TY - JOUR
T1 - Stereotactic ablative radiation therapy for pulmonary metastases
T2 - Improving overall survival and identifying subgroups at high risk of local failure
AU - Pasalic, Dario
AU - Lu, Yi
AU - Betancourt-Cuellar, Sonia L.
AU - Taku, Nicolette
AU - Mesko, Shane M.
AU - Bagley, Alexander F.
AU - Chance, William W.
AU - Allen, Pamela K.
AU - Tang, Chad
AU - Antonoff, Mara B.
AU - Balter, Peter A.
AU - Mehran, Reza J.
AU - Welsh, James W.
AU - Liao, Zhongxing
AU - Gomez, Daniel
AU - Erasmus, Jeremy J.
AU - Nguyen, Quynh Nhu
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/4
Y1 - 2020/4
N2 - Background & purpose: Stereotactic ablative radiation therapy (SABR) is an emerging treatment option for patients with pulmonary metastases; identifying patients who would benefit from SABR can improve outcomes. Materials & methods: We retrospectively analyzed local failure (LF), distant failure (DF), overall survival (OS), and toxicity in 317 patients with 406 pulmonary metastases treated with SABR in January 2006–September 2017 at a tertiary cancer center. Results: Median follow-up time was 23 months. Primary adrenal, colorectal, sarcoma, or pancreatic (“less responsive”) tumors led to high rates of LF. LF rates for patients with less responsive vs. responsive tumors were 4.6% vs. 1.6% at 12 months and 12.8% vs. 3.9% at 24 months (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.11–0.73; Log-Rank P = 0.0087). A nomogram for 24-month local control was created using Cox multivariate factors (surgical history, planning target volume, primary disease site, lung lobe location). Treating patients with ≤3 pulmonary metastases vs. >3 pulmonary metastases was associated with improved 24-month (74.2% vs. 59.3%) and 48-month (47.7% vs. 35.1%) OS (HR 0.66, 95% CI 0.47–0.95; Log-Rank P = 0.043), and reduced 12-month (22.5% vs. 50.8%) and 24-month (31.8% vs. 61.4%) intrathoracic DF (HR 0.53, 95% CI 0.38–0.74; Log-Rank P < 0.0001). The most common toxicity was asymptomatic pneumonitis (14.8%). Six patients had grade 3 events (5 pneumonitis, 1 brachial plexus). Conclusions: SABR for pulmonary metastases was effective and well tolerated. Irradiating limited intrathoracic sites of disease led to improved OS and intrathoracic DM. Higher SABR doses or surgery could be considered for less radio-responsive primary tumors.
AB - Background & purpose: Stereotactic ablative radiation therapy (SABR) is an emerging treatment option for patients with pulmonary metastases; identifying patients who would benefit from SABR can improve outcomes. Materials & methods: We retrospectively analyzed local failure (LF), distant failure (DF), overall survival (OS), and toxicity in 317 patients with 406 pulmonary metastases treated with SABR in January 2006–September 2017 at a tertiary cancer center. Results: Median follow-up time was 23 months. Primary adrenal, colorectal, sarcoma, or pancreatic (“less responsive”) tumors led to high rates of LF. LF rates for patients with less responsive vs. responsive tumors were 4.6% vs. 1.6% at 12 months and 12.8% vs. 3.9% at 24 months (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.11–0.73; Log-Rank P = 0.0087). A nomogram for 24-month local control was created using Cox multivariate factors (surgical history, planning target volume, primary disease site, lung lobe location). Treating patients with ≤3 pulmonary metastases vs. >3 pulmonary metastases was associated with improved 24-month (74.2% vs. 59.3%) and 48-month (47.7% vs. 35.1%) OS (HR 0.66, 95% CI 0.47–0.95; Log-Rank P = 0.043), and reduced 12-month (22.5% vs. 50.8%) and 24-month (31.8% vs. 61.4%) intrathoracic DF (HR 0.53, 95% CI 0.38–0.74; Log-Rank P < 0.0001). The most common toxicity was asymptomatic pneumonitis (14.8%). Six patients had grade 3 events (5 pneumonitis, 1 brachial plexus). Conclusions: SABR for pulmonary metastases was effective and well tolerated. Irradiating limited intrathoracic sites of disease led to improved OS and intrathoracic DM. Higher SABR doses or surgery could be considered for less radio-responsive primary tumors.
KW - Intrathoracic control
KW - Nomogram
KW - Oligometastasis
KW - Pulmonary oligometastases
KW - Stereotactic body radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=85078975115&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85078975115&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2020.01.010
DO - 10.1016/j.radonc.2020.01.010
M3 - Article
C2 - 32044530
AN - SCOPUS:85078975115
SN - 0167-8140
VL - 145
SP - 178
EP - 185
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -