Advertisement

Der Onkologe

, Volume 20, Issue 8, pp 757–765 | Cite as

Stereotaktische Strahlentherapie von Metastasen

Palliativer Effekt und Tumorkontrolle
  • O. Riesterer
  • M. Guckenberger
Leitthema

Zusammenfassung

Hintergrund

Aufgrund längeren Krankheitsverlaufs durch neue Systemtherapien und basierend auf dem Konzept der Oligometastasierung wird in der klinischen Praxis immer häufiger die Indikation für eine lokal definitive Behandlung von Metastasen gestellt. Mit der stereotaktischen Radiotherapie können Metastasen in wenigen Sitzungen effizient abgetötet werden.

Fragestellung

Was ist die Evidenz zur stereotaktischen Radiotherapie von Patienten mit Oligometastasen? Wie ist der Einfluss der Metastasenkontrollrate auf das Überleben nach stereotaktischer Radiotherapie? Wie toxisch ist die Behandlung? Wie ist die Abgrenzung von anderen lokalen Therapiemethoden wie z. B. der Chirurgie? Gibt es prognostische Faktoren bei Patienten mit Oligometastasen?

Material und Methode

Literatursuche nach prospektiven und retrospektiven Studien.

Ergebnisse

Den einzigen Beweis für einen lebensverlängernden Effekt durch lokale Behandlung von Oligometastasen liefert eine randomisierte Studie, die den radiochirurgischen Boost nach Ganzhirnbestrahlung bei Patienten mit Hirnfiliae untersuchte. Prospektive Phase-II-Studien zur stereotaktischen Radiotherapie von Hirn-, Lungen-, Leber-, Wirbelkörper- und Oligometastasen an multiplen Lokalisationen belegen die hohe Tumorkontrollrate und gute Verträglichkeit dieser Behandlung. Prognostische Faktoren sind in erster Linie Histologie, Anzahl und Größe der Metastasen sowie das krankheitsfreie Überleben.

Schlussfolgerung

Die stereotaktische Radiotherapie ist eine valide Therapieoption in der Behandlung von Patienten mit Oligometastasen und sollte in der klinischen Praxis auch als Alternative zur Metastasenchirurgie und lokal ablativer Verfahren erwogen werden.

Schlüsselwörter

Körperstereotaxie Stereotaktische Radiotherapie Metastasen Oligometastasen Prognostische Faktoren 

Stereotactic radiotherapy of metastases

Palliative effect and tumor control

Abstract

Background

In clinical practice metastases are being treated increasingly more with local definitive intent based on a prolonged course of the disease due to novel systemic therapies and the concept of oligometastasis. With stereotactic radiotherapy metastases can be treated with very high efficiency in only a few fractions.

Objectives

Identification of clinical studies investigating the use of stereotactic radiotherapy for treatment of oligometastases. Metastasis control rates and survival after stereotactic radiotherapy. Toxicity of the treatment. Differentiation from other local treatment approaches including surgery. Prognostic factors in patients with oligometastases.

Methods

A literature search was carried out for prospective and retrospective studies on local stereotactic radiotherapy.

Results

The only proof that local treatment can prolong survival in patients with oligometastases comes from a randomized study that investigated the use of a radiosurgical boost after whole brain radiotherapy in patients with brain metastases. Various prospective phase II studies demonstrated excellent metastasis control rates and tolerability of extracranial stereotactic radiotherapy for treatment of lung, liver, spinal and oligometastases at multiple sites. Relevant prognostic factors for oligometastatic disease are histology, number and size of metastases and disease-free survival.

Conclusion

Stereotactic radiotherapy has become a valid treatment option for patients with oligometastases and in clinical practice should also be considered as an alternative to surgical treatment of metastases.

Keywords

Stereotactic body radiotherapy Stereotactic ablative radiotherapy Metastases Oligometastases Prognostic factors 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. O. Riesterer und M. Guckenberger geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen und Tieren.

