Juliane Rieber1, Nasrin Abbassi-Senger2, Sonja Adebahr3, Nicolaus Andratschke4, Oliver Blanck5, Marciana Duma6, Michael J Eble7, Iris Ernst8, Michael Flentje9, Sabine Gerum10, Peter Hass11, Christoph Henkenberens12, Guido Hildebrandt13, Detlef Imhoff14, Henning Kahl15, Nathalie Desirée Klass16, Robert Krempien17, Fabian Lohaus18, Frank Lohr19, Cordula Petersen20, Elsge Schrade21, Jan Streblow22, Lorenz Uhlmann23, Andrea Wittig24, Florian Sterzing25, Matthias Guckenberger26. 1. Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany. Electronic address: juliane.rieber@med.uniheidelberg.de. 2. Department of Radiation Oncology, University Hospital Jena, Jena, Germany. 3. Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany; German Cancer Consortium, Heidelberg, Partner Site Freiburg, Freiburg, Germany. 4. Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiation Oncology, University of Rostock, Rostock, Germany. 5. Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany. 6. Department of Radiation Oncology, Technical University Munich, Munich, Germany. 7. Department of Radiation Oncology, University Hospital Aachen, Aachen, Germany. 8. Department of Radiation Oncology, University Hospital Münster, Münster, Germany. 9. Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany. 10. Department of Radiation Oncology, Ludwig Maximilians University Munich, Munich, Germany. 11. Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany. 12. Department of Radiotherapy and Special Oncology, Medical School Hannover, Hannover, Germany. 13. Department of Radiation Oncology, University of Rostock, Rostock, Germany. 14. Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany. 15. Department of Radiation Oncology, Hospital Augsburg, Augsburg, Germany. 16. Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland. 17. Department of Radiation Oncology, Helios Klinikum Berlin-Buch, Berlin, Germany. 18. Department of Radiation Oncology, Medical Faculty and University Hospital C.G. Carus, Technical University Dresden, Dresden, Germany; German Cancer Research Center, Heidelberg and German Cancer Consortium partner site Dresden, Dresden, Germany; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 19. Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany. 20. Department of Radiation Oncology, University Hospital Hamburg, Hamburg, Germany. 21. Department of Radiation Oncology, Hospital Heidenheim, Heidenheim, Germany. 22. Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany. 23. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany. 24. Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Marburg, Germany. 25. Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; German Cancer Research Center, Clinical Cooperation Unit Radiation Oncology, Heidelberg, Germany. 26. Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany.
Abstract
PURPOSE: Many technological and methodical advances have made stereotactic body radiotherapy (SBRT) more accurate and more efficient during the last years. This study aims to investigate whether experience in SBRT and technological innovations also translated into improved local control (LC) and overall survival (OS). METHODS AND MATERIALS: A database of 700 patients treated with SBRT for lung metastases in 20 German centers between 1997 and 2014 was used for analysis. It was the aim of this study to investigate the impact of fluorodeoxyglucose positron-emission tomography (FDG-PET) staging, biopsy confirmation, image guidance, immobilization, and dose calculation algorithm, as well as the influence of SBRT experience, on LC and OS. RESULTS: Median follow-up time was 14.3 months (range, 0-131.9 months), with 2-year LC and OS of 81.2% (95% confidence interval [CI] 75.8%-85.7%) and 54.4% (95% CI 50.2%-59.0%), respectively. In multivariate analysis, all treatment technologies except FDG-PET staging did not significantly influence outcome. Patients who received pre-SBRT FDG-PET staging showed superior 1- and 2-year OS of 82.7% (95% CI 77.4%-88.6%) and 64.8% (95% CI 57.5%-73.3%), compared with patients without FDG-PET staging resulting in 1- and 2-year OS rates of 72.8% (95% CI 67.4%-78.8%) and 52.6% (95% CI 46.0%-60.4%), respectively (P=.012). Experience with SBRT was identified as the main prognostic factor for LC: institutions with higher SBRT experience (patients treated with SBRT within the last 2 years of the inclusion period) showed superior LC compared with less-experienced centers (P≤.001). Experience with SBRT within the last 2 years was independent from known prognostic factors for LC. CONCLUSION: Investigated technological and methodical advancements other than FDG-PET staging before SBRT did not significantly improve outcome in SBRT for pulmonary metastases. In contrast, LC was superior with increasing SBRT experience of the individual center.
PURPOSE: Many technological and methodical advances have made stereotactic body radiotherapy (SBRT) more accurate and more efficient during the last years. This study aims to investigate whether experience in SBRT and technological innovations also translated into improved local control (LC) and overall survival (OS). METHODS AND MATERIALS: A database of 700 patients treated with SBRT for lung metastases in 20 German centers between 1997 and 2014 was used for analysis. It was the aim of this study to investigate the impact of fluorodeoxyglucose positron-emission tomography (FDG-PET) staging, biopsy confirmation, image guidance, immobilization, and dose calculation algorithm, as well as the influence of SBRT experience, on LC and OS. RESULTS: Median follow-up time was 14.3 months (range, 0-131.9 months), with 2-year LC and OS of 81.2% (95% confidence interval [CI] 75.8%-85.7%) and 54.4% (95% CI 50.2%-59.0%), respectively. In multivariate analysis, all treatment technologies except FDG-PET staging did not significantly influence outcome. Patients who received pre-SBRT FDG-PET staging showed superior 1- and 2-year OS of 82.7% (95% CI 77.4%-88.6%) and 64.8% (95% CI 57.5%-73.3%), compared with patients without FDG-PET staging resulting in 1- and 2-year OS rates of 72.8% (95% CI 67.4%-78.8%) and 52.6% (95% CI 46.0%-60.4%), respectively (P=.012). Experience with SBRT was identified as the main prognostic factor for LC: institutions with higher SBRT experience (patients treated with SBRT within the last 2 years of the inclusion period) showed superior LC compared with less-experienced centers (P≤.001). Experience with SBRT within the last 2 years was independent from known prognostic factors for LC. CONCLUSION: Investigated technological and methodical advancements other than FDG-PET staging before SBRT did not significantly improve outcome in SBRT for pulmonary metastases. In contrast, LC was superior with increasing SBRT experience of the individual center.
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