estimated using Kaplan-Meier and competing-risk methods. RESULTS Eighty-five patients and 109 lesions were treated between 2008 and 2018. The median patient follow-up was 50 months (IQR: 28-107). The median and 5-year OS was 34 months and 26% (95% CI: 16-41%), respectively. The 2-year cumulative incidence of LF was 30% (95% CI: 23-41%). Univariate associates with OS included patient age ≥60 years, bone metastasis, increasing tumor size, KRAS mutation, and combined KRAS and TP53 mutation, while increasing tumor size, bone metastasis, biologically effective dose <100 Gy, and combined KRAS and TP53 mutation were associated with LF. Multivariate associates with OS included patient age ≥60 years (HR: 2.4, 95% CI: 1.2-4.8, p = 0.01), lesion size per 1 cm (HR: 1.3, 95% CI: 1.1-1.5, p < 0.01), and KRAS mutation (HR: 2.2, 95% CI: 1.2-4.3, p < 0.01), while no multivariable model for LF retained more than a single variable. CONCLUSION Genomic factors, in particular KRAS and TP53 mutation, may assist in patient selection and radiotherapeutic decision-making for patients with oligometastatic CRC. Prospective validation, ideally with genomic correlation of all irradiated metastases, is warranted.
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Affiliation(s)
- Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, United States
| | - Samuel Jang
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - Trey C Mullikin
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - William S Harmsen
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, United States
| | - Molly M Petersen
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, United States
| | - Kenneth R Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | | | - Joleen M Hubbard
- Division of Medical Oncology, Mayo Clinic, Rochester, United States
| | | | - Thomas J Whitaker
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - Lindsey A Waltman
- Department of Laboratory Medicine and pathology, Mayo Clinic, Rochester, United States
| | - Benjamin R Kipp
- Department of Laboratory Medicine and pathology, Mayo Clinic, Rochester, United States
| | - Kenneth W Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - Michael G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
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Hasegawa T, Takaki H, Kodama H, Yamanaka T, Nakatsuka A, Sato Y, Takao M, Katayama Y, Fukai I, Kato T, Tokui T, Tempaku H, Adachi K, Matsushima Y, Inaba Y, Yamakado K. Three-year Survival Rate after Radiofrequency Ablation for Surgically Resectable Colorectal Lung Metastases: A Prospective Multicenter Study. Radiology 2020; 294:686-695. [PMID: 31934829 DOI: 10.1148/radiol.2020191272] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Although radiofrequency ablation (RFA) is widely performed for the treatment of colorectal cancer (CRC) lung metastases, its efficacy for candidates with surgically resectable disease is unclear. Purpose To evaluate the prognosis after RFA in participants with resectable CRC lung metastases. Materials and Methods For this prospective multicenter study (ClinicalTrials.gov identifier: NCT00776399), participants with five or fewer surgically resectable lung metastases measuring 3 cm or less were included. Participants with CRC and a total of 100 lung metastases measuring 0.4-2.8 cm (mean, 1.0 cm ± 0.5) were chosen and treated with 88 sessions of RFA from January 2008 to April 2014. The primary end point was the 3-year overall survival (OS) rate, with an expected rate of 55%. The local tumor progression rate and safety were evaluated as secondary end points. The OS rates were generated by using the Kaplan-Meier method. Log-rank tests and Cox proportional regression models were used to identify the prognostic factors by means of univariable and multivariable analyses. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events, version 3.0. Results Seventy participants with CRC (mean age, 66 years ± 10; 49 men) were evaluated. The 3-year OS rate was 84% (59 of 70 participants; 95% confidence interval [CI]: 76%, 93%). In multivariable analysis, factors associated with worse OS included rectal rather than colon location (hazard ratio [HR] = 7.7; 95% CI: 2.6, 22.6; P < .001), positive carcinoembryonic antigen (HR = 5.8; 95% CI: 2.0, 16.9; P = .001), and absence of previous chemotherapy (HR = 9.8; 95% CI: 2.5, 38.0; P < .001). Local tumor progression was found in six of the 70 participants (9%). A grade 5 adverse event was seen in one of the 88 RFA sessions (1%), and grade 2 adverse events were seen in 18 (20%). Conclusion Lung radiofrequency ablation provided a favorable 3-year overall survival rate of 84% for resectable colorectal lung metastases measuring 3 cm or smaller. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Gemmete in this issue.
