Stereotactic body radiotherapy for metastatic sarcoma to the lung: adding to the arsenal of local therapy. Radiat Oncol 2023 Mar 01;18(1):42
Date
03/02/2023Pubmed ID
36859309Pubmed Central ID
PMC9976442DOI
10.1186/s13014-023-02226-3Scopus ID
2-s2.0-85149210071 (requires institutional sign-in at Scopus site) 1 CitationAbstract
INTRODUCTION: Conventional treatment of pulmonary metastatic sarcoma primarily involves surgery, with systemic therapy added in select patients. However, broader applications of radiation therapy techniques have prompted investigation into the use of stereotactic body radiotherapy (SBRT) for treatment of metastatic sarcoma, an attractive non-invasive intervention with potential for lower rates of adverse events than surgery. Current data are limited to retrospective analyses. This study analyzed 2-year local control and overall survival and adverse events in patients prospectively treated with SBRT to pulmonary sarcoma metastases.
METHODS: Patients prospectively treated with SBRT to the lung for biopsy-proven metastatic sarcoma at a single institution from 2010 to 2022 were included. SBRT dose/fractionation treatment regimens ranged from 34 to 54 Gy in 1-10 fractions using photons. Local recurrence, local progression-free survival (LPFS) and overall survival (OS) were calculated from the end of SBRT. Univariable analysis (UVA) was performed using the log-rank test. Multivariable analysis (MVA) was performed using the Cox proportional hazards model. Adverse events due to SBRT were graded based on the Common Terminology Criteria for Adverse Events, version 4.0.
RESULTS: Eighteen patients with metastatic sarcoma were treated to 26 pulmonary metastases. The median local progression-free survival was not met. The median overall survival was not met. The local control rate at 2 years was 96%. 2-year LPFS was 95.5% and OS was 74%. Three patients (16.7%) developed grade 1 adverse events from SBRT. There were no adverse events attributed to radiation that were grade 2 or higher.
CONCLUSION: We report prospective data demonstrating that SBRT for sarcoma pulmonary metastases affords a high rate of local control and low toxicity, consistent with prior sarcoma SBRT retrospective data. This study adds to the wealth of information on SBRT in a radioresistant tumor. Though largely limited to retrospective reviews, current data indicate high rates of local control with favorable toxicity profiles. Therefore, SBRT for pulmonary sarcoma metastases may be considered for properly selected patients.
Author List
Gutkin PM, Gore E, Charlson J, Neilson JC, Johnstone C, King DM, Hackbarth DA, Wooldridge A, Mannem R, Bedi MAuthors
Manpreet Bedi MD, MS Professor in the Radiation Oncology department at Medical College of WisconsinJohn A. Charlson MD Associate Professor in the Medicine department at Medical College of Wisconsin
Elizabeth M. Gore MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Candice A. Johnstone MD, MPH Professor in the Radiation Oncology department at Medical College of Wisconsin
David M. King MD Chair, Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
Rajeev Mannem MD Chief, Associate Professor in the Radiology department at Medical College of Wisconsin
John C. Neilson MD Associate Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
Adam Neal Wooldridge MD, MPH Assistant Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
HumansLung
Lung Neoplasms
Neoplasms, Second Primary
Prospective Studies
Radiosurgery
Retrospective Studies
Sarcoma
Soft Tissue Neoplasms
