Davide Franceschini1, Federico Bianciardi2, Rosario Mazzola3, Fiorenza De Rose1, Piercarlo Gentile2, Filippo Alongi3,4, Marta Scorsetti1,5. 1. Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Rozzano-Milano, Italy. 2. Department of Radiation Therapy, San Pietro Fatebenefratelli Hospital, Rome, Italy. 3. Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy. 4. Radiation Oncology Department, University of Brescia, Brescia, Italy. 5. Department of Biomedical Sciences, Humanitas University, Rozzano-Milano, Italy.
Abstract
OBJECTIVE: To evaluate safety and efficacy of image guided-hypofractionated radiation therapy (IG-HRT) in patients with thoracic nodes oligometastases. METHODS: The present study is a multicenter analysis. Oligometastatic patients, affected by a maximum of five active lesions in three or less different organs, treated with IG-HRT to thoracic nodes metastases between 2012 and 2017 were included in the analysis. Primary end point was local control (LC), secondary end points were overall survival (OS), progression-free survival, acute and late toxicity. Univariate and multivariate analysis were performed to identify possible prognostic factors for the survival end points. RESULTS: 76 patients were included in the analysis. Different RT dose and fractionation schedules were prescribed according to site, number, size of the lymph node(s) and to respect dose constraints for relevant organs at risk. Median biologically effective dose delivered was 75 Gy (interquartile range: 59-86 Gy). Treatment was optimal; one G1 acute toxicity and seven G1 late toxicities of any grade were recorded. Median follow-up time was 23.16 months. 16 patients (21.05%) had a local progression, while 52 patients progressed in distant sites (68.42 %).Median local relapse free survival was not reached, LC at 6, 12 and 24 months was 96.05% [confidence interval (CI) 88.26-98.71%], 86.68% (CI 75.86-92.87) and 68.21% (CI 51.89-80.00%), respectively. Median OS was 28.3 months (interquartile range 16.1-47.2). Median progression-freesurvival was 9.2 months (interquartile range 4.1-17.93).At multivariate analysis, RT dose, colorectal histology, systemic therapies were correlated with LC. Performance status and the presence of metastatic sites other than the thoracic nodes were correlated with OS. Local response was a predictor of OS. CONCLUSION: IG-HRT for thoracic nodes was safe and feasible. Higher RT doses were correlated to better LC and should be taken in consideration at least in patients with isolated nodal metastases and colorectal histology. ADVANCES IN KNOWLEDGE: Radiotherapy is safe and effective treatment for thoracic nodes metastases, higher radiotherapy doses are correlated to better LC. Oligometastatic patients can receive IG-HRT also for thoracic nodes metastases.
OBJECTIVE: To evaluate safety and efficacy of image guided-hypofractionated radiation therapy (IG-HRT) in patients with thoracic nodes oligometastases. METHODS: The present study is a multicenter analysis. Oligometastatic patients, affected by a maximum of five active lesions in three or less different organs, treated with IG-HRT to thoracic nodes metastases between 2012 and 2017 were included in the analysis. Primary end point was local control (LC), secondary end points were overall survival (OS), progression-free survival, acute and late toxicity. Univariate and multivariate analysis were performed to identify possible prognostic factors for the survival end points. RESULTS: 76 patients were included in the analysis. Different RT dose and fractionation schedules were prescribed according to site, number, size of the lymph node(s) and to respect dose constraints for relevant organs at risk. Median biologically effective dose delivered was 75 Gy (interquartile range: 59-86 Gy). Treatment was optimal; one G1 acute toxicity and seven G1 late toxicities of any grade were recorded. Median follow-up time was 23.16 months. 16 patients (21.05%) had a local progression, while 52 patients progressed in distant sites (68.42 %).Median local relapse free survival was not reached, LC at 6, 12 and 24 months was 96.05% [confidence interval (CI) 88.26-98.71%], 86.68% (CI 75.86-92.87) and 68.21% (CI 51.89-80.00%), respectively. Median OS was 28.3 months (interquartile range 16.1-47.2). Median progression-freesurvival was 9.2 months (interquartile range 4.1-17.93).At multivariate analysis, RT dose, colorectal histology, systemic therapies were correlated with LC. Performance status and the presence of metastatic sites other than the thoracic nodes were correlated with OS. Local response was a predictor of OS. CONCLUSION: IG-HRT for thoracic nodes was safe and feasible. Higher RT doses were correlated to better LC and should be taken in consideration at least in patients with isolated nodal metastases and colorectal histology. ADVANCES IN KNOWLEDGE: Radiotherapy is safe and effective treatment for thoracic nodes metastases, higher radiotherapy doses are correlated to better LC. Oligometastatic patients can receive IG-HRT also for thoracic nodes metastases.
Authors: Daniel H Schanne; Ursula Nestle; Michael Allgäuer; Nicolaus Andratschke; Steffen Appold; Ute Dieckmann; Iris Ernst; Ute Ganswindt; Anca L Grosu; Richard Holy; Michael Molls; Meinhard Nevinny-Stickel; Sabine Semrau; Florian Sterzing; Andrea Wittig; Matthias Guckenberger Journal: Strahlenther Onkol Date: 2014-08-27 Impact factor: 3.621
Authors: B Dautzenberg; R Arriagada; A B Chammard; A Jarema; M Mezzetti; K Mattson; J L Lagrange; C Le Pechoux; B Lebeau; C Chastang Journal: Cancer Date: 1999-07-15 Impact factor: 6.860
Authors: Davide Franceschini; Luca Cozzi; Fiorenza De Rose; Piera Navarria; Ciro Franzese; Tiziana Comito; Cristina Iftode; Angelo Tozzi; Lucia Di Brina; Anna Maria Ascolese; Elena Clerici; Giuseppe D'Agostino; Antonella Fogliata; Marta Scorsetti Journal: J Cancer Res Clin Oncol Date: 2017-03-03 Impact factor: 4.553
Authors: Michael T Milano; Yuhchyau Chen; Alan W Katz; Abraham Philip; Michael C Schell; Paul Okunieff Journal: Radiother Oncol Date: 2009-03-28 Impact factor: 6.280
Authors: E Van Cutsem; A Cervantes; R Adam; A Sobrero; J H Van Krieken; D Aderka; E Aranda Aguilar; A Bardelli; A Benson; G Bodoky; F Ciardiello; A D'Hoore; E Diaz-Rubio; J-Y Douillard; M Ducreux; A Falcone; A Grothey; T Gruenberger; K Haustermans; V Heinemann; P Hoff; C-H Köhne; R Labianca; P Laurent-Puig; B Ma; T Maughan; K Muro; N Normanno; P Österlund; W J G Oyen; D Papamichael; G Pentheroudakis; P Pfeiffer; T J Price; C Punt; J Ricke; A Roth; R Salazar; W Scheithauer; H J Schmoll; J Tabernero; J Taïeb; S Tejpar; H Wasan; T Yoshino; A Zaanan; D Arnold Journal: Ann Oncol Date: 2016-07-05 Impact factor: 32.976
Authors: Joe Y Chang; Qiao-Qiao Li; Qing-Yong Xu; Pamela K Allen; Neal Rebueno; Daniel R Gomez; Peter Balter; Ritsuko Komaki; Reza Mehran; Stephen G Swisher; Jack A Roth Journal: Int J Radiat Oncol Biol Phys Date: 2014-04-01 Impact factor: 7.038
Authors: Julian C Hong; Diandra N Ayala-Peacock; Jason Lee; A William Blackstock; Paul Okunieff; Max W Sung; Ralph R Weichselbaum; Johnny Kao; James J Urbanic; Michael T Milano; Steven J Chmura; Joseph K Salama Journal: PLoS One Date: 2018-04-12 Impact factor: 3.240