Stereotactic ablative radiation therapy for pulmonary metastases: Improving overall survival and identifying subgroups at high risk of local failure.

Humans Lung Neoplasms / radiotherapy Proportional Hazards Models Radiosurgery / adverse effects Retrospective Studies Sarcoma
Intrathoracic control Nomogram Oligometastasis Pulmonary oligometastases Stereotactic body radiotherapy

Journal

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
ISSN: 1879-0887
Titre abrégé: Radiother Oncol
Pays: Ireland
ID NLM: 8407192

Informations de publication

Date de publication:
04 2020
Historique:
received: 02 08 2019
revised: 10 12 2019
accepted: 09 01 2020
pubmed: 12 2 2020
medline: 15 4 2021
entrez: 12 2 2020
Statut: ppublish

Résumé

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. 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. 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). 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.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.radonc.2020.01.010 PMID: 32044530
pubmed: 32044530
pii: S0167-8140(20)30022-0
doi: 10.1016/j.radonc.2020.01.010
pii:
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

178-185

Informations de copyright

Copyright © 2020 Elsevier B.V. All rights reserved.

Auteurs

Dario Pasalic (D)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Yi Lu (Y)

Department of Radiation Oncology, Ningbo Medical Center, Lihuili Eastern Hospital, Ningbo, China.

Sonia L Betancourt-Cuellar (SL)

Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Nicolette Taku (N)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Shane M Mesko (SM)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Alexander F Bagley (AF)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

William W Chance (WW)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Pamela K Allen (PK)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Chad Tang (C)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Mara B Antonoff (MB)

Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.

Peter A Balter (PA)

Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA.

Reza J Mehran (RJ)

Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.

James W Welsh (JW)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Zhongxing Liao (Z)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Daniel Gomez (D)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Jeremy J Erasmus (JJ)

Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, USA.

Quynh-Nhu Nguyen (QN)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: qnnguyen@mdanderson.org.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Stereotactic ablative radiation therapy for...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Tumeurs de l'appareil respiratoire › Tumeurs du poumon › Stereotactic ablative radiation therapy for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de survie › Modèles des risques proportionnels › Stereotactic ablative radiation therapy for...
questionsmedicales.fr › Techniques d'investigation › Techniques stéréotaxiques › Radiochirurgie › Stereotactic ablative radiation therapy for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Stereotactic ablative radiation therapy for...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs du tissu conjonctif et des tissus mous › Sarcomes › Stereotactic ablative radiation therapy for...