Hypofractionated Image-Guided Radiation Therapy With Simultaneous-Integrated Boost Technique for Limited Metastases: A Multi-Institutional Analysis.
Abstract
Purpose: To perform a multi-institutional analysis following treatment of limited
osseous and/or nodal metastases in patients using a novel hypofractionated image-guided
radiotherapy with simultaneous-integrated boost (HIGRT-SIB) technique. Methods: Consecutive
patients treated with HIGRT-SIB for ≤5 active metastases at Duke University Medical
Center or Durham Veterans' Affairs Medical Center between 2013 and 2018 were analyzed
to determine toxicities and recurrence patterns following treatment. Most patients
received 50 Gy to the PTVboost and 30 Gy to the PTVelect simultaneously in 10 fractions.
High-dose treatment volume recurrence (HDTVR) and low-dose treatment volume recurrence
(LDTVR) were defined as recurrences within PTVboost and PTVelect, respectively. Marginal
recurrence (MR) was defined as recurrence outside PTVelect, but within the adjacent
bone or nodal chain. Distant recurrence (DR) was defined as recurrences not meeting
HDTVR, LDTVR, or MR criteria. Freedom from pain recurrence (FFPR) was calculated in
patients with painful osseous metastases prior to HIGRT-SIB. Outcome rates were estimated
at 12 months using the Kaplan-Meier method. Results: Forty-two patients met inclusion
criteria with 59 sites treated with HIGRT-SIB (53% nodal and 47% osseous). Median
time from diagnosis to first metastasis was 31 months and the median age at HIGRT-SIB
was 69 years. The most common primary tumors were prostate (36%), gastrointestinal
(24%), and lung (24%). Median follow-up was 11 months. One acute grade ≥3 toxicity
(febrile neutropenia) occurred after docetaxel administration immediately following
HIGRT-SIB. Four patients developed late grade ≥3 toxicities: two ipsilateral vocal
cord paralyzes and two vertebral compression fractures. The overall pain response
rate was 94% and the estimated FFPR at 12 months was 72%. The estimated 12 month rate
of HDTVR, LDTVR, MR, and DR was 3.6, 6.2, 7.6, and 55.8%, respectively. DR preceded
MR, HDTVR, or LDTVR in each instance. The estimated 12 month probability of in-field
and marginal control was 90.0%. Conclusion: Targeting areas at high-risk for occult
disease with a lower radiation dose, while simultaneously boosting gross disease with
HIGRT in patients with limited osseous and/or nodal metastases, has a high rate of
treated metastasis control, a low rate of MR, acceptable toxicity, and high rate of
pain palliation. Further investigation with prospective trials is warranted.
Type
Journal articleSubject
electivemarginal recurrence
occult
oligometastasis
oligoprogression
radiotherapy
simultaneous-integrated boost
stereotactic
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https://hdl.handle.net/10161/19054Published Version (Please cite this version)
10.3389/fonc.2019.00469Publication Info
Jacobs, Corbin D; Palta, Manisha; Williamson, Hannah; Price, Jeremy G; Czito, Brian
G; Salama, Joseph K; & Moravan, Michael J (2019). Hypofractionated Image-Guided Radiation Therapy With Simultaneous-Integrated Boost
Technique for Limited Metastases: A Multi-Institutional Analysis. Frontiers in Oncology, 9. pp. 469. 10.3389/fonc.2019.00469. Retrieved from https://hdl.handle.net/10161/19054.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Brian Gary Czito
Professor of Radiation Oncology
Listed in Best Doctors in America. Listed in Top Doctors in North Carolina. His research
interests include gastrointestinal malignancies, including treatment and integration
of novel systemic agents with radiation therapy in the treatment of esophageal, gastric,
hepatobiliary, pancreatic, colorectal and anal malignancies; phase I/II clinical trials
evaluating novel systemic/targeted agents in conjunction with radiation therapy; investigation
and optimization of the treatment of gastrointest
Michael James Moravan
Assistant Professor of Radiation Oncology
Manisha Palta
Associate Professor of Radiation Oncology
Clinical research in gastrointestinal malignancies, lymphomas and breast malignancies.
Joseph Kamel Salama
Professor of Radiation Oncology
Development of novel radiation treatment techniques for patients with limited metastatic
disease, and integration of these treatments with systemic therapies. Treatment of
head and neck cancers with chemotherapy, radiation and novel targeted drugs. Improving
outcomes for medically inoperable patients with lung cancer with new radiation methods.
Developing predictors for toxicity of patients treated with chemotherapy and radiation
therapy for non-small cell and small cell lung cancer.</do
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