Efficacy and safety of stereotactic body radiation therapy for the treatment of pulmonary metastases from sarcoma: A potential alternative to resection

• Published in: Journal of surgical oncology Vol. 114; no. 1; pp. 65 - 69
• Main Authors: Baumann, Brian C., Nagda, Suneel N., Kolker, James D., Levin, William P., Weber, Kristy L., Berman, Abigail T., Staddon, Arthur, Hartner, Lee, Hahn, Stephen M., Glatstein, Eli, Simone II, Charles B.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.07.2016; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Chemotherapy; Chemotherapy, Adjuvant; Female; Follow-Up Studies; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - drug therapy; Lung Neoplasms - radiotherapy; Lung Neoplasms - secondary; Male; Metastasis; metastatectomy; Middle Aged; Neoadjuvant Therapy; Positron-Emission Tomography; pulmonary metastasis; Radiation therapy; Radiosurgery; Radiotherapy, Adjuvant; sarcoma; Sarcoma - diagnostic imaging; Sarcoma - drug therapy; Sarcoma - radiotherapy; Sarcoma - secondary; SBRT; stereotactic body radiation therapy; Tomography, X-Ray Computed; Treatment Outcome; metastatectomy; sarcoma; stereotactic body radiation therapy; pulmonary metastasis; SBRT
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24268

Background/Objectives Oligometastatic sarcoma pulmonary metastases (PM) are typically treated with resection and/or chemotherapy. We hypothesize that stereotactic body radiotherapy (SBRT) can be an alternative to surgery that can achieve high rates of local control (LC) with limited toxicity. Methods Thirty consecutive sarcoma patients received SBRT to 39 PM's from 2011 to 2015 at two university hospitals to a median dose of 50 Gy in 4–5 fractions with CyberKnife or linear accelerator. Patients underwent CT or PET/CT scans q3 months after SBRT. Results 77% received prior chemotherapy, 70% had 1–3 prior pulmonary resections, and 26% received prior thoracic radiotherapy. Median lesion size was 2.4 cm (range 0.5–8.1 cm). Median follow‐up was 16 and 23 months for patients alive at last follow‐up. At 12 and 24 months, LC was 94% and 86%, and OS was 76% and 43%. LC and OS did not differ by SBRT technique, fractionation regimen, lesion location, histology, or size (all P > 0.05). Three developed grade 2 chest‐wall toxicity with no other grade ≥2 toxicities. Conclusions This is the largest series on SBRT for sarcoma PM's and demonstrates that SBRT is well‐tolerated with excellent LC across tumor locations and sizes. SBRT should be considered in these patients, and prospective studies are warranted. J. Surg. Oncol. 2016;114:65–69. © 2016 Wiley Periodicals, Inc.