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Stereotactic body radiotherapy for pulmonary oligometastases: a monoinstitutional analysis of clinical outcomes and potential prognostic factors

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Abstract

Purpose

We report the retrospective data of a cohort of patients who received stereotactic body radiotherapy for pulmonary oligometastases, aiming to assess the clinical factors potentially affecting clinical outcomes.

Methods

The present series reports the outcomes of a cohort of 71 patients with pulmonary oligometastases with no extrapulmonary disease. All patients were treated with stereotactic body radiotherapy (SBRT) performed with volumetric modulated arc therapy-image guided radiotherapy (VMAT-IGRT) to up to five secondary lesions. Survival estimates were performed using the Kaplan–Meier method.

Results

A total of 98 lesions in 71 patients were treated from February 2014 to August 2020. The most frequent histologies were colorectal in 37.7%, lung cancer in 44.8%, head and neck cancer in 8.1%, and other in 9.4%. Median age was 71 years (range 32–93 years). Concurrent systemic therapy was administered in 32.3%. SBRT was delivered to a median total dose of 60 Gy (range 55–70 Gy) in 3–10 fractions for a median BED10 = 105 Gy (range 96–180 Gy). Median follow-up was 29.5 months (range 6–81), with no acute or late G > 2 adverse event. Our LC rates at 2 and 4 years were 92.4 and 89.8%, respectively. DPFS rates at 2 and 4 years were 45.3 and 27.2%, respectively. A second SBRT course was proposed in 21 patients (29.5%) who developed an oligoprogression, resulting in median time to second progression of 9 months (range 2–44) and 2‑year PFS2 rate of 42.4%. At univariate analysis, patients with sequential oligometastases reported better OS rates (p = 0.002), which was also confirmed at multivariate analysis, where distant progression was also related to worse OS (p = 0.022). Higher local control rates relate to better PFS (p = 0.04). The 2‑ and 4‑year OS rates were 61 and 39.7%

Conclusion

SBRT is feasible for pulmonary oligometastases with favorable outcomes and toxicity. At multivariate analysis, patients with sequential oligometastatic progression maintain a survival advantage. Also, local control was found to be related to improved PFS rates.

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Abbreviations

CTCAE:

Common Terminology Criteria for Adverse Events

CTV:

Clinical target volume

DFI:

Disease-free interval

DPFS:

Distant progression-free survival

GTV:

Gross tumor volume

IGRT:

Image-guided radiotherapy

ITV:

Internal target volume

LC:

Local control

OAR:

Organ at risk

OS:

Overall survival

PET:

Positron-emission tomography

PTV:

Planning target volume

SBRT:

Stereotactic body radiotherapy

VMAT:

Volumetric modulated arc therapy

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Author information

Authors and Affiliations

  1. Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy

    Francesco Cuccia MD, Rosario Mazzola, Vanessa Figlia, Niccolò Giaj-Levra, Luca Nicosia, Francesco Ricchetti, Michele Rigo, Giorgio Attinà, Claudio Vitale, Edoardo Pastorello, Ruggero Ruggieri & Filippo Alongi

  2. University of Brescia, Brescia, Italy

    Filippo Alongi

Authors
  1. Francesco Cuccia MD
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  2. Rosario Mazzola
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  3. Vanessa Figlia
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  4. Niccolò Giaj-Levra
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  5. Luca Nicosia
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  6. Francesco Ricchetti
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  7. Michele Rigo
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  8. Giorgio Attinà
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  9. Claudio Vitale
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  10. Edoardo Pastorello
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  11. Ruggero Ruggieri
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  12. Filippo Alongi
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Contributions

All authors equally contributed to the drafting of the manuscript. The final version of the present manuscript has been approved by all authors.

Corresponding author

Correspondence to Francesco Cuccia MD.

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Conflict of interest

F. Cuccia, R. Mazzola, V. Figlia, N. Giaj-Levra, L. Nicosia, F. Ricchetti, M. Rigo, G. Attinà, C. Vitale, E. Pastorello, R. Ruggieri, and F. Alongi declare that they have no competing interests.

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Cuccia, F., Mazzola, R., Figlia, V. et al. Stereotactic body radiotherapy for pulmonary oligometastases: a monoinstitutional analysis of clinical outcomes and potential prognostic factors. Strahlenther Onkol 198, 934–939 (2022). https://doi.org/10.1007/s00066-022-01951-0

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  • DOI: https://doi.org/10.1007/s00066-022-01951-0

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