Initial UK Experience of Stereotactic Body Radiotherapy for Extracranial Oligometastases: Can We Change the Therapeutic Paradigm?. Issue 7 (July 2015)

• Record Type: Journal Article
• Authors: Aitken, K.; Tree, A.; Thomas, K.; Nutting, C.; Hawkins, M.; Tait, D.; Mandeville, H.; Ahmed, M.; Lalondrelle, S.; Miah, A.; Taylor, A.; Ross, G.; Khoo, V.; van As, N.
• Is Part Of: Clinical oncology. Volume 27:Issue 7(2015)
• Page Start: 411
• Page End: 419
• Publication Date: 2015-07
• Subjects: Extracranial oligometastases -- SBRT -- stereotactic radiotherapy; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2015.03.006
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: Aims: To retrospectively review the toxicity and early outcome data from patients who have received stereotactic body radiotherapy (SBRT) for extracranial oligometastases at a single UK institution. Materials and methods: Eligible patients had ≤3 extracranial metastases and performance status ≤2. Prior systemic therapy and radical treatment of oligometastastic relapse with any standard treatment modality was permitted. Patients with synchronous metastatic disease were excluded unless they had evidence of controlled primary disease after radical therapy. Follow-up consisted of clinical examination, biochemical and radiological assessments in accordance with standard clinical care. Progression events were defined using RECIST. Toxicity was evaluated using CTCAE v4.0. Local control, progression-free survival (PFS), freedom from widespread distant metastasis (defined as disease not amenable to further radical salvage therapy) and overall survival were calculated. Results: Between July 2011 and April 2014, 73 patients with 87 metastases received SBRT (range 1–3 per patient). The median follow-up was 14.5 months (range 0–26.4). The median PFS was 14.5 months (1 year PFS 57%, 2 year 28%); 1 year overall survival 96%, 2 year 79.8%; 2 year local control 88%. At 2 years, 46% of patients were free from widespread distant metastases. No ≥ grade 3 acute or late toxicity was observed. Conclusion: At this time point, observed toxicity is minimal with excellent local control rates. This promising treatment paradigm requires further investigation in the context of a randomised controlled trial to establish if the addition of SBRT to standard care improves survival outcomes. Highlights: Oligometastasis refers to a state of limited metastatic disease (defined as ≤3 extracranial sites). We evaluated stereotactic body radiotherapy (SBRT) as a treatment for patients with oligometastatic disease. SBRT was well tolerated and resulted in high rates of local metastasis control. At 2 years, 28% of patients remained free of disease progression. Randomised controlled trials should be carried out to compare SBRT with standard therapy in this setting.