Literatur

  1. 1.
    Andrews DW, Scott CB, Sperduto PW et al (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 363:1665–1672PubMedCrossRefGoogle Scholar
  2. 2.
    Anonymous (1997) Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. The International Registry of Lung Metastases. J Thorac Cardiovasc Surg 113:37–49CrossRefGoogle Scholar
  3. 3.
    Brennan C, Yang TJ, Hilden P et al (2014) A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases. Int J Radiat Oncol Biol Phys 88:130–136PubMedCrossRefGoogle Scholar
  4. 4.
    Chang EL, Shiu AS, Mendel E et al (2007) Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine 7:151–160PubMedCrossRefGoogle Scholar
  5. 5.
    Chow E, Harris K, Fan G et al (2007) Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 25:1423–1436PubMedCrossRefGoogle Scholar
  6. 6.
    De Ruysscher D, Wanders R, Van Baardwijk A et al (2012) Radical treatment of non-small-cell lung cancer patients with synchronous oligometastases: long-term results of a prospective phase II trial (Nct01282450). J Thorac Oncol 7:1547–1555CrossRefGoogle Scholar
  7. 7.
    Fernando HC, Landreneau RJ, Mandrekar SJ et al (2011) Thirty- and ninety-day outcomes after sublobar resection with and without brachytherapy for non-small cell lung cancer: results from a multicenter phase III study. J Thorac Cardiovasc Surg 142:1143–1151PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318 (discussion 318–321)PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Garcia-Barros M, Paris F, Cordon-Cardo C et al (2003) Tumor response to radiotherapy regulated by endothelial cell apoptosis. Science 300:1155–1159PubMedCrossRefGoogle Scholar
  10. 10.
    Gerszten PC, Burton SA, Ozhasoglu C et al (2007) Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976) 32:193–199Google Scholar
  11. 11.
    Gibbs IC, Patil C, Gerszten PC et al (2009) Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery 64:A67–A72PubMedCrossRefGoogle Scholar
  12. 12.
    Gridelli C, Peters S, Sgambato A et al (2014) ALK inhibitors in the treatment of advanced NSCLC. Cancer Treat Rev 40:300–306PubMedCrossRefGoogle Scholar
  13. 13.
    Guckenberger M, Allgauer M, Appold S et al (2013) Safety and efficacy of stereotactic body radiotherapy for stage 1 non-small-cell lung cancer in routine clinical practice: a patterns-of-care and outcome analysis. J Thorac Oncol 8:1050–1058PubMedCrossRefGoogle Scholar
  14. 14.
    Hellman S, Weichselbaum RR (1995) Oligometastases. J Clin Oncol 13:8–10PubMedGoogle Scholar
  15. 15.
    Hoyer M, Roed H, Traberg Hansen A et al (2006) Phase II study on stereotactic body radiotherapy of colorectal metastases. Acta Oncol 45:823–830PubMedCrossRefGoogle Scholar
  16. 16.
    Lee MT, Kim JJ, Dinniwell R et al (2009) Phase I study of individualized stereotactic body radiotherapy of liver metastases. J Clin Oncol 27:1585–1591PubMedCrossRefGoogle Scholar
  17. 17.
    Lee Y, Auh SL, Wang Y et al (2009) Therapeutic effects of ablative radiation on local tumor require CD8+ T cells: changing strategies for cancer treatment. Blood 114:589–595PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Lussier YA, Khodarev NN, Regan K et al (2012) Oligo- and polymetastatic progression in lung metastasis(es) patients is associated with specific microRNAs. PLoS One 7:e50141PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Lussier YA, Xing HR, Salama JK et al (2011) MicroRNA expression characterizes oligometastasis(es). PLoS One 6:e28650PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Mathieu D, Kondziolka D, Flickinger JC et al (2008) Tumor bed radiosurgery after resection of cerebral metastases. Neurosurgery 62:817–823 (discussion 823–814)PubMedCrossRefGoogle Scholar
  21. 21.
    Mendez Romero A, Wunderink W, Hussain SM et al (2006) Stereotactic body radiation therapy for primary and metastatic liver tumors: a single institution phase i-ii study. Acta Oncol 45:831–837CrossRefGoogle Scholar
  22. 22.
