Late metastatic presentation is associated with improved survival and delayed wide‐spread progression after ablative stereotactic body radiotherapy for oligometastasis
Abstract Background Stereotactic body radiotherapy (SBRT) is increasingly used to treat oligometastatic disease (OMD), but the effect of metastasis timing on patient outcomes remains uncertain. Methods An international database of patients with OMD treated with SBRT was assembled with rigorous quali...
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| 格式: | 文件 |
| 语言: | English |
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Wiley
2021-09-01
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| 丛编: | Cancer Medicine |
| 主题: | |
| 在线阅读: | https://doi.org/10.1002/cam4.4133 |
| _version_ | 1831768761744490496 |
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| author | Xuguang Chen Hanbo Chen Ian Poon Darby Erler Serena Badellino Tithi Biswas Roi Dagan Matthew Foote Alexander V. Louie Umberto Ricardi Arjun Sahgal Kristin J. Redmond |
| author_facet | Xuguang Chen Hanbo Chen Ian Poon Darby Erler Serena Badellino Tithi Biswas Roi Dagan Matthew Foote Alexander V. Louie Umberto Ricardi Arjun Sahgal Kristin J. Redmond |
| author_sort | Xuguang Chen |
| collection | DOAJ |
| description | Abstract Background Stereotactic body radiotherapy (SBRT) is increasingly used to treat oligometastatic disease (OMD), but the effect of metastasis timing on patient outcomes remains uncertain. Methods An international database of patients with OMD treated with SBRT was assembled with rigorous quality assurance. Early versus late metastases were defined as those diagnosed ≤24 versus >24 months from the primary tumor. Overall survival (OS), progression‐free survival (PFS), and incidences of wide‐spread progression (WSP) were estimated using multivariable Cox proportional hazard models stratified by primary tumor types. Results The database consists of 1033 patients with median follow‐up of 24.1 months (0.3–104.7). Late metastatic presentation (N = 427) was associated with improved OS compared to early metastasis (median survival 53.6 vs. 33.0 months, hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.47–0.72, p < 0.0001). Patients with non‐small cell lung cancer (NSCLC, N = 255, HR 0.49, 95% CI: 0.33–0.74, p = 0.0005) and colorectal cancer (N = 235, HR 0.50, 95% CI: 0.30–0.84, p = 0.008) had better OS if presenting with late metastasis. Late metastasis correlated with longer PFS (median 17.1 vs. 9.0 months, HR 0.71, 95% CI: 0.61–0.83, p < 0.0001) and lower 2‐year incidence of WSP (26.1% vs. 43.6%, HR 0.60, 95% CI: 0.49–0.74, p < 0.0001). Fewer WSP were observed in patients with NSCLC (HR 0.52, 95% CI: 0.33–0.83, p = 0.006) and kidney cancer (N = 63, HR 0.37, 95% CI: 0.14–0.97, p = 0.044) with late metastases. Across cancer types, greater SBRT target size was a significant predictor for worse OS. Conclusion Late metastatic presentation is associated with improved survival and delayed progression in patients with OMD treated with SBRT. |
| first_indexed | 2024-12-22T07:08:19Z |
| format | Article |
| id | doaj.art-d3cb54297a1f4e3c9f99058edb00c3e9 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-12-22T07:08:19Z |
| publishDate | 2021-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-d3cb54297a1f4e3c9f99058edb00c3e92022-12-21T18:34:37ZengWileyCancer Medicine2045-76342021-09-0110186189619810.1002/cam4.4133Late metastatic presentation is associated with improved survival and delayed wide‐spread progression after ablative stereotactic body radiotherapy for oligometastasisXuguang Chen0Hanbo Chen1Ian Poon2Darby Erler3Serena Badellino4Tithi Biswas5Roi Dagan6Matthew Foote7Alexander V. Louie8Umberto Ricardi9Arjun Sahgal10Kristin J. Redmond11Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins University School of Medicine Baltimore USADepartment of Radiation Oncology Sunnybrook Odette Cancer Center University of Toronto Toronto ON CanadaDepartment of Radiation Oncology Sunnybrook Odette Cancer Center University of Toronto Toronto ON CanadaDepartment of Radiation Oncology Sunnybrook Odette Cancer Center University of Toronto Toronto ON CanadaOncology Department University of Turin Turin ItalyUniversity Hospitals Seidman Cancer CenterCase Western Reserve University Cleveland OH USADepartment of Radiation Oncology University of Florida Jacksonville FL USADepartment of Radiation Oncology University of QueenslandPrincess Alexandra Hospital Queensland AustraliaDepartment of Radiation Oncology Sunnybrook Odette Cancer Center University of Toronto Toronto ON CanadaOncology Department University of Turin Turin ItalyDepartment of Radiation Oncology Sunnybrook Odette Cancer Center University of Toronto Toronto ON CanadaDepartment of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins University School of Medicine Baltimore USAAbstract Background Stereotactic body radiotherapy (SBRT) is increasingly used to treat oligometastatic disease (OMD), but the effect of metastasis timing on patient outcomes remains uncertain. Methods An international database of patients with OMD treated with SBRT was assembled with rigorous quality assurance. Early versus late metastases were defined as those diagnosed ≤24 versus >24 months from the primary tumor. Overall survival (OS), progression‐free survival (PFS), and incidences of wide‐spread progression (WSP) were estimated using multivariable Cox proportional hazard models stratified by primary tumor types. Results The database consists of 1033 patients with median follow‐up of 24.1 months (0.3–104.7). Late metastatic presentation (N = 427) was associated with improved OS compared to early metastasis (median survival 53.6 vs. 33.0 months, hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.47–0.72, p < 0.0001). Patients with non‐small cell lung cancer (NSCLC, N = 255, HR 0.49, 95% CI: 0.33–0.74, p = 0.0005) and colorectal cancer (N = 235, HR 0.50, 95% CI: 0.30–0.84, p = 0.008) had better OS if presenting with late metastasis. Late metastasis correlated with longer PFS (median 17.1 vs. 9.0 months, HR 0.71, 95% CI: 0.61–0.83, p < 0.0001) and lower 2‐year incidence of WSP (26.1% vs. 43.6%, HR 0.60, 95% CI: 0.49–0.74, p < 0.0001). Fewer WSP were observed in patients with NSCLC (HR 0.52, 95% CI: 0.33–0.83, p = 0.006) and kidney cancer (N = 63, HR 0.37, 95% CI: 0.14–0.97, p = 0.044) with late metastases. Across cancer types, greater SBRT target size was a significant predictor for worse OS. Conclusion Late metastatic presentation is associated with improved survival and delayed progression in patients with OMD treated with SBRT.https://doi.org/10.1002/cam4.4133late metastasismetastasis‐directed radiotherapyoligometastasisSABRSBRTwide‐spread progression |
| spellingShingle | Xuguang Chen Hanbo Chen Ian Poon Darby Erler Serena Badellino Tithi Biswas Roi Dagan Matthew Foote Alexander V. Louie Umberto Ricardi Arjun Sahgal Kristin J. Redmond Late metastatic presentation is associated with improved survival and delayed wide‐spread progression after ablative stereotactic body radiotherapy for oligometastasis Cancer Medicine late metastasis metastasis‐directed radiotherapy oligometastasis SABR SBRT wide‐spread progression |
| title | Late metastatic presentation is associated with improved survival and delayed wide‐spread progression after ablative stereotactic body radiotherapy for oligometastasis |
| title_full | Late metastatic presentation is associated with improved survival and delayed wide‐spread progression after ablative stereotactic body radiotherapy for oligometastasis |
| title_fullStr | Late metastatic presentation is associated with improved survival and delayed wide‐spread progression after ablative stereotactic body radiotherapy for oligometastasis |
| title_full_unstemmed | Late metastatic presentation is associated with improved survival and delayed wide‐spread progression after ablative stereotactic body radiotherapy for oligometastasis |
| title_short | Late metastatic presentation is associated with improved survival and delayed wide‐spread progression after ablative stereotactic body radiotherapy for oligometastasis |
| title_sort | late metastatic presentation is associated with improved survival and delayed wide spread progression after ablative stereotactic body radiotherapy for oligometastasis |
| topic | late metastasis metastasis‐directed radiotherapy oligometastasis SABR SBRT wide‐spread progression |
| url | https://doi.org/10.1002/cam4.4133 |
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