Effectiveness of Stereotactic Ablative Radiotherapy for Systemic Therapy Respondents with Inoperable Pulmonary Oligometastases and Oligoprogression
Stereotactic ablative radiotherapy (SABR) may improve survival in patients with inoperable pulmonary oligometastases. However, the impact of pulmonary oligometastatic status after systemic therapy on SABR outcomes remains unclear. Hence, we investigated the outcomes of SABR in 45 patients with 77 lu...
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MDPI AG
2023-04-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/9/1597 |
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| author | Chin-Beng Ho Jo-Ting Tsai Chun-You Chen Her-Shyong Shiah Hsuan-Yu Chen Lai-Lei Ting Chia-Chun Kuo I-Chun Lai Hsin-Yi Lai Chi-Li Chung Kai-Ling Lee Huey-En Tzeng Kuen-Haur Lee Hsin-Lun Lee Shang-Wen Chen Jeng-Fong Chiou |
| author_facet | Chin-Beng Ho Jo-Ting Tsai Chun-You Chen Her-Shyong Shiah Hsuan-Yu Chen Lai-Lei Ting Chia-Chun Kuo I-Chun Lai Hsin-Yi Lai Chi-Li Chung Kai-Ling Lee Huey-En Tzeng Kuen-Haur Lee Hsin-Lun Lee Shang-Wen Chen Jeng-Fong Chiou |
| author_sort | Chin-Beng Ho |
| collection | DOAJ |
| description | Stereotactic ablative radiotherapy (SABR) may improve survival in patients with inoperable pulmonary oligometastases. However, the impact of pulmonary oligometastatic status after systemic therapy on SABR outcomes remains unclear. Hence, we investigated the outcomes of SABR in 45 patients with 77 lung tumors and the prognostic value of pulmonary oligoprogression. Eligibility criteria were pulmonary oligometastases (defined as ≤5 metastatic lung tumors), controlled extrapulmonary disease (EPD) after front-line systemic therapy, SABR as primary local treatment for inoperable pulmonary metastases, and consecutive imaging follow-up. Oligometastatic lung tumor was classified into controlled or oligoprogressive status. Overall survival (OS), in-field progression-free survival (IFPFS), out-field progression-free survival (OFPFS), and prognostic variables were evaluated. With 21.8 months median follow-up, the median OS, IFPFS, and OFPFS were 28.3, not reached, and 6.5 months, respectively. Two-year OS, IFPFS, and OFPFS rates were 56.0%, 74.2%, and 17.3%, respectively. Oligoprogressive status (<i>p</i> = 0.003), disease-free interval < 24 months (<i>p</i> = 0.041), and biologically effective dose (BED<sub>10</sub>) < 100 Gy (<i>p</i> = 0.006) were independently associated with inferior OS. BED<sub>10</sub> ≥ 100 Gy (<i>p</i> = 0.029) was independently correlated with longer IFPFS. Oligoprogressive status (<i>p</i> = 0.017) and EPD (<i>p</i> = 0.019) were significantly associated with inferior OFPFS. Grade ≥ 2 radiation pneumonitis occurred in four (8.9%) patients. Conclusively, SABR with BED<sub>10</sub> ≥ 100 Gy could provide substantial in-field tumor control and longer OS for systemic therapy respondents with inoperable pulmonary oligometastases. Oligoprogressive lung tumors exhibited a higher risk of out-field treatment failure and shorter OS. Hence, systemic therapy should be tailored for patients with oligoprogression to reduce the risk of out-field treatment failure. However, in the absence of effective systemic therapy, SABR is a reasonable alternative to reduce resistant tumor burden. |
| first_indexed | 2024-03-11T04:21:11Z |
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| language | English |
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| series | Diagnostics |
| spelling | doaj.art-6f9f9045cd914a84a5296d51701317082023-11-17T22:45:51ZengMDPI AGDiagnostics2075-44182023-04-01139159710.3390/diagnostics13091597Effectiveness of Stereotactic Ablative Radiotherapy for Systemic Therapy Respondents with Inoperable Pulmonary Oligometastases and OligoprogressionChin-Beng Ho0Jo-Ting Tsai1Chun-You Chen2Her-Shyong Shiah3Hsuan-Yu Chen4Lai-Lei Ting5Chia-Chun Kuo6I-Chun Lai7Hsin-Yi Lai8Chi-Li Chung9Kai-Ling Lee10Huey-En Tzeng11Kuen-Haur Lee12Hsin-Lun Lee13Shang-Wen Chen14Jeng-Fong Chiou15Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei 110301, TaiwanDepartment of Radiation Oncology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, TaiwanTaipei Cancer Center, Taipei Medical University, Taipei 110301, TaiwanDivision of Hematology and Oncology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231016, TaiwanPh.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei 110301, TaiwanDepartment of Radiation Oncology, Taipei Medical University Hospital, Taipei 110301, TaiwanPh.