Do Patients With Pulmonary Metastases From Soft Tissue Sarcoma Benefit From Stereotactic Body...
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Conclusions: Within the limitations of small numbers and short follow up, this study demonstrates that IORT offers a viable method of delivering focal therapy to reduce the risk associated with close margins while maintaining adequate local control with reduced dose EBRT. Author Disclosure: S.Y. Tsuji, None; R.J. O’Donnell, None; D. Haas-Kogan, None; A.R. Gottschalk, None. 2980 Do Patients With Pulmonary Metastases From Soft Tissue Sarcoma Benefit From Stereotactic Body Radiation Therapy K. S. Corbin 1 , A. Philip 2 , O. Hyrien 3 , D. Sahasrabudhe 4 , R. Chen 3 , C. Jones 5 , P. Okunieff 2 , L. S. Constine 2 1 University of Rochester School of Medicine, Rochester, NY, 2 Department of Radiation Oncology, University of Rochester Cancer Center, Rochester, NY, 3 Biostats Computational Biology, University of Rochester, Rochester, NY, 4 Division of Hematology/Oncology, University of Rochester Cancer Center, Rochester, NY, 5 Thoracic/Foregut Surgery Division, University of Rochester School of Medicine, Rochester, NY Purpose/Objective(s): Pulmonary metastases (PM) from soft tissue sarcoma (STS) are historically treated with surgery (metasta- tectomy) or chemotherapy (CT), and patient survival is limited. We questioned whether stereotactic body radiation therapy (SBRT) offers the potential to locally control targeted lesions with limited toxicity, and might prolong survival. Materials/Methods: All adult ($18 years) patients with PM from STS seen by orthopedic surgery, medical oncology, or radiation oncology since 1990 were eligible for review. The 58 identified patients (57% male) were 18–88 years old (median 57). Median follow up was 1.4 years (range 0.1 13.5 years). Twenty eight (48.3%) had PM at diagnosis, with a median of 6 nodules. The others demonstrated PM up to 6.2 years later (mean/median 9/17.2 months). CT was usually anthracycline-based. Surgical procedures varied. SBRT used the Novalis Exac Trac patient positioning platform, vacuum bag immobilization, and relaxed end-expiratory breath holding techniques. The PTV = GTV + 0.7–10 mm; dose was prescribed to the isocenter, usually 50 Gy in 10 fractions. Results: Twenty patients (39.2%) were irradiated, and 16 (31.4%) had one or more nodules treated with SBRT (median = 4.5 nod- ules). Sixteen patients (29.6%) had $1 surgical interventions, and 31 (57.4%) received CT. On univariate analysis (Table), patient age, gender, number of PM, surgical intervention, and CT were not associated with overall survival. SBRT (p = 0.012, Hazard ratio = 0.43) (Fig), and any radiation to the lung (p = 0.011, Hazard ratio = 0.71) were beneficial, and PM at diagnosis (p = 0.028, Hazard ratio = 1.87) was adverse. At 2.5 years, survival for SBRT patients was 73% vs. 25% for patients without SBRT (Fig). 12.1% of all patients are currently alive. No patient demonstrated Grade 3 or greater pulmonary toxicity. On multivariate Cox’s PH analysis with stepwise selection, SBRT was most significant (p = 0.007). Conclusions: Although most patients with PM from STS die, some patients have prolonged survival. Interestingly, the number of PM did not predict outcome, nor did patient age, suggesting that older patients or patients with greater disease burdens should not be excluded from therapeutic intervention. Of the interventions, SBRT was the most significant predictor for improved survival. Although selection bias clearly exists, it occurs in both directions since some patients considered unfit for chemotherapy or surgery due to co-medical infirmity or large number of PM still receive SBRT, particularly for large or (potentially) obstructive lesions. SBRT should be considered for patients with pulmonary metastatic soft tissue sarcoma. Cox’s Propotional Hazard Variable Log-rank test (p-value) Estimate Standard error Hazard Ratio Age 0.73 0.007 0.010 1.00 Gender 0.98 0.98 0.29 1.01 SBRT 0.012 0.84 0.35 0.43 Chemotherapy 0.99 0.005 0.31 1.00 Radiation to lung 0.011 0.34 0.14 0.71 Surgical intervention 0.26 0.21 0.24 0.81 Metastases @ diagnosis 0.028 0.63 0.29 1.87 Author Disclosure: K.S. Corbin, None; A. Philip, None; O. Hyrien, None; D. Sahasrabudhe, None; R. Chen, None; C. Jones, None; P. Okunieff, None; L.S. Constine, None. S752 I. J. Radiation Oncology d Biology d Physics Volume 69, Number 3, Supplement, 2007
Transcript of Do Patients With Pulmonary Metastases From Soft Tissue Sarcoma Benefit From Stereotactic Body...
