Retrospective study of systemic chemotherapy in combination with consolidative stereotactic body radiation therapy (SBRT) in patients with five or fewer oligometastases from breast, colorectal, and lung cancers.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21036-e21036
Author(s):  
Alice Ulhoa-Cintra ◽  
Dulabh K. Monga ◽  
Alexander V. Kirichenko
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Systemic Chemotherapy ◽  
Stereotactic Body Radiation Therapy ◽  
Nsclc Patient ◽  
Tumor Control ◽  
Lung Cancers ◽  
Stereotactic Body Radiation ◽  
Low Toxicity

e21036 Background: The oligometastatic state is one of limited metastases, amenable to local therapies of curative potential. Stereotactic body radiation therapy (SBRT) is a non-surgical treatment with a primary goal of rapid local tumor control and low toxicity allowing prompt return to systemic therapy. Breast (BRC), colorectal (CRC) and non-small cell lung cancers (NSCLC) have oligometastases as first presentation. In these patients, consolidative SBRT offers effective local control and low toxicity, with the potential for improved survival benefit without affecting quality of life. We report our experience on such patients. Methods: 31 patients with BRC (9), CRC (16) and NSCLC (6) with ≤ 5 unresectable metastases to one to three organ sites were identified. Data were obtained from chart review. Primary end point was infield local control. Lesions with at least 6 months of radiographic follow-up were assessable. Secondary end points were toxicity and survival. Results: All patients completed SBRT to 38 lesions (≤2/patient). 29 received prior chemotherapy for metastatic disease. 14 were treated with at least 1 prior regimen and 15 at least 2 (0-8). At a median follow-up of 16 months (4-32), 22 patients (8 BRC, 10 CRC and 4 NSCLC) were assessable. At 6 months, 20 patients had infield local control and 3 demonstrated distant metastases. At 1 year, this was seen in 19 and 7 patients respectively. The most common toxicity was grade ≤2 fatigue. All BRC had infield local control at 6 months and 1 year. Among CRC, 9 had infield local control at 6 months and 7 at 1 year. 3 NSCLC patients had infield local control at 6 months and 1 year. No BRC demonstrated distant progression at 6 months; at 1 year, it was seen in 2 patients. 3 CRC had evidence of distant progression at 6 months and 1 year. 1 NSCLC patient had distant progression at 6 months and 2 at 1 year. 6 patients died from their underlying malignancy; the median survival for 5 of these patients was 20 months (5-34). Conclusions: The combination of systemic chemotherapy and consolidative SBRT is safe and effective for patients with oligometastatic disease

scholarly journals Safety and Efficacy of Stereotactic Body Radiation Therapy in the Treatment of Pulmonary Metastases from High Grade Sarcoma

Sarcoma ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Niraj Mehta ◽  
Michael Selch ◽  
Pin-Chieh Wang ◽  
Noah Federman ◽  
Jay M. Lee ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Radiation Pneumonitis ◽  
High Grade ◽  
Term Survival ◽  
Stereotactic Body Radiation ◽  
High Grade Sarcoma ◽  
Radiation Esophagitis

Introduction. Patients with high-grade sarcoma (HGS) frequently develop metastatic disease thus limiting their long-term survival. Lung metastases (LM) have historically been treated with surgical resection (metastasectomy). A potential alternative for controlling LM could be stereotactic body radiation therapy (SBRT). We evaluated the outcomes from our institutional experience utilizing SBRT. Methods. Sixteen consecutive patients with LM from HGS were treated with SBRT between 2009 and 2011. Routine radiographic and clinical follow-up was performed. Local failure was defined as CT progression on 2 consecutive scans or growth after initial shrinkage. Radiation pneumonitis and radiation esophagitis were scored using Common Toxicity Criteria (CTC) version 3.0. Results. All 16 patients received chemotherapy, and a subset (38%) also underwent prior pulmonary metastasectomy. Median patient age was 56 (12–85), and median follow-up time was 20 months (range 3–43). A total of 25 lesions were treated and evaluable for this analysis. Most common histologies were leiomyosarcoma (28%), synovial sarcoma (20%), and osteosarcoma (16%). Median SBRT prescription dose was 54 Gy (36–54) in 3-4 fractions. At 43 months, local control was 94%. No patient experienced G2-4 radiation pneumonitis, and no patient experienced radiation esophagitis. Conclusions. Our retrospective experience suggests that SBRT for LM from HGS provides excellent local control and minimal toxicity.

