Skip to main content

Advertisement

Log in

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

  • Original Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

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

References

  1. Herold CJ, Bankier AA, Fleischmann D (1996) Lung metastases. Eur Radiol 6(5):596–606

    Article  CAS  Google Scholar 

  2. Hellman S, Weichselbaum RR (1995) Oligometastases. J Clin Oncol 13:8–10

    Article  CAS  Google Scholar 

  3. Filippi AR, Guerrera F, Badellino S, Ceccarelli M, Castiglione A, Guarneri A et al (2016) Exploratory analysis on overall survival after either surgery or stereotactic radiotherapy for lung Oligometastases from colorectal Cancer. J Clin Oncol 28(8):505–512

    Article  CAS  Google Scholar 

  4. Nuyttens JJ, van der Voort van Zyp NC, Verhoef C, Maat A, van Klaveren RJ, van der Holt B et al (2015) Stereotactic body radiation therapy for oligometastases to the lung: a phase 2 study. Int J Radiat Oncol Biol Phys 91(2):337–343

    Article  Google Scholar 

  5. Figlia V, Mazzola R, Cuccia F, Alongi F, Mortellaro G, Cespuglio D, Cucchiara T, Iacoviello G, Valenti V, Molino M, Verderame F, Matranga D, Casto AL, Ferrera G (2018) Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience. Radiol Med 123(6):406–414. https://doi.org/10.1007/s11547-018-0858-7

    Article  PubMed  Google Scholar 

  6. Cuccia F, Mortellaro G, Mazzola R, Donofrio A, Valenti V, Tripoli A, Matranga D, Casto LA, Failla G, Di Miceli G, Ferrera G (2020) Prognostic value of two geriatric screening tools in a cohort of older patients with early stage Non-Small Cell Lung Cancer treated with hypofractionated stereotactic radiotherapy. J Geriatr Oncol 11(3):475–481. https://doi.org/10.1016/j.jgo.2019.05.002

    Article  PubMed  Google Scholar 

  7. Nicosia L, Franceschini D, Perrone-Congedi F, Casamassima F, Gerardi MA, Rigo M, Mazzola R, Perna M, Scotti V, Fodor A, Iurato A, Pasqualetti F, Gadducci G, Chiesa S, Niespolo RM, Bruni A, Alicino G, Frassinelli L, Borghetti P, Di Marzo A, Ravasio A, De Bari B, Sepulcri M, Aiello D, Mortellaro G, Sangalli C, Franceschini M, Montesi G, Aquilanti FM, Lunardi G, Valdagni R, Fazio I, Corti L, Vavassori V, Maranzano E, Magrini SM, Arcangeli S, Valentini V, Paiar F, Ramella S, Di Muzio NG, Livi L, Jereczek-Fossa BA, Osti MF, Scorsetti M, Alongi F (2021) A multicenter LArge retrospectIve daTabase on the personalization of Stereotactic ABlative Radiotherapy use in lung metastases from colon-rectal cancer: the LaIT-SABR study. Radiother Oncol. https://doi.org/10.1016/j.radonc.2021.10.023

    Article  PubMed  Google Scholar 

  8. Singh D, Chen Y, Hare MZ, Usuki KY, Zhang H, Lundquist T, Joyce N, Schell MC, Milano MT (2014) Local control rates with five-fraction stereotactic body radiotherapy for oligometastatic cancer to the lung. J Thorac Dis 6(4):369–374. https://doi.org/10.3978/j.issn.2072-1439.2013.12.03

    Article  PubMed  PubMed Central  Google Scholar 

  9. Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Schlijper R, Bauman GS, Laba J, Qu XM, Warner A, Senan S (2020) Stereotactic ablative radiotherapy for the comprehensive treatment of oligometastatic cancers: long-term results of the SABR-COMET phase II randomized trial. J Clin Oncol 38(25):2830–2838. https://doi.org/10.1200/JCO.20.00818

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pastorino U, Buyse M, Friedel G, Ginsberg RJ, Girard P, Goldstraw P, Johnston M, McCormack P, Pass H, Putnam JB Jr, International Registry of Lung Metastases (1997) Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 113(1):37–49. https://doi.org/10.1016/s0022-5223(97)70397-0