    Milano MT, Katz AW, Muhs AG et al (2008) A prospective pilot study of curative-intent stereotactic body radiation therapy in patients with 5 or fewer oligometastatic lesions. Cancer 112:650–658PubMedCrossRefGoogle Scholar
  23. 23.
    Milano MT, Katz AW, Zhang H et al (2012) Oligometastases treated with stereotactic body radiotherapy: long-term follow-up of prospective study. Int J Radiat Oncol Biol Phys 83:878–886PubMedCrossRefGoogle Scholar
  24. 24.
    Mok T, Yang JJ, Lam KC (2013) Treating patients with EGFR-sensitizing mutations: first line or second line–is there a difference? J Clin Oncol 31:1081–1088PubMedCrossRefGoogle Scholar
  25. 25.
    Nordlinger B, Guiguet M, Vaillant JC et al (1996) Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 77:1254–1262PubMedCrossRefGoogle Scholar
  26. 26.
    Patchell RA, Tibbs PA, Regine WF et al (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489PubMedCrossRefGoogle Scholar
  27. 27.
    Patchell RA, Tibbs PA, Regine WF et al (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366:643–648PubMedCrossRefGoogle Scholar
  28. 28.
    Postow MA, Callahan MK, Barker CA et al (2012) Immunologic correlates of the abscopal effect in a patient with melanoma. N Engl J Med 366:925–931PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Powell JW, Dexter E, Scalzetti EM et al (2009) Treatment advances for medically inoperable non-small-cell lung cancer: emphasis on prospective trials. Lancet Oncol 10:885–894PubMedCrossRefGoogle Scholar
  30. 30.
    Rusthoven KE, Kavanagh BD, Burri SH et al (2009) Multi-institutional phase I/II trial of stereotactic body radiation therapy for lung metastases. J Clin Oncol 27:1579–1584PubMedCrossRefGoogle Scholar
  31. 31.
    Rusthoven KE, Kavanagh BD, Cardenes H et al (2009) Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol 27:1572–1578PubMedCrossRefGoogle Scholar
  32. 32.
    Ryu S, Jin R, Jin JY et al (2008) Pain control by image-guided radiosurgery for solitary spinal metastasis. J Pain Symptom Manage 35:292–298PubMedCrossRefGoogle Scholar
  33. 33.
    Ryu S, Rock J, Rosenblum M et al (2004) Patterns of failure after single-dose radiosurgery for spinal metastasis. J Neurosurg 101(Suppl 3):402–405PubMedCrossRefGoogle Scholar
  34. 34.
    Salama JK, Hasselle MD, Chmura SJ et al (2012) Stereotactic body radiotherapy for multisite extracranial oligometastases: final report of a dose escalation trial in patients with 1–5 sites of metastatic disease. Cancer 118:2962–2970PubMedCrossRefGoogle Scholar
  35. 35.
    Sperduto PW, Kased N, Roberge D et al (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Svedman C, Sandstrom P, Pisa P et al (2006) A prospective Phase II trial of using extracranial stereotactic radiotherapy in primary and metastatic renal cell carcinoma. Acta Oncol 45:870–875PubMedCrossRefGoogle Scholar
  37. 37.
    Wang XS, Rhines LD, Shiu AS et al (2012) Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1–2 trial. Lancet Oncol 13:395–402PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Wong SL, Mangu PB, Choti MA et al (2010) American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer. J Clin Oncol 28:493–508PubMedCrossRefGoogle Scholar
  39. 39.
    Wuttig D, Baier B, Fuessel S et al (2009) Gene signatures of pulmonary metastases of renal cell carcinoma reflect the disease-free interval and the number of metastases per patient. Int J Cancer 125:474–482PubMedCrossRefGoogle Scholar
  40. 40.
    Yachida S, Jones S, Bozic I et al (2010) Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature 467:1114–1117PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Yamada Y, Bilsky MH, Lovelock DM et al (2008) High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiat Oncol Biol Phys 71:484–490PubMedCrossRefGoogle Scholar
  42. 42.
    Yamamoto M, Serizawa T, Shuto T et al (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15(4):387–395PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Universitätsspital ZürichZürichSchweiz

Personalised recommendations