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Affiliation(s)
- Takaaki Hasegawa
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Haruyuki Takaki
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Hiroshi Kodama
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Takashi Yamanaka
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Atsuhiro Nakatsuka
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yozo Sato
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Motoshi Takao
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yoshihiko Katayama
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Ichiro Fukai
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Toshio Kato
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Toshiya Tokui
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Hironori Tempaku
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Katsutoshi Adachi
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yasushi Matsushima
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yoshitaka Inaba
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Koichiro Yamakado
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
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48
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Cao C, Wang D, Tian DH, Wilson-Smith A, Huang J, Rimner A. A systematic review and meta-analysis of stereotactic body radiation therapy for colorectal pulmonary metastases. J Thorac Dis 2019; 11:5187-5198. [PMID: 32030236 DOI: 10.21037/jtd.2019.12.12] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background There is growing evidence to support the hypothesis that radical treatment of pulmonary oligometastatic disease with stereotactic body radiation therapy (SBRT) can improve oncological outcomes. However, some reports suggest colorectal cancer (CRC) pulmonary metastases are associated with radioresistance. The present systematic review aimed to assess the local control (LC), overall survival (OS), and progression-free survival (PFS) of patients with CRC pulmonary metastases treated by SBRT. Secondary outcomes included assessment of peri-procedural complications and identification of prognostic factors on LC. Methods Electronic databases were systematically searched from their dates of inception using predefined criteria. Summative statistical analysis was performed for patients with CRC pulmonary metastases, and comparative meta-analysis was performed for patients with CRC versus non-CRC pulmonary metastases. Results Using predefined criteria, 18 relevant studies were identified from the existing literature. LC for CRC pulmonary metastases treated by SBRT at 1-, 2-, and 3-year were estimated to be 81%, 66%, and 60%, respectively. OS and PFS at 3-year were 52% and 13%, respectively. Patients with CRC pulmonary metastases were associated with significantly lower LC compared to non-CRC pulmonary metastases [HR, 2.93; 95% confidence interval (CI), 1.93-4.45; P<0.00001], but higher OS (HR, 0.61; 95% CI, 0.45-0.82; P=0.001). There were no reported periprocedural mortalities and low incidences of periprocedural morbidities. Conclusions These findings may have implications for patient and treatment selection, dose fractionation, and support the hypothesis that CRC pulmonary metastases may require higher biological effective doses while respecting normal tissue constraints when treated with SBRT.
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Affiliation(s)
- Christopher Cao
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Chris O'Brien Lifehouse Hospital, Sydney, Australia
| | - Daniel Wang
- Department of Medicine, Cornell University, New York, USA
| | - David H Tian
- Collaborative Research Group, Macquarie University, Sydney, Australia.,Department of Anaesthesia, Westmead Hospital, Sydney, Australia
| | | | - James Huang
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
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49
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Long term results of single high dose Stereotactic Body Radiotherapy in the treatment of primary lung tumors. Sci Rep 2019; 9:15498. [PMID: 31664125 PMCID: PMC6820864 DOI: 10.1038/s41598-019-51900-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/24/2019] [Indexed: 12/19/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is a standard treatment for inoperable early-stage NSCLC, with local control rates comparable to surgical series. Promising results have been achieved utilizing a high single-dose schedule. The aim of our study was to evaluate long-term local control and toxicity in a series of patients treated with SBRT delivered in a single dose of 30 Gy. 44 patients affected by early stage NSCLC were treated with SBRT delivered in a single dose of 30 Gy. Survival and prognostic factors were retrospectively evaluated. Median follow-up was 34 months (range 3-81). Three- and 5-year local progression-free survival (LPFS) were 87.8% and 87.8% respectively (median 30 months; range 6-81 months), 3- and 5-year OS and CSS were 64.9% and 36.9%, 80.9% and 65.5%, respectively. Two (4.6%) cases of grade 3 pneumonitis occurred. At the univariate analysis lesion diameter ≤ 25 mm was predictive of better 5-year LPFS (95.8% versus 56.3%; p = 0.003) and 5-year PFS (69.8% versus 27.8%; p = 0.002). The results of our study indicated a high local control, survival and tolerability after a long-term follow-up with the use of SBRT 30 Gy single dose. Further prospective studies could better define the role of this regimen.
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50
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Kim L, Markovina S, Van Nest SJ, Eisaman S, Santanam L, Sullivan JM, Dominello M, Joiner MC, Burmeister J. Three discipline collaborative radiation therapy (3DCRT) special debate: Equipment development is stifling innovation in radiation oncology. J Appl Clin Med Phys 2019; 20:6-11. [PMID: 31127693 PMCID: PMC6753737 DOI: 10.1002/acm2.12620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Leonard Kim
- Department of Radiation OncologyMD Anderson Cancer Center at CooperCamdenNJUSA
| | | | | | - Subarna Eisaman
- Department of Radiation OncologyUniversity of PittsburghPittsburghPAUSA
| | - Lakshmi Santanam
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Julie M. Sullivan
- Center for Devices and Radiological HealthU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Michael Dominello
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
| | - Michael C. Joiner
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
| | - Jay Burmeister
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
- Gershenson Radiation Oncology CenterBarbara Ann Karmanos Cancer InstituteDetroitMIUSA
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