Juliane Rieber1, Jan Streblow1, Lorenz Uhlmann2, Michael Flentje3, Marciana Duma4, Iris Ernst5, Oliver Blanck6, Andrea Wittig7, Judit Boda-Heggemann8, Robert Krempien9, Fabian Lohaus10, Nathalie Desirée Klass11, Michael J Eble12, Detlef Imhoff13, Henning Kahl14, Cordula Petersen15, Sabine Gerum16, Christoph Henkenberens17, Sonja Adebahr18, Peter Hass19, Elsge Schrade20, Thomas G Wendt21, Guido Hildebrandt22, Nicolaus Andratschke23, Florian Sterzing24, Matthias Guckenberger25. 1. Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany. 2. Institute of Medical Biometry and Informatics, University of Heidelberg, Germany. 3. Department of Radiation Oncology, University Hospital Wuerzburg, Germany. 4. Department of Radiation Oncology, Technical University Munich, Germany. 5. Department of Radiation Oncology, University Hospital Münster, Germany. 6. Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig-Holstein, Kiel, Germany. 7. Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Germany. 8. Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany. 9. Department of Radiation Oncology, Helios Klinikum Berlin Buch, Germany. 10. Department of Radiation Oncology, Medical Faculty and University Hospital C.G. Carus, Technical University Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK) partner site Dresden, Germany; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany. 11. Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland. 12. Department of Radiation Oncology, University Hospital Aachen, Germany. 13. Department of Radiation Oncology, University Hospital Frankfurt, Germany. 14. Department of Radiation Oncology, Hospital Augsburg, Germany. 15. Department of Radiation Oncology, University Hospital Hamburg, Germany. 16. Department of Radiation Oncology, Ludwig Maximilians University Munich, Germany. 17. Department of Radiotherapy and Special Oncology, Medical School Hannover, Germany. 18. Department of Radiation Oncology, University Hospital Freiburg, Germany. 19. Department of Radiation Oncology, University Hospital Magdeburg, Germany. 20. Department of Radiation Oncology, Hospital Heidenheim, Germany. 21. Department of Radiation Oncology, University Hospital Jena, Germany. 22. Department of Radiation Oncology, University of Rostock, Germany. 23. Department of Radiation Oncology, University of Rostock, Germany; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland. 24. Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany; German Cancer Research Center, Clinical Cooperation Unit Radiation Oncology, Heidelberg, Germany. 25. Department of Radiation Oncology, University Hospital Wuerzburg, Germany; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland. Electronic address: juliane.rieber@med.uni-heidelberg.de.
Abstract
OBJECTIVES: The current literature on stereotactic body radiotherapy (SBRT) for oligometastatic disease is characterized by small patient cohorts with heterogeneous primary tumors, metastases location and dose regimes. Hence, this study established a multi-institutional database of 700 patients treated with SBRT for pulmonary metastases to identify prognostic factors influencing survival and local control. MATERIALS AND METHODS: All German radiotherapy departments were contacted and invited to participate in this analysis. A total number of 700 patients with medically inoperable lung metastases treated with SBRT in 20 centers between 1997 and 2014 were included in a database. Primary and metastatic tumor characteristics, treatment characteristics and follow-up data including survival, local control, distant metastases, and toxicity were evaluated. Lung metastases were treated with median PTV-encompassing single doses of 12.5Gy (range 3.0-33.0Gy) in a median number of 3 fractions (range 1-13). RESULTS: After a median follow-up time of 14.3 months, 2-year local control (LC) and overall survival (OS) were 81.2% and 54.4%, respectively. In multivariate analysis, OS was most significantly influenced by pretreatment performance status, maximum metastasis diameter, primary tumor histology, time interval between primary tumor diagnosis and SBRT treatment and number of metastases. For LC, independent prognostic factors were pretreatment performance status, biological effective dose (BED) at PTV isocenter (BEDISO) and single fraction (PTV-encompassing) dose in multivariate analysis. Radiation-induced pneumonitis grade 2 or higher was observed in 6.5% of patients. The only factor significantly influencing toxicity was BEDISO (p=0.006). CONCLUSION: SBRT for medically inoperable patients with pulmonary metastases achieved excellent local control and promising overall survival. Important prognostic factors were identified for selecting patients who might benefit most from this therapy approach.
OBJECTIVES: The current literature on stereotactic body radiotherapy (SBRT) for oligometastatic disease is characterized by small patient cohorts with heterogeneous primary tumors, metastases location and dose regimes. Hence, this study established a multi-institutional database of 700 patients treated with SBRT for pulmonary metastases to identify prognostic factors influencing survival and local control. MATERIALS AND METHODS: All German radiotherapy departments were contacted and invited to participate in this analysis. A total number of 700 patients with medically inoperable lung metastases treated with SBRT in 20 centers between 1997 and 2014 were included in a database. Primary and metastatic tumor characteristics, treatment characteristics and follow-up data including survival, local control, distant metastases, and toxicity were evaluated. Lung metastases were treated with median PTV-encompassing single doses of 12.5Gy (range 3.0-33.0Gy) in a median number of 3 fractions (range 1-13). RESULTS: After a median follow-up time of 14.3 months, 2-year local control (LC) and overall survival (OS) were 81.2% and 54.4%, respectively. In multivariate analysis, OS was most significantly influenced by pretreatment performance status, maximum metastasis diameter, primary tumor histology, time interval between primary tumor diagnosis and SBRT treatment and number of metastases. For LC, independent prognostic factors were pretreatment performance status, biological effective dose (BED) at PTV isocenter (BEDISO) and single fraction (PTV-encompassing) dose in multivariate analysis. Radiation-induced pneumonitis grade 2 or higher was observed in 6.5% of patients. The only factor significantly influencing toxicity was BEDISO (p=0.006). CONCLUSION: SBRT for medically inoperable patients with pulmonary metastases achieved excellent local control and promising overall survival. Important prognostic factors were identified for selecting patients who might benefit most from this therapy approach.
Authors: Susanne Stera; Panagiotis Balermpas; Mark K H Chan; Stefan Huttenlocher; Stefan Wurster; Christian Keller; Detlef Imhoff; Dirk Rades; Jürgen Dunst; Claus Rödel; Guido Hildebrandt; Oliver Blanck Journal: Strahlenther Onkol Date: 2017-09-05 Impact factor: 3.621
Authors: Juliane Hoerner-Rieber; Marciana Duma; Oliver Blanck; Guido Hildebrandt; Andrea Wittig; Fabian Lohaus; Michael Flentje; Frederick Mantel; Robert Krempien; Michael J Eble; Klaus Henning Kahl; Judit Boda-Heggemann; Stefan Rieken; Matthias Guckenberger Journal: J Thorac Dis Date: 2017-11 Impact factor: 2.895