scholarly journals Cyberknife Stereotactic Body Radiation Therapy for Nonresectable Tumors of the Liver: Preliminary Results

HPB Surgery ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
K. Goyal ◽  
D. Einstein ◽  
M. Yao ◽  
C. Kunos ◽  
F. Barton ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Local Treatment ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Liver Malignancies ◽  
Preliminary Results ◽  
Stereotactic Body Radiation ◽  
Tumors Of The Liver

Purpose. Stereotactic body radiation therapy (SBRT) has emerged as a treatment option for local tumor control of primary and secondary malignancies of the liver. We report on our updated experience with SBRT in patients with non-resectable tumors of the liver. Methods. Our first 17 consecutive patients (mean age 58.1 years) receiving SBRT for HCC (), IHC (), and LM () are presented. Mean radiation dose was 34Gy delivered over 1–3 fractions. Results. Treated patients had a mean decrease in maximum pretreatment tumor diameter from  cm to  cm at three months after treatment (). The mean total tumor volume reduction was 44% at six months (). 82% of all patients (14/17) achieved local control with a median follow-up of 8 months. 100% of patients with HCC () achieved local control. Patients with surgically placed fiducial markers had no complications related to marker placement. Conclusion. Our preliminary results showed that SBRT is a safe and effective local treatment modality in selected patients with liver malignancies with minimal adverse events. Further studies are needed to define its role in the management of these malignancies.

Stereotactic body radiation therapy for pancreatic cancer: Single institutional experience.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 328-328 ◽  
Author(s):  
Shalini Moningi ◽  
Siva P. Raman ◽  
Avani Satish Dholakia ◽  
Amy Hacker-Prietz ◽  
Timothy M. Pawlik ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Acute Toxicity ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Locally Advanced ◽  
Stereotactic Body Radiation ◽  
Early Results ◽  
Grade 3

328 Background: Stereotactic Body Radiation Therapy (SBRT) is emerging as a possible standard treatment for pancreatic cancer; however, there is limited data to support its efficacy. This study reviews our institution’s experience using SBRT in the treatment of pancreatic cancer (PCA). Methods: Charts of all PCA patients receiving SBRT from January 2010 to June 2013 were retrospectively reviewed. The primary end points were overall survival (OS) and tumor response assessed by RECIST criteria. 95% of the PTV (GTV + 2-3 mm) received a total dose of 20-33 Gy in five fractions (4-6.6 Gy/fraction), with up to 20% heterogeneity allowed. Pre- and post-SBRT chemotherapy regimens included gemcitabine, cisplatin, FOLFIRINOX, 5-FU or paclitaxel. Results: 84 patients received SBRT, with a median follow-up time of 15.3 months. Median age was 66.5 years, 57.1% were male and 65.5% had head tumors. 66 patients received definitive SBRT for locally advanced or borderline resectable PCA, 4 patients were treated with adjuvant SBRT, and 14 received SBRT for treatment of recurrent disease. Median OS from the date of diagnosis for patients receiving definitive radiation was 17.8 mos (95% CI 14.9-20.9).For recurrent patients the median OS from first day of SBRT was 11.8 mos (95%CI 8.3-15.3). In the definitive SBRT group, among patients who were alive and had follow-up scans, the 6 and 12 month local control rate (stable or partial response) based on RECIST criteria was 84.6% and 81.8%, respectively. Five patients underwent surgery following SBRT and all had negative resection margins. Acute toxicity was minimal with most experiencing grade 1 or 2 fatigue and no grade 3/4 acute toxicity. Late grade 3/4 GI toxicity was seen in 5% (4/84) and 1 patient had a grade 5 GI bleed due to direct tumor invasion into the duodenum. Conclusions: Our early results using SBRT in the definitive and recurrent settings show favorable local control, toxicity, and survival when compared to historical outcomes using chemoradiation. Acute and late toxicity was minimal however the optimal dose and fractionation as well as normal tissue dose constraints need to be determined. Integration of SBRT with more aggressive chemotherapy may result in improved outcomes in patients with PCA.

