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Can thoracic nodes oligometastases be safely treated with image guided hypofractionated radiation therapy?
- Source :
-
The British journal of radiology [Br J Radiol] 2019 Nov; Vol. 92 (1103), pp. 20181026. Date of Electronic Publication: 2019 Sep 17. - Publication Year :
- 2019
-
Abstract
- Objective: To evaluate safety and efficacy of image guided-hypofractionated radiation therapy (IG-HRT) in patients with thoracic nodes oligometastases.<br />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.<br />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.<br />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.<br />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.
- Subjects :
- Aged
Breast Neoplasms mortality
Disease Progression
Disease-Free Survival
Dose-Response Relationship, Radiation
Feasibility Studies
Female
Humans
Intestinal Neoplasms mortality
Kidney Neoplasms mortality
Lung Neoplasms mortality
Lymphatic Metastasis
Male
Mediastinal Neoplasms diagnostic imaging
Mediastinal Neoplasms mortality
Middle Aged
Radiation Dose Hypofractionation
Radiotherapy, Image-Guided methods
Retrospective Studies
Thoracic Neoplasms diagnostic imaging
Thoracic Neoplasms mortality
Tomography, X-Ray Computed methods
Mediastinal Neoplasms radiotherapy
Thoracic Neoplasms radiotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 1748-880X
- Volume :
- 92
- Issue :
- 1103
- Database :
- MEDLINE
- Journal :
- The British journal of radiology
- Publication Type :
- Academic Journal
- Accession number :
- 31529985
- Full Text :
- https://doi.org/10.1259/bjr.20181026