S752 I. J. Radiation Oncology d Biology d Physics Volume 69, Number 3, Supplement, 2007
Conclusions: Within the limitations of small numbers and short follow up, this study demonstrates that IORT offers a viablemethod of delivering focal therapy to reduce the risk associated with close margins while maintaining adequate local controlwith reduced dose EBRT.
Author Disclosure: S.Y. Tsuji, None; R.J. O’Donnell, None; D. Haas-Kogan, None; A.R. Gottschalk, None.
2980 Do Patients With Pulmonary Metastases From Soft Tissue Sarcoma Benefit From Stereotactic Body
Radiation TherapyK. S. Corbin1, A. Philip2, O. Hyrien3, D. Sahasrabudhe4, R. Chen3, C. Jones5, P. Okunieff2, L. S. Constine2
1University of Rochester School of Medicine, Rochester, NY, 2Department of Radiation Oncology, University of RochesterCancer Center, Rochester, NY, 3Biostats Computational Biology, University of Rochester, Rochester, NY, 4Division ofHematology/Oncology, University of Rochester Cancer Center, Rochester, NY, 5Thoracic/Foregut Surgery Division,University of Rochester School of Medicine, Rochester, NY
Purpose/Objective(s): Pulmonary metastases (PM) from soft tissue sarcoma (STS) are historically treated with surgery (metasta-tectomy) or chemotherapy (CT), and patient survival is limited. We questioned whether stereotactic body radiation therapy (SBRT)offers the potential to locally control targeted lesions with limited toxicity, and might prolong survival.
Materials/Methods: All adult ($18 years) patients with PM from STS seen by orthopedic surgery, medical oncology, or radiationoncology since 1990 were eligible for review. The 58 identified patients (57% male) were 18–88 years old (median 57). Medianfollow up was 1.4 years (range 0.1�13.5 years). Twenty eight (48.3%) had PM at diagnosis, with a median of 6 nodules. The othersdemonstrated PM up to 6.2 years later (mean/median 9/17.2 months). CT was usually anthracycline-based. Surgical proceduresvaried. SBRT used the Novalis Exac Trac patient positioning platform, vacuum bag immobilization, and relaxed end-expiratorybreath holding techniques. The PTV = GTV + 0.7–10 mm; dose was prescribed to the isocenter, usually 50 Gy in 10 fractions.
Results: Twenty patients (39.2%) were irradiated, and 16 (31.4%) had one or more nodules treated with SBRT (median = 4.5 nod-ules). Sixteen patients (29.6%) had $1 surgical interventions, and 31 (57.4%) received CT. On univariate analysis (Table), patientage, gender, number of PM, surgical intervention, and CT were not associated with overall survival. SBRT (p = 0.012, Hazard ratio= 0.43) (Fig), and any radiation to the lung (p = 0.011, Hazard ratio = 0.71) were beneficial, and PM at diagnosis (p = 0.028, Hazardratio = 1.87) was adverse. At 2.5 years, survival for SBRT patients was 73% vs. 25% for patients without SBRT (Fig). 12.1% of allpatients are currently alive. No patient demonstrated Grade 3 or greater pulmonary toxicity. On multivariate Cox’s PH analysis withstepwise selection, SBRT was most significant (p = 0.007).
Conclusions: Although most patients with PM from STS die, some patients have prolonged survival. Interestingly, the number ofPM did not predict outcome, nor did patient age, suggesting that older patients or patients with greater disease burdens should notbe excluded from therapeutic intervention. Of the interventions, SBRT was the most significant predictor for improved survival.Although selection bias clearly exists, it occurs in both directions since some patients considered unfit for chemotherapy or surgerydue to co-medical infirmity or large number of PM still receive SBRT, particularly for large or (potentially) obstructive lesions.SBRT should be considered for patients with pulmonary metastatic soft tissue sarcoma.
Cox’s Propotional Hazard
Variable Log-rank test (p-value) Estimate Standard error Hazard Ratio
Age
0.73 0.007 0.010 1.00Gender
0.98 0.98 0.29 1.01SBRT
0.012 �0.84 0.35 0.43Chemotherapy
0.99 0.005 0.31 1.00Radiation to lung
0.011 �0.34 0.14 0.71Surgical intervention
0.26 �0.21 0.24 0.81Metastases @ diagnosis
0.028 0.63 0.29 1.87Author Disclosure: K.S. Corbin, None; A. Philip, None; O. Hyrien, None; D. Sahasrabudhe, None; R. Chen, None; C. Jones, None;P. Okunieff, None; L.S. Constine, None.