Multi-Institutional Phase I/II Trial of Stereotactic Body Radiation Therapy for Liver Metastases

2009 ◽  
Vol 27 (10) ◽  
pp. 1572-1578 ◽  
Author(s):  
Kyle E. Rusthoven ◽  
Brian D. Kavanagh ◽  
Higinia Cardenes ◽  
Volker W. Stieber ◽  
Stuart H. Burri ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Phase I ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Hepatic Metastases ◽  
High Dose ◽  
Tumor Diameter ◽  
Stereotactic Body Radiation ◽  
Maximal Diameter

Purpose To evaluate the efficacy and tolerability of high-dose stereotactic body radiation therapy (SBRT) for the treatment of patients with one to three hepatic metastases. Patients and Methods Patients with one to three hepatic lesions and maximum individual tumor diameters less than 6 cm were enrolled and treated on a multi-institutional, phase I/II clinical trial in which they received SBRT delivered in three fractions. During phase I, the total dose was safely escalated from 36 Gy to 60 Gy. The phase II dose was 60 Gy. The primary end point was local control. Lesions with at least 6 months of radiographic follow-up were considered assessable for local control. Secondary end points were toxicity and survival. Results Forty-seven patients with 63 lesions were treated with SBRT. Among them, 69% had received at least one prior systemic therapy regimen for metastatic disease (range, 0 to 5 regimens), and 45% had extrahepatic disease at study entry. Only one patient experienced grade 3 or higher toxicity (2%). Forty-nine discrete lesions were assessable for local control. Median follow-up for assessable lesions was 16 months (range, 6 to 54 months). The median maximal tumor diameter was 2.7 cm (range, 0.4 to 5.8 cm). Local progression occurred in only three lesions at a median of 7.5 months (range, 7 to 13 months) after SBRT. Actuarial in-field local control rates at one and two years after SBRT were 95% and 92%, respectively. Among lesions with maximal diameter of 3 cm or less, 2-year local control was 100%. Median survival was 20.5 months. Conclusion This multi-institutional, phase I/II trial demonstrates that high-dose liver SBRT is safe and effective for the treatment of patients with one to three hepatic metastases.

Stereotactic body radiation therapy in the treatment of unresectable intrahepatic cholangiocarcinoma.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 335-335 ◽  
Author(s):  
J. O'Connor ◽  
R. Goldstein
Keyword(s):  
Radiation Therapy ◽  
Acute Toxicity ◽  
Local Control ◽  
Intrahepatic Cholangiocarcinoma ◽  
Stereotactic Body Radiation Therapy ◽  
Complete Response ◽  
Median Dose ◽  
Stereotactic Body Radiation ◽  
The Right

335 Background: Unresectable intrahepatic cholangiocarcinoma has a poor prognosis with less than 5% of patients surviving 5 years. We review our experience with stereotactic body radiation therapy (SBRT) in the treatment of unresectable intrahepatic cholangiocarcinoma and evaluate acute toxicity and local control. Methods: From November 2005 until August 2010, 12 patients with unresectable intrahepatic cholangiocarcinoma were treated with SBRT. All patients were evaluated by a liver surgeon and were deemed unresectable prior to radiosurgery. The median tumor size was 4.3 cm (range 1.9–9.3 cm). All tumors were located in the right hepatic lobe. Three patients had received prior radiation therapy and SBRT was given as a boost with a median dose of 24 Gy in three fractions. Nine patients received SBRT as the sole local modality to a median dose of 51 Gy (range 30–55 Gy) in three fractions on consecutive days. Local control was determined by follow-up imaging with MRI. The median follow up is 12 months. Toxicity was assessed using Common Toxicity Criteria (CTC) guidelines version 3.0. Results: Overall, only 3 of 12 (25%) patients experienced acute toxicity. Three patients had abdominal discomfort and one patient had nausea. All toxicities were grade 1. Ten of 12 (83%) patients received chemotherapy. Four patients received chemotherapy before SBRT and five patients received chemotherapy after. One patient received chemotherapy before and after SBRT. Overall local control is 75% for eight patients with follow-up imaging. Two of eight (25%) patients had a complete response. Four of eight (67%) patients had a partial response or stable disease. One patient had a local recurrence 13 months after receiving SBRT (51 Gy in three fractions) and was retreated with SBRT (28 Gy in three fractions) with no acute toxicity. There was no difference in outcome whether SBRT was given before or after chemotherapy. Conclusions: Stereotactic body radiation therapy given sequentially with chemotherapy is well tolerated with few side effects in the treatment of unresectable intrahepatic cholangiocarcinoma and early local control is promising. No significant financial relationships to disclose.

