Stereotactic Body Radiotherapy for Lung Oligo-metastases: Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines.

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. 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. 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 %). SBRT represents an effective definitive local treatment modality combining high local control rates with low risk of radiation-induced toxicities.

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest Rupesh Kotecha: Honoraria from consulting for Accuray Inc., Elekta AB, ViewRay Inc., Novocure Inc., Elsevier Inc., and Brainlab and institutional research funding from Medtronic Inc., Blue Earth Diagnostics Ltd., Novocure Inc., GT Medical Technologies, AstraZeneca, Exelixis, ViewRay Inc., and Brainlab. Arjun Sahgal: Grants or contracts from ELEKTA AB and VARIAN, consulting fees from ELEKTA, ASTRA ZENECA, SEAGeN INC.; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from ASTRA ZENECA, ELEKTA AB, VARAIAN, BRAINLAB, SEAGEN INC.; support for attending meetings and/or travel by ELEKTA, VARIAN, BRAINLAB; Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: Vice President of International Stereotactic Radiosurgery Society (ISRS); Other financial or non-financial interests: Co-Chair of the AO Spine Knowledge Forum Tumour, Member to the Elekta MRLinac Research. Simon S. Lo: Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: (1) Radiosurgery Society: Medical Director of Distinction in Practice in Stereotactic Radiotherapy Accreditation Program and Member of Board of Directors. (2) American College of Radiology:Alternate Councilor (on behalf of American Radium Society) and Chair of the Nominating Committee of CARROS (Radiation Oncology Chapter). Alexander V. Louie: received honoraria from AstraZeneca for advisory board and speaker’s fees. The remianing authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.