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Prognostic factors in stereotactic body radiotherapy of lung metastases

Prognostische Faktoren bei der stereotaktischen Strahlentherapie von Lungenmetastasen

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Abstract

Purpose

The aim of this study was to evaluate prognostic factors in patients with lung metastases who undergo lung stereotactic body radiotherapy (SBRT).

Materials and methods

A total of 87 patients with 129 lung metastases who underwent SBRT between November 2004 and May 2012 were enrolled in this retrospective study. The patient collective consisted of 54 men (62.1%) and 33 women (37.9%); the median age was 65 years (range 36–88). The Karnofsky performance index was ≥70% (median 90%) for all cases, but one (60%). Adverse effects were categorized using the CTCAE 4.0 classification system. Retrospective analyses regarding patients’ characteristics, progression-free survival (PFS), overall survival (OS), disease-specific survival (DSS), and local tumor control rates (LTC) were performed.

Results

On univariate and multivariate analysis OS, DSS, and PFS were significantly (p < 0.05) better for patients with ≤3 lung metastases; no extrathoracic metastases at the time of the SBRT; a gross tumor volume (GTV) <7.7 cm3 and patients that received a staging that included positron emission tomography with fluorine 18 fluorodeoxyglucose/computed tomography (FDG-PET/CT) imaging. Furthermore, a longer OS was observed if newly diagnosed metastases during follow-up were limited to the lung (median survival: 43.7 months versus 21.7 months; p = 0.023).

Conclusion

The number and pattern of metastases, and the size of the target volume are strong predictors for the outcome of patients receiving SBRT of lung tumors. FDG-PET/CT should be part of pretherapeutic staging before SBRT.

Zusammenfassung

Hintergrund

Ziel dieser Studie war es, prognostische Faktoren bei Patienten mit Lungenmetastasen zu evaluieren, die mit einer stereotaktischen Strahlentherapie (SBRT) behandelt wurden.

Material und Methoden

In dieser retrospektiven Studie wurden 87 Patienten mit insgesamt 129 Lungenmetastasen, die zwischen November 2004 und Mai 2012 in unserem Institut mit einer SBRT behandelt wurden, untersucht. Das Patientenkollektiv setzte sich aus 54 Männern (62,1%) und 33 Frauen (37,9%) zusammen; das mediane Alter betrug 65 Jahre (Spanne 36–88 Jahre). Mit einer Ausnahme (60%) war der Karnofsky-Index ≥70% (median 90%). Die Nebenwirkungen wurden entsprechend CTCAE V. 4.0. klassifiziert. Das progressionsfreie Überleben (PFÜ), das Gesamtüberleben (GÜ), das krankheitsspezifische Überleben (KSÜ) und die lokale Tumorkontrolle (LTK) wurden unter Berücksichtigung prognostischer Einflussfaktoren analysiert.

Ergebnisse

Patienten mit maximal 3 Lungenmetastasen ohne extrathorakale Metastasierung mit einem Gesamttumorvolumen (GTV) <7,7 cm3 und Patienten, die ein Staging mittels FDG-PET (18 Fluordesoxyglukose-Positronenemissionstomographie) vor Beginn der Behandlung erhalten hatten, zeigten ein signifikant längeres GÜ, PFÜ und KSÜ. Des Weiteren wurde für Patienten, bei denen neue Metastasen während des Follow-ups auf die Lunge begrenzt waren, ein längeres GÜ verzeichnet (median: 43,7 Monate vs. 21,7 Monate; p = 0,023)

Schlussfolgerung

Die Anzahl der Metastasen, das Metastasierungsmuster und die Größe des Zielvolumens sind wesentliche Prädiktoren hinsichtlich der Prognose bei der SBRT von Lungentumoren. Ein FDG-PET ist ein wichtiger Bestandteil des prätherapeutischen Stagings vor SBRT.

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Authors and Affiliations

  1. Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Straße 22, 81675, München, Germany

    K. J. Borm, M. Oechsner PhD, K. Schiller, J. C. Peeken, H. Dapper, S. Münch, S. E. Combs & M. N. Duma

  2. Fakultät für Medizin, Technische Universität München, München, Germany

    L. Kroll

  3. Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany

    S. E. Combs & M. N. Duma

  4. Deutsches Konsortium für Translationale Krebsforschung (DKTK) – Partner Site Munich, 81675, Munich, Germany

    S. E. Combs

Authors
  1. K. J. Borm
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  2. M. Oechsner PhD
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  3. K. Schiller
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  4. J. C. Peeken
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  5. H. Dapper
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  6. S. Münch
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  7. L. Kroll
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  9. M. N. Duma
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Corresponding author

Correspondence to M. N. Duma.

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Conflict of interest

K.J. Borm, M. Oechsner, K. Schiller, J.C. Peeken, H. Dapper, S. Münch, L. Kroll, S.E. Combs and M.N. Duma declare that they have no competing interests.

Ethical standards

The ethics committee of the Technical University Munich approved this retrospective study (84/16S). All patients gave their informed consent both informed and written before starting the radiotherapy that they will undergo CT radiotherapy treatment planning. Data from the CT radiotherapy treatment planning were retrospectively analyzed.

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Borm, K.J., Oechsner, M., Schiller, K. et al. Prognostic factors in stereotactic body radiotherapy of lung metastases. Strahlenther Onkol 194, 886–893 (2018). https://doi.org/10.1007/s00066-018-1335-x

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  • DOI: https://doi.org/10.1007/s00066-018-1335-x

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