scholarly journals Single-Fraction Spine Stereotactic Body Radiation Therapy for the Treatment of Chordoma

2016 ◽  
Vol 16 (3) ◽  
pp. 302-309 ◽  
Author(s):  
Edward W. Jung ◽  
David L. Jung ◽  
Ehsan H. Balagamwala ◽  
Lilyana Angelov ◽  
John H. Suh ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Target Volume ◽  
Control Treatment ◽  
Single Fraction ◽  
Stereotactic Body Radiation ◽  
Pain Symptoms

Purpose: Chordoma is a radioresistant tumor that presents a therapeutic challenge with spine involvement, as high doses of radiation are needed for local control while limiting dose to the spinal cord. The purpose of this study is to determine the efficacy and safety of single-fraction spine stereotactic body radiation therapy for the treatment of spine chordoma. Methods: A retrospective review of our institutional database from 2006 to 2013 identified 8 patients (12 cases) with chordoma of the spine who were treated with spine stereotactic body radiation therapy. Surgical resection was performed in 7 of the 12 cases. The treatment volume was defined by the bony vertebral level of the tumor along with soft tissue extension appreciated on magnetic resonance imaging fusion. Medical records and imaging were assessed for pain relief and local control. Treatment toxicity was evaluated using Common Terminology Criteria for Adverse Events version 4.0. Results: Median age was 59 years (range, 17-91). Median target volume was 48 cm3 (1-304), and median prescription dose was 16 Gy (11-16). Median conformality index was 1.44 (1.14-3.21), and homogeneity index was 1.12 (1.05-1.19). With a median follow-up time of 9.7 months (.5-84), local control was achieved in 75% of the cases treated. One patient developed limited grade 2 spinal cord myelopathy that resolved with steroids. There were no other treatment toxicities from spine stereotactic body radiation therapy. Conclusion: Single-fraction spine stereotactic body radiation therapy can be safely delivered to treat chordoma of the spine with the potential to improve pain symptoms. Although the early data are suggestive, long-term follow-up with more patients is necessary to determine the efficacy of spine stereotactic body radiation therapy in the treatment of chordoma of the spine.

Multi-Institutional Phase I/II Trial of Stereotactic Body Radiation Therapy for Lung Metastases

2009 ◽  
Vol 27 (10) ◽  
pp. 1579-1584 ◽  
Author(s):  
Kyle E. Rusthoven ◽  
Brian D. Kavanagh ◽  
Stuart H. Burri ◽  
Changhu Chen ◽  
Higinia Cardenes ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Phase I ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Lung Metastases ◽  
High Dose ◽  
Tumor Diameter ◽  
Stereotactic Body Radiation ◽  
Local Progression

Purpose To evaluate the efficacy and tolerability of high-dose stereotactic body radiation therapy (SBRT) for the treatment of patients with one to three lung metastases. Patients and Methods Patients with one to three lung metastases with cumulative maximum tumor diameter smaller than 7 cm were enrolled and treated on a multi-institutional phase I/II clinical trial in which they received SBRT delivered in 3 fractions. In phase I, the total dose was safely escalated from 48 to 60 Gy. The phase II dose was 60 Gy. The primary end point was local control. Lesions with at least 6 months of radiographic follow-up were considered assessable for local control. Secondary end points included toxicity and survival. Results Thirty-eight patients with 63 lesions were enrolled and treated at three participating institutions. Seventy-one percent had received at least one prior systemic regimen for metastatic disease and 34% had received at least two prior regimens (range, zero to five). Two patients had local recurrence after prior surgical resection. There was no grade 4 toxicity. The incidence of any grade 3 toxicity was 8% (three of 38). Symptomatic pneumonitis occurred in one patient (2.6%). Fifty lesions were assessable for local control. Median follow-up for assessable lesions was 15.4 months (range, 6 to 48 months). The median gross tumor volume was 4.2 mL (range, 0.2 to 52.3 mL). Actuarial local control at one and two years after SBRT was 100% and 96%, respectively. Local progression occurred in one patient, 13 months after SBRT. Median survival was 19 months. Conclusion This multi-institutional phase I/II trial demonstrates that high-dose SBRT is safe and effective for the treatment of patients with one to three lung metastases.

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