Abstract
Aims
To retrospectively evaluate the outcome of stereotactic body radiation therapy (SBRT) in the treatment of elderly patients affected by isolated body metastasis from different primitive tumors.
Methods
70 patients with isolated body metastasis were treated. Median age at diagnosis was 75 years (IQR 69–80). The most common SBRT fractionation scheme was 5 × 7 Gy (total dose 35 Gy). The primary endpoints were Local Control (LC) and Toxicity. Secondary endpoints were Overall Survival (OS) and Disease-Specific Survival (DSS). Response to radiotherapy was assessed according to RECIST criteria v1.1. Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v 4.0. We performed survival analysis with the Kaplan–Meier method. The correlation between time actuarial incidence and clinical parameters was studied.
Results
Median follow-up was 26.5 months. 44 patients (62.8%) were alive at the time of analysis, while 22 (31.4%) died because of the disease. Local control at 2 and 3 years was 87%. The 2-year OS and DSS were 84 and 71%, respectively, while the 3-year values were 57 and 62%. PFS at 2 and 3 years was 41 and 25%, respectively. On univariate analysis, KPS ≥ 90 is statistically correlated with improved OS and DSS (p < 0.05). Acute toxicity of grade ≥ 2 occurred in 4 (5.7%) patients, while late toxicity ≥ 2 was recorded in 6 (8.6%) patients.
Conclusions
Ablative Radiotherapy represents a safe, effective, and minimally invasive treatment modality for elderly oligometastatic patients who are judged unfit for systemic therapy.
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References
Smith BD, Smith GL, Hurria A, Hortobagyi GN, Bucholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27:2758–2765
Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr (1999) Albain KS Underrepresentation of patients 65 years of age or older in cancer-treatment trial. N Engl J Med 341:2061–2067
Hayashi S, Tanaka H, Kajiura Y, Ohno Y, Hoshi H (2014) Stereotactic body radiotherapy for very elderly patients (age, greater than or equal to 85 years) with stage I non-small cell lung cancer. Radiat Oncol 9:138
Nieder C, Angelo K, Haukland E (2014) Pawinski A Survival after palliative radiotherapy in geriatric cancer patients. Anticancer Res 34:6641–6645
Weichselbaum RR, Hellman S (2011) Oligometastases revisited. Nat Rev Clin Oncol 8:378–382
Lancia A, Ingrosso G, Carosi A et al (2017) Oligometastatic cancer: stereotactic ablative radiotherapy for patients affected by isolated body metastasis. Acta Oncol 56(11):1621–1625
Ricardi U, Badellino S, Filippi AR (2016) Clinical applications of stereotactic radiation therapy for oligometastatic cancer patients: a disease-oriented approach. J Radiat Res 57:i58–i68
Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247
Dagan R, Lo SS, Redmond KJ et al (2016) A multi-national report on stereotactic body radiotherapy for oligometastases: patient selection and follow-up. Acta Oncol 55:633–637
Kavanagh BD, McGarry RC, Timmerman RD (2006) Extracranial radiosurgery (stereotactic body radiotherapy) for oligometastases. Semin Radiat Oncol 16:77–84
Kress MA, Collins BT, Collins SP et al (2012) Scoring system predictive of survival for patients undergoing stereotactic body radiation therapy for liver tumors. Radiat Oncol 7:148
Fleckenstein J, Petroff A, Schafers HJ et al (2016) Long-term outcomes in radically treated synchronous vs. metachronous oligometastatic non-small-cell lung cancer. BMC Cancer 16:348
Kunkler IH, Audisio R, Belkacemi Y (2014) Review of current best practice and priorities for research in radiation oncology for elderly patients with cancer: the International Society of Geriatric Oncology (SIOG) task force. Ann Oncol 25:2134–2146
Rosenbluth RG (2012) Geriatric Oncology. Clin Geriatr Med 28:1
Extermann M, Hurria A (2007) Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol 25:1824–1831
Nguyen NP, Godinez J, Shen W et al (2016) Is surgery indicated for elderly patients with early stage nonsmall cell lung cancer, in the era of stereotactic body radiotherapy? Medicine (Baltimore) 95:e5212
Scorsetti M, Clerici E, Navarria P et al (2015) The role of stereotactic body radiation therapy (SBRT) in the treatment of oligometastatic disease in the elderly. Br J Radiol 88:20150111
Morris L, Thiruthaneeswaran N, Lehman M, Hasselburg G, Turner S (2017) Are future radiation oncologists equipped with the knowledge to manage elderly patients with cancer? Int J Radiat Oncol Biol Phys 98:743–747
Palma DA, Haasbeek CJA, Rodrigues GB et al (2012) Stereotactic ablative radiotherapy for comprehensive treatment of oligometastatic tumors (SABR-COMET): Study protocol for a randomized phase II trial. BMC Cancer 12:305
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Lancia, A., Ingrosso, G., Carosi, A. et al. Oligometastatic cancer in elderly patients: the “blitzkrieg” radiotherapy approach. Aging Clin Exp Res 31, 109–114 (2019). https://doi.org/10.1007/s40520-018-0937-6
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DOI: https://doi.org/10.1007/s40520-018-0937-6