Oligometastatic breast cancer treated with curative-intent stereotactic body radiation therapy.
ABSTRACT 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.
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ABSTRACT: Anticancer cytotoxic agents go through a process by which their antitumor activity-on the basis of the amount of tumor shrinkage they could generate-has been investigated. In the late 1970s, the International Union Against Cancer and the World Health Organization introduced specific criteria for the codification of tumor response evaluation. In 1994, several organizations involved in clinical research combined forces to tackle the review of these criteria on the basis of the experience and knowledge acquired since then. After several years of intensive discussions, a new set of guidelines is ready that will supersede the former criteria. In parallel to this initiative, one of the participating groups developed a model by which response rates could be derived from unidimensional measurement of tumor lesions instead of the usual bidimensional approach. This new concept has been largely validated by the Response Evaluation Criteria in Solid Tumors Group and integrated into the present guidelines. This special article also provides some philosophic background to clarify the various purposes of response evaluation. It proposes a model by which a combined assessment of all existing lesions, characterized by target lesions (to be measured) and nontarget lesions, is used to extrapolate an overall response to treatment. Methods of assessing tumor lesions are better codified, briefly within the guidelines and in more detail in Appendix I. All other aspects of response evaluation have been discussed, reviewed, and amended whenever appropriate.JNCI Journal of the National Cancer Institute 03/2000; 92(3):205-16. · 14.34 Impact Factor
Article: Oligometastases.Journal of Clinical Oncology 02/1995; 13(1):8-10. · 18.04 Impact Factor
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ABSTRACT: The curative treatment of oligometastases with radiotherapy remains an area of active investigation. We hypothesise that treating oligometastases with SBRT can prolong life and potentially cure patients, while in patients with multiple lung metastases SBRT can improve quality of life. Fifty patients with lung metastases were treated on this study. Individuals with five or fewer total lesions were treated with curative intent. Individuals with > five metastases were treated palliatively. Most patients (62%) received 5 Gy/fraction for a total of 50 Gy. The number of targets treated per patient ranged from one to five (mean 2.6). Tumor sizes ranged from 0.3-7.7 cm in maximal diameter (median 2.1 cm). Mean follow-up was 18.7 months. Local control of treated lesions was obtained in 42 of 49 evaluable patients (83%). Of the 125 total lesions treated, eight progressed after treatment (94% crude local control). The median overall survival time from time of treatment completion of the curatively treated patients was 23.4 months. The progression-free survival of the same group of patients was 25% and 16% at 12 and 24 months, respectively. Grade 1 toxicity occurred in 35% of all the patients, 6.1% had grade 2 toxicity, and 2% had grade 3 toxicity. Excellent local tumor control rates with low toxicity are seen with SBRT. Median survival time and progression-free survival both appear better than that achieved with standard care alone. Long-term progression-free survival can be seen in a subset of patients when all tumors are targeted.Acta Oncologica 02/2006; 45(7):808-17. · 2.87 Impact Factor