    Article  CAS  PubMed  Google Scholar 

  11. Li S, Nie S, Li Z, Che G (2019) Is stereotactic radiotherapy equivalent to metastasectomy in patients with pulmonary oligometastases? Interact CardioVasc Thorac Surg 29(4):544–550. https://doi.org/10.1093/icvts/ivz133

    Article  CAS  PubMed  Google Scholar 

  12. Lindsay DP, Caster JM, Wang K, Myung JH, Chen RC, Chera B et al (2017) Nanotechnology-based quantification of circulating tumor cells in oligometastatic patients undergoing definitive radiation therapy. Int J Radiat Oncol Biol Phys 99(2):S51

    Article  Google Scholar 

  13. Zhao Y, Khawandanh E, Thomas S, Zhang S, Dunne EM, Liu M, Schellenberg D (2020) Outcomes of stereotactic body radiotherapy 60 Gy in 8 fractions when prioritizing organs at risk for central and ultracentral lung tumors. Radiat Oncol 15(1):61. https://doi.org/10.1186/s13014-020-01491-w

    Article  CAS  PubMed  Google Scholar 

  14. Hanna GG, Murray L, Patel R et al (2018) UK consensus on normal tissue dose constraints for stereotactic radiotherapy. Clin Oncol 30(1):5–14. https://doi.org/10.1016/j.clon.2017.09.007

    Article  CAS  Google Scholar 

  15. Adebahr S, Collette S, Shash E, Lambrecht M, Le Pechoux C, Faivre-Finn C, De Ruysscher D, Peulen H, Belderbos J, Dziadziuszko R, Fink C, Guckenberger M, Hurkmans C, Nestle U (2015) LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective. Br J Radiol 88(1051):20150036. https://doi.org/10.1259/bjr.20150036

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Nicosia L, Cuccia F, Mazzola R, Ricchetti F, Figlia V, Giaj-Levra N, Rigo M, Tomasini D, Pasinetti N, Corradini S, Ruggieri R, Alongi F (2020) Disease course of lung oligometastatic colorectal cancer treated with stereotactic body radiotherapy. Strahlenther Onkol. https://doi.org/10.1007/s00066-020-01627-7

    Article  PubMed  Google Scholar 

  17. Greco C, Pares O, Pimentel N, Louro V, Morales J, Nunes B, Castanheira J, Oliveira C, Silva A, Vaz S, Costa D, Zelefsky M, Kolesnick R, Fuks Z (2019) Phenotype-oriented ablation of oligometastatic cancer with single dose radiation therapy. Int J Radiat Oncol Biol Phys 104(3):593–603. https://doi.org/10.1016/j.ijrobp.2019.02.033

    Article  PubMed  Google Scholar 

  18. Kalinauskaite GG, Tinhofer II, Kufeld MM, Kluge AA, Grün AA, Budach VV, Senger CC, Stromberger CC (2020) Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases. BMC Cancer 20(1):404. https://doi.org/10.1186/s12885-020-06892-4

    Article  PubMed  PubMed Central  Google Scholar 

  19. Niibe Y, Yamamoto T, Onishi H, Yamashita H, Katsui K, Matsumoto Y, Oh RJ, Aoki M, Shintani T, Yamada K, Kobayashi M, Ozaki M, Manabe Y, Yahara K, Nishikawa A, Kakuhara H, Yamamoto K, Inoue T, Takada YU, Nagata K, Suzuki O, Terahara A, Jingu K (2020) Pulmonary oligometastases treated by stereotactic body radiation therapy: a nationwide survey of 1,378 patients. Anticancer Res 40(1):393–399. https://doi.org/10.21873/anticanres.13965

    Article  PubMed  Google Scholar 

  20. Yamamoto T, Niibe Y, Matsumoto Y, Onishi H, Aoki M, Nishikawa A, Oh RJ, Shintani T, Yahara K, Ozaki M, Manabe Y, Jingu K (2020) Analyses of local control and survival after stereotactic body radiotherapy for pulmonary oligometastases from colorectal adenocarcinoma. J Radiat Res 61(6):935–944. https://doi.org/10.1093/jrr/rraa071

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

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.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

Navigation