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei 110301, TaiwanDepartment of Heavy Particles and Radiation Oncology, Taipei Veterans General Hospital, Taipei 112201, TaiwanDepartment of Medical Imaging, Taipei Medical University Hospital, Taipei Medical University, Taipei 110301, TaiwanDivision of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei 110301, TaiwanDivision of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei 110301, TaiwanGraduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 110301, TaiwanPh.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei 110301, TaiwanDepartment of Radiation Oncology, Taipei Medical University Hospital, Taipei 110301, TaiwanDepartment of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, TaiwanPh.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei 110301, TaiwanStereotactic ablative radiotherapy (SABR) may improve survival in patients with inoperable pulmonary oligometastases. However, the impact of pulmonary oligometastatic status after systemic therapy on SABR outcomes remains unclear. Hence, we investigated the outcomes of SABR in 45 patients with 77 lung tumors and the prognostic value of pulmonary oligoprogression. Eligibility criteria were pulmonary oligometastases (defined as ≤5 metastatic lung tumors), controlled extrapulmonary disease (EPD) after front-line systemic therapy, SABR as primary local treatment for inoperable pulmonary metastases, and consecutive imaging follow-up. Oligometastatic lung tumor was classified into controlled or oligoprogressive status. Overall survival (OS), in-field progression-free survival (IFPFS), out-field progression-free survival (OFPFS), and prognostic variables were evaluated. With 21.8 months median follow-up, the median OS, IFPFS, and OFPFS were 28.3, not reached, and 6.5 months, respectively. Two-year OS, IFPFS, and OFPFS rates were 56.0%, 74.2%, and 17.3%, respectively. Oligoprogressive status (<i>p</i> = 0.003), disease-free interval < 24 months (<i>p</i> = 0.041), and biologically effective dose (BED<sub>10</sub>) < 100 Gy (<i>p</i> = 0.006) were independently associated with inferior OS. BED<sub>10</sub> ≥ 100 Gy (<i>p</i> = 0.029) was independently correlated with longer IFPFS. Oligoprogressive status (<i>p</i> = 0.017) and EPD (<i>p</i> = 0.019) were significantly associated with inferior OFPFS. Grade ≥ 2 radiation pneumonitis occurred in four (8.9%) patients. Conclusively, SABR with BED<sub>10</sub> ≥ 100 Gy could provide substantial in-field tumor control and longer OS for systemic therapy respondents with inoperable pulmonary oligometastases. Oligoprogressive lung tumors exhibited a higher risk of out-field treatment failure and shorter OS. Hence, systemic therapy should be tailored for patients with oligoprogression to reduce the risk of out-field treatment failure. However, in the absence of effective systemic therapy, SABR is a reasonable alternative to reduce resistant tumor burden.https://www.mdpi.com/2075-4418/13/9/1597pulmonary metastasesoligometastasesoligoprogressionextrapulmonary diseasemetastasectomystereotactic ablative radiotherapy (SABR) |
| spellingShingle | Chin-Beng Ho Jo-Ting Tsai Chun-You Chen Her-Shyong Shiah Hsuan-Yu Chen Lai-Lei Ting Chia-Chun Kuo I-Chun Lai Hsin-Yi Lai Chi-Li Chung Kai-Ling Lee Huey-En Tzeng Kuen-Haur Lee Hsin-Lun Lee Shang-Wen Chen Jeng-Fong Chiou Effectiveness of Stereotactic Ablative Radiotherapy for Systemic Therapy Respondents with Inoperable Pulmonary Oligometastases and Oligoprogression Diagnostics pulmonary metastases oligometastases oligoprogression extrapulmonary disease metastasectomy stereotactic ablative radiotherapy (SABR) |
| title | Effectiveness of Stereotactic Ablative Radiotherapy for Systemic Therapy Respondents with Inoperable Pulmonary Oligometastases and Oligoprogression |
| title_full | Effectiveness of Stereotactic Ablative Radiotherapy for Systemic Therapy Respondents with Inoperable Pulmonary Oligometastases and Oligoprogression |
| title_fullStr | Effectiveness of Stereotactic Ablative Radiotherapy for Systemic Therapy Respondents with Inoperable Pulmonary Oligometastases and Oligoprogression |
| title_full_unstemmed | Effectiveness of Stereotactic Ablative Radiotherapy for Systemic Therapy Respondents with Inoperable Pulmonary Oligometastases and Oligoprogression |
| title_short | Effectiveness of Stereotactic Ablative Radiotherapy for Systemic Therapy Respondents with Inoperable Pulmonary Oligometastases and Oligoprogression |
| title_sort | effectiveness of stereotactic ablative radiotherapy for systemic therapy respondents with inoperable pulmonary oligometastases and oligoprogression |
| topic | pulmonary metastases oligometastases oligoprogression extrapulmonary disease metastasectomy stereotactic ablative radiotherapy (SABR) |
| url | https://www.mdpi.com/2075-4418/13/9/1597 |
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