Prospective pilot study to assess patient outcome after stereotactic body radiation therapy (SBRT) for limited metastases from breast cancer.
Forty patients with < or =5 metastatic lesions received curative-intent SBRT, while 11 patients with >5 lesions, undergoing SBRT to < or =5 metastatic lesions, were treated with palliative-intent.
Among those treated with curative-intent, 4-year actuarial outcomes were: overall survival of 59%, progression-free survival of 38% and lesion local control of 89%. On univariate analyses, 1 metastatic lesion (versus 2-5), smaller tumor volume, bone-only disease, and stable or regressing lesions prior to SBRT were associated with more favorable outcome. Patients treated with palliative-intent SBRT were spared morbidity and mortality from progression of treated lesions, though all developed further metastatic progression shortly (median 4 months) after enrollment.
SBRT may yield prolonged survival and perhaps cure in select patients with limited metastases. Palliative-intent SBRT may be warranted for symptomatic or potentially symptomatic metastases.
"Most patients who have had any recurrent or metastatic sites of cancer are considered to be in their last stage of life. However, new notions of oligometastases and oligorecurrence have been proposed         . Oligometastases is the state in which the patient shows distant recurrence in only a limited number of regions. "
"If we used this dose scheme, the local control rate was quite low by 39% according to the results of previous studies. Dose increment would be needed for oligometastases patients who may have survival improvement by local control [18,20]. "
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the treatment effectiveness and proper radiation dose of helical tomotherapy (HT) in spine oligometastases from gastrointestinal cancers.
From 2006 to 2010, 20 gastrointestinal cancer patients were treated with HT for spine oligometastases (31 spine lesions). The gross tumor volume (GTV) was the tumor evident from magnetic resonance imaging images fused with simulation computed tomography images. Clinical target volume (CTV) encompassed involved vertebral bodies or dorsal elements. We assumed that the planning target volume was equal to the CTV. We assessed local control rate after HT for 31 spine metastases. Pain response was scored by using a numeric pain intensity scale (NPIS, from 0 to 10).
Spine metastatic lesions were treated with median dose of 40 Gy (range, 24 to 51 Gy) and median 5 Gy per fraction (range, 2.5 to 8 Gy) to GTV with median 8 fractions (range, 3 to 20 fraction). Median biologically equivalent dose (BED, α/β = 10 Gy) was 52 Gy(10) (range, 37.5 to 76.8 Gy(10)) to GTV. Six month local control rate for spine metastasis was 90.3%. Overall infield failure rate was 15% and outfield failure rate was 75%. Most patients showed pain relief after HT (93.8%). Median local recurrence free survival was 3 months. BED over 57 Gy(10) and oligometastases were identified as prognostic factors associated with improved local progression free survival (p = 0.012, p = 0.041).
HT was capable of delivering higher BED to metastatic lesions in close proximity of the spinal cord. Spine metastases from gastrointestinal tumors were sensitive to high dose radiation, and BED (α/β = 10 Gy) higher than 57 Gy(10) could improve local control.
[Show abstract][Hide abstract] ABSTRACT: In conclusion: • During the last two decades, as a result of the use of systemic therapy in conjunction with breast-conservation surgery and radiation therapy, the incidence of locoregional recurrence has been reduced to a level where further reduction, a goal worthy of achieving, is likely to have little impact on survival. • Despite the extensive information presented in this commentary, there is no new scientifically based evidence to justify replacing the current breast cancer hypothesis. • It is likely that findings from research related to molecular biology and genetics will be the source of information that will result in a new, testable thesis that will eventually replace the alternative hypothesis and thus the paradigm that currently governs the treatment of breast cancer.
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