Stereotactic body radiotherapy for oligometastatic soft tissue sarcoma
Stereotactic body radiotherapy (SBRT) is emerging as a novel treatment option in metastatic soft tissue sarcoma (STS). The aim of our study was to evaluate the effectiveness of exclusive SBRT on disease control and survival in oligometastatic (≤ 3 synchronous lesions) STS.
Materials and methods
In total, 16 consecutive patients, accounting for 26 metastases (including 21 lung and 5 lymph node or soft tissue metastases), were treated at our institution with SBRT. Patient- and treatment-related characteristics were collected. Local control (LC), overall survival (OS), distant metastases-free survival (DMFS), and time to initiation of chemotherapy or best supportive care (corrected disease-free survival, cDFS) were assessed.
Four-year OS was 54% and median OS was 69 months [95% confidence interval (CI) 20–118 months]. LC of 26 lesions at 4 years was 78%. Median DMFS and cDFS were 17 (95% CI 5–30 months) and 28 months (95% CI 5–52 months), respectively. Disease-free interval < 24 months from primary tumor treatment to first metastasis was the only predictor of reduced LC, cDFS, and OS (p = 0.022, 0.023, and 0.028, respectively). No acute or chronic grade ≥ 3 toxicity was observed. Median follow-up was 36 months (IQR 18–71 months).
In patients with oligometastatic STS, SBRT yields satisfying local control with minimal toxicity. Median OS was 69 months. Repeated SBRT may be considered to extend disease-free and systemic therapy-free interval. Increased time from primary tumor to first metastasis identifies patients with potentially greater benefit from SBRT.
KeywordsStereotactic body radiotherapy Oligometastases Soft tissue sarcoma Radiotherapy
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
All the authors listed (Mauro Loi, Marloes Duijm, Sarah Baker, Linda Rossi, Dirk Grunhagen, Cornelis Verhoef, Joost Nuyttens) report no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Authorization by the institutional review board was demanded.
Informed consent to the procedures was obtained from all individual participants.
- 5.Chudgar NP, Brennan MF, Munhoz RR, Bucciarelli PR, Tan KS, D’Angelo SP, Bains MS, Bott M, Huang J, Park BJ, Rusch VW, Adusumilli PS, Tap WD, Singer S, Jones DR (2017) Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma. J Thorac Cardiovasc Surg. 154(1):319.e1–330.e1CrossRefGoogle Scholar
- 6.Fuller BG (2001) The role of radiotherapy in the treatment of bone and soft-tissue sarcomas musculoskeletal cancer surgery. In: Malawer M, Sugarbaker P (eds) Musculoskeletal cancer surgery: treatment of sarcomas and allied diseases. Springer, Dordrecht, pp 85–133Google Scholar
- 8.Dhakal S, Corbin KS, Milano MT, Philip A, Sahasrabudhe D, Jones C, Constine LS (2012) Stereotactic body radiotherapy for pulmonary metastases from soft-tissue sarcomas: excellent local lesion control and improved patient survival. Int J Radiat Oncol Biol Phys 82(2):940–945CrossRefPubMedGoogle Scholar
- 12.Folkert MR, Bilsky MH, Tom AK, Oh JH, Alektiar KM, Laufer I, Tap WD, Yamada Y (2014) Outcomes and toxicity for hypofractionated and single-fraction image-guided stereotactic radiosurgery for sarcomas metastasizing to the spine. Int J Radiat Oncol Biol Phys 88(5):1085–1091CrossRefPubMedGoogle Scholar
- 14.Navarria P, Ascolese AM, Cozzi L, Tomatis S, D’Agostino GR, De Rose F, De Sanctis R, Marrari A, Santoro A, Fogliata A, Cariboni U, Alloisio M, Quagliuolo V, Scorsetti M (2015) Stereotactic body radiation therapy for lung metastases from soft tissue sarcoma. Eur J Cancer 51(5):668–674CrossRefPubMedGoogle Scholar
- 16.Baumann BC, Nagda SN, Kolker JD, Levin WP, Weber KL, Berman AT, Staddon A, Hartner L, Hahn SM, Glatstein E, Simone CB 2nd (2016) Efficacy and safety of stereotactic body radiation therapy for the treatment of pulmonary metastases from sarcoma: a potential alternative to resection. J Surg Oncol 114(1):65–69CrossRefPubMedGoogle Scholar
- 21.Falk AT, Moureau-Zabotto L, Ouali M, Penel N, Italiano A, Bay JO, Olivier T, Sunyach MP, Boudou-Roquette P, Salas S, Le Maignan C, Ducassou A, Isambert N, Kalbacher E, Pan C, Saada E, Bertucci F, Thyss A, Thariat J, Groupe Sarcome Francais-Groupe D’etude Des Tumeurs Osseuses (2015) Effect on survival of local ablative treatment of metastases from sarcomas: a study of the French sarcoma group. Clin Oncol (R Coll Radiol) 27(1):48–55CrossRefGoogle Scholar