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Stereotactic Ablative Radiation Therapy for Pulmonary Metastases: Histology, Dose, and Indication Matter
- Source :
- International Journal of Radiation Oncology*Biology*Physics. 98:419-427
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- To assess the association between colorectal cancer (CRC) histology, dose, and local failure (LF) after stereotactic ablative radiation therapy (SABR) for pulmonary metastases, and to describe subsequent cancer progression, change of systemic therapy (CST), survival, and their association with treatment indications.From a prospective SABR cohort, 180 pulmonary metastases in 120 patients were identified. Treatment indications were single metastasis, oligometastases, oligoprogression, and dominant areas of progression. Doses of 48 to 52 Gy/4 to 5 fractions were delivered. Since 2010 the dose for peripheral CRC metastases was increased to 60 Gy/4 fractions. Cumulative incidence function (CIF) was used to report LF, progression probability, and CST. The Kaplan-Meier method estimated overall survival (OS). Univariate and multivariable analyses to assess variable associations were conducted.Median follow-up was 22 months (interquartile range, 14-33 months). At 24 months, the CIF of LF was 23.6% (95% confidence interval [CI] 15.1%-33.3%) and 8.3% (95% CI 2.6%-18.6%), respectively, for CRC and non-CRC metastases (P.001). This association remained significant after adjusting for confounders (subdistribution hazard ratio [SHR] 13.6, 95% CI 4.2-44.1, P.001). Among CRC metastases, 56 and 45 received60 Gy and 60 Gy, respectively. Delivering 60 Gy was independently associated with a lower hazard of LF (SHR 0.271, 95% CI 0.078-0.940, P=.040). At 12 months the CIF of progression was 41.67% (95% CI 21.69%-60.56%), 42.51% (95% CI 29.09%-55.29%), 62.96% (95% CI 41.25%-78.53%), and 78.57% (95% CI 42.20%-93.48%), respectively, for patients treated for single metastasis, oligometastases, oligoprogression, and dominant area of progression (P.001). A CST was observed, respectively, in 4 (17%), 17 (31%), 12 (44%), and 10 (71%) patients with a median time of 13.1, 11.1, 8.4, and 8.4 months.Colorectal cancer lung metastases are associated with a higher hazard of LF and require higher SABR doses. Outcomes for patients with oligometastases and oligoprogression treated with SABR seem favorable. Prospective clinical trials are needed to confirm these benefits.
- Subjects :
- Male
Cancer Research
medicine.medical_specialty
Lung Neoplasms
Time Factors
Colorectal cancer
medicine.medical_treatment
Kaplan-Meier Estimate
Radiosurgery
SABR volatility model
Gastroenterology
030218 nuclear medicine & medical imaging
Metastasis
03 medical and health sciences
0302 clinical medicine
Interquartile range
Internal medicine
medicine
Humans
Radiology, Nuclear Medicine and imaging
Treatment Failure
Four-Dimensional Computed Tomography
Aged
Probability
Analysis of Variance
Radiation
business.industry
Radiotherapy Planning, Computer-Assisted
Dose fractionation
Cancer
medicine.disease
Radiation therapy
Oncology
030220 oncology & carcinogenesis
Disease Progression
Female
Dose Fractionation, Radiation
Colorectal Neoplasms
business
Nuclear medicine
Follow-Up Studies
Subjects
Details
- ISSN :
- 03603016
- Volume :
- 98
- Database :
- OpenAIRE
- Journal :
- International Journal of Radiation Oncology*Biology*Physics
- Accession number :
- edsair.doi.dedup.....605334ac9293547713cb66b9c70b3f1a