The treatment of oligometastatic disease has become common as imaging techniques have advanced and the management of systemic disease has improved. Use of highly targeted, hypofractionated regimens of stereotactic body radiotherapy (SBRT) is now a primary management option for patients with oligometastatic disease.
Methods
The properties of SBRT are summarized and the results of retrospective and prospective studies of SBRT use in the management of oligometastases are reviewed. Future directions of SBRT, including optimizing dose and fractionation schedules, are also discussed.
Results
SBRT can deliver highly conformal, dosed radiation treatments for ablative tumors in a few treatment sessions. Phase 1/2 trials and retrospective institutional results support use of SBRT as a treatment option for oligometastatic disease metastasized to the lung, liver, and