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Following reports of improved efficacy in vertebral metastases, Stereotactic Body Radiotherapy has been increasingly applied for local palliation and disease control in non-spinal bone metastases. However, its use in the management of rib metastases (RM) has been traditionally limited due to purported risk of iatrogenic fracture, possibly resulting in impaired pain control. For this reason, SBRT in this setting has been scarcely reported in literature. The aim of our study is to evaluate pain control and local failure rates in RM treated with SBRT. We collected data from a cohort of RM patients treated from October 2014 to December 2023 with SBRT. Clinical and treatment-related data were collected. Pain Control (PC) was defined as absence or reduction of pain allowing for decreased medication intake. Local Failure (LF) was defined as radiologic progression on follow-up imaging. Univariable analysis with the log-rank test and multivariable analysis with the Cox model were performed to investigate predictors of PC and LF. Data from 55 patients accounting for 64 RM were collected. Median age was 70 (range = 37-78) years. Most represented primary tumors were prostate (41%, n = 26) and non-small cell lung cancer (21%, n = 13). Baseline pain before SBRT was reported in 26 (41%) lesions, requiring daily opioid intake in 12 cases (20%). SBRT was delivered with C-arm (92%, n = 59) and robotic-arm (8%, n = 5) Linac using the following regimens: 16 Gy/1 fraction, 24 Gy/2 fractions, 24-30 Gy/3 fractions, 30-55 Gy/5 fractions. Median EQD2 (assuming an α/β = 10) was 47 Gy (range = 35-96.25). Median follow-up was 14 (range = 1-76) months. PC was 87% at 6 months and 82% at 1 year. Age> 70 (P = 0.002), EQD2 ≤40 Gy (P = 0.009) and baseline pain (P = 0.004) were correlated with impaired PC although only EQD2 ≤40 Gy (P = 0.007) and baseline pain (P = 0.012) proved significant at multivariate analysis. LF rate was 2.0% at 6 months and 4.8% at 1 year. Median OS was 60 (95% CI= 25-70) months. No predictive factors of LF were identified at statistical analysis. Pain flare was observed in 1 patient. No rib fracture and/or skin fibrosis was observed. SBRT for RM is associated with low rates of local failure and durable pain control. Administration of SBRT before the onset of symptoms and use dose intensive regimens may result in improved pain control. [ABSTRACT FROM AUTHOR]

Aims Robotic stereotactic body radiotherapy (rSBRT) to local recurrences emerged as a valuable option for exclusive local failure after prior external beam radiation therapy (EBRT) for localised prostate cancer. The aim of this study was to assess the efficacy and safety of rSBRT in patients experiencing locally recurrent prostate cancer after prior definitive or postoperative radiotherapy using the Cyberknife. Materials and methods Data from 50 patients were retrospectively reviewed. Local recurrence was assessed by 18F-choline positron emission tomography and pelvic magnetic resonance imaging; a dose of 30 Gy was delivered in five fractions. Prostate-specific antigen (PSA) was assessed at 2 months, 6 months and every 4 months thereafter. Toxicity was assessed according to CTCAE v.4.03. Results All patients received prior EBRT. The median EQD2 total dose was 74 Gy (60–80 Gy). Eleven patients were receiving androgen deprivation after prior biochemical failure. At 6 months, 41 patients showed a median PSA decline of –77.1% (14.3–99.3%), whereas nine patients experienced a median PSA elevation of +58.7% (0–2300.0%). Biochemical relapse-free survival (BRFS) was 80.0%. Impaired BRFS was correlated with the high-risk category at diagnosis ( P = 0.014, hazard ratio 5.61) and ongoing androgen deprivation ( P = 0.025, hazard ratio 2.98). Neither clinical variables nor dosimetric parameters were found to be predictive for toxicity. Conclusion Focal rSBRT can achieve durable remission in locally relapsing patients and systemic treatment can be postponed with acceptable toxicity. Accurate patient selection is mandatory to maximise disease control. [ABSTRACT FROM AUTHOR]

The use of ablative Stereotactic Body Radiotherapy for the treatment of mediastinal and hilar lymph nodal metastases (MHL) has been traditionally limited due to proximity of critical organs and uncertainty in target recognition and treatment administration due to respiratory motion, potentially resulting in fatal adverse events. Fiducial-markers implanted via EBUS may allow delivery of ablative SBRT by Real-time tumor tracking (RTTT) or by refining CBCT image guidance. We report preliminary follow-up data from an observational prospective clinical study (FLUXUS) assessing the use of ablative SBRT in oligometastatic or oligoprogressive MHL. Data from a prospective cohort of patients treated from December 2021 to December 2023 with ablative SBRT for oligometastatic or oligoprogressive MHL from miscellaneous primary tumors were collected. Gold-anchor 25G FM were placed intralesionally via EBUS under general anesthesia following rigid bronchoscopy. One week later, blank and contrast enhanced simulation CT was acquired: in order to verify the solidarity between the FM and the tumor across the respiratory cycle an additional 4D CT was obtained. SBRT was delivered using RTTT with a robotic-arm Linac or surface and CBCT guided deep-inspiration breath hold (DIBH). Preliminary outcome and toxicity results were assessed. Eighteen patients, accounting for 21 MHL were included. Median age was 73 (range 48-87) years. Median follow-up was 6 months. Primary tumor locations were lung (n = 8), breast (n = 4), gastroesophageal (n = 3), and other (n = 3). Disease setting was oligometastatic and oligoprogressive MHL in 7 and 11 patients, respectively. MHL were located in nodal station 10-11 (n = 7), 4 (n = 6), 7 (n = 5), 2-3 (n = 2) and 8 (n = 1). Median number of implanted FM was 3 (range 2-3): no periprocedural complication or migration was observed. RTT and DIBH were used in 15 and 3 patients, respectively. In 3 patients, 2 MHL were simultaneously treated during the same treatment course, the remaining patients receiving SBRT to a single nodal site. Median prescription dose was 35 Gy (range, 30-40 Gy) in 5 fractions, corresponding to a median EQD2 of 49.5 Gy (range, 48-100 Gy) assuming α/β = 10. Local control (LC) was 95% at 1 year. Distant relapse-free (DRFS) and overall survival (OS) were 54% and 73% at 1 year, respectively. All 6 patients who were chemotherapy-naïve before SBRT were free from systemic therapy at the time of the analysis. Acute transient toxicity, consisting of grade 1 cough and pyrosis was observed in 2 patients. Only one patient experienced a grade≥3 late toxicity, consisting of aorto-esophageal fistula resulting in fatal hematemesis. FM placement is a minimally invasive and well tolerated procedure in elderly patients and allow the delivery of ablative SBRT to MHL with promising outcome and toxicity results. Caution is required in case of suspicion of mediastinal organ infiltration. [ABSTRACT FROM AUTHOR]

Salvage radiotherapy (SRT) is one of the most widely used approaches in case of biochemical recurrence after radical prostatectomy for prostate cancer. Macroscopic recurrence within the prostate bed in this scenario is often detected through PSMA PET/CT or Magnetic resonance imaging (MRI). Stereotactic salvage radiotherapy (SSRT) has been proposed as a method to improve disease control by dose escalation in these patients. STARR is a prospective trial exploring clinical outcomes after SSRT on macroscopic recurrence within prostate bed after radical prostatectomy. STARR trial is a prospective multicenter study enrolling subjects affected by prostate bed macroscopic recurrence. All relapses were detected by Choline, PSMA CT-PET or MRI performed after a post prostatectomy PSA rise above 0.2 ng/ml. All patients with regional or distant metastatic disease were excluded. SSRT consisting in a total dose of 35 Gy in 5 fractions every other day was administered on macroscopic relapse defined through CT-PET and/or MRI co-registration with planning CT. Androgen Deprivation therapy (ADT) was not prescribed. A PSA nadir <0.2 ng/ml and <50% of baseline, respectively, were defined as complete biochemical response (CBR) or biochemical response (BR). Sixty-one patients were enrolled between March 2021 and November 2023. The current analysis included 50 enrolled patients at the promoting institution with > 3 months of follow up. After a median follow up of 10 months (95% CI = 7-17), Acute genitourinary and gastrointestinal toxicity occurred in 4 (3 G1 and 1 G2), and 5 patients (3 G1 and 2 G2), respectively. Late genitourinary and gastrointestinal toxicity were identified in 7 (all G1) and 1 patient (G2), respectively. BR and CBR were detected at 3 months in 41 (82%) and 23 (46%) cases, respectively. Seven recurrences were detected (3 biochemical and 4 metastatic recurrences detected through PSMA PET-CT) Forty-six patients (92%) were free from ADT at the end of follow up. SSRT yielded optimal results in terms of safety, with only mild adverse events. Biochemical outcomes are promising, with a significant benefit in terms of clinically meaningful outcomes (i.e. new distant metastases occurrence and need for ADT start). [ABSTRACT FROM AUTHOR]

Oligometastatic disease in head and neck squamous cell carcinoma (HNSCC) is a rare setting. Local ablative therapies are the most adopted strategies although no evidence-based recommendations are currently published. The aim of our analysis was to update and report on long-term clinical outcomes of a cohort of HNSCC patients treated with stereotactic body radiotherapy (SBRT) for lung-only oligometastatic disease. Eligible patients had 1 to 5 lung metastases. The oligometastatic pattern was classified as "de novo" (suitable for SBRT only) or "oligoprogressive" (after first line of systemic therapy). We evaluated time to progression (TTP) as the time from the last day of SBRT to disease progression or death from any cause. Predictive factors of better clinical outcome and survival analysis were performed by Cox regression and Kaplan Meier methods, respectively. A cohort of 46 patients and 47 metastases were retrospectively evaluated. The median age was 67 years (range 37-86) and 87% of patients had a ECOG PS 0-1. HPV negative status (77%) and "de novo" oligometastatic pattern (78%) were reported by the majority of patients. After a median follow up of 28 months (range 2-88), median TTP and overall survival (OS) were 18 months (95% CI 4.8 – 31.2) and 62 months (95% CI 10,8 - 113.2), respectively. The median volume of planning target volume (PTV) was 20.4 cc (range 7.1-55.3). At univariate analysis, patients aged > 70 years reported a better TTP (p 0.013). No statistically significant correlation was observed in respect with gender (p 0.23), ECOG PS (p 0.34), oligometastatic pattern (p 0.13) and p16/HPV status (p 0.22). Out of 26 histologically proven metastases, we collected only 2 patients reporting concordance between p16/HPV positive status of primary tumor and lung metastases. Overall, 6 patients reported grade (G) 1-2 acute toxicity and no acute G3 adverse events were observed. Our findings suggested that SBRT may improve clinical outcome prolonging time to progression and to systemic treatments in a properly selected cohort of HNSCC patients with lung-only oligometastatic disease. Distant metastases from HPV-related primary HNSCC should be tested for p16/HPV status given the clinical implications of HPV positivity for diagnosis and treatment. [ABSTRACT FROM AUTHOR]