Stereotactic Body Radiation Therapy for Oligometastases to the Lung: A Phase 2 Study

Journal Article · Sun Feb 01 04:00:00 EST 2015 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2014.10.021· OSTI ID:22458600

Verhoef, Cornelis ^[1]; Maat, A. ^[2]; Klaveren, Robertus J. van ^[3]; Holt, Bronno van der ^[4]; Aerts, Joachim ^[3]; Hoogeman, Mischa ^[5]

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1. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands)
2. Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam (Netherlands)
3. Department of Pulmonology, Erasmus MC Cancer Institute, Rotterdam (Netherlands)
4. Clinical Trial Center, Erasmus MC Cancer Institute, Rotterdam (Netherlands)
5. Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands)

Purpose: To assess, in a phase 2 study, the efficacy and toxicity of stereotactic body radiation therapy for oligometastases to the lung in inoperable patients. Methods and Materials: Patients with lung metastases were included in this study if (1) the primary tumor was controlled; (2) patients were ineligible for or refused surgery and chemotherapy; and (3) patients had 5 or fewer metastatic lesions in no more than 2 organs. Large peripheral tumors were treated with a dose of 60 Gy (3 fractions), small peripheral tumors with 30 Gy (1 fraction), central tumors received 60 Gy (5 fractions), and mediastinal tumors or tumors close to the esophagus received 56 Gy (7 fractions). Results: Thirty patients with 57 metastatic lung tumors from various primary cancers were analyzed. The median follow-up was 36 months (range, 4-60 months). At 2 years, local control for the 11 central tumors was 100%, for the 23 peripheral tumors treated to 60 Gy it was 91%, and for the 23 tumors treated in a single 30-Gy fraction it was 74% (P=.13). This resulted in an overall local control rate at 1 year of 79%, with a 2-sided 80% confidence interval of 67% to 87%. Because the hypothesized value of 70% lies within the confidence interval, we cannot reject the hypothesis that the true local control rate at 1 year is ≤70%, and therefore we did not achieve the goal of the study: an actuarial local control of the treated lung lesions at 1 year of 90%. The 4-year overall survival rate was 38%. Grade 3 acute toxicity occurred in 5 patients. Three patients complained of chronic grade 3 toxicity, including pain, fatigue, and pneumonitis, and 3 patients had rib fractures. Conclusions: The local control was promising, and the 4-year overall survival rate was 38%. The treatment was well tolerated, even for central lesions.

• OSTI ID: 22458600
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 91; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CHEMOTHERAPY
CONTROL
ESOPHAGUS
FATIGUE
FRACTURES
HYPOTHESIS
LUNGS
METASTASES
NEOPLASMS
PAIN
PATIENTS
PNEUMONITIS
RADIATION DOSES
RADIOTHERAPY
SURGERY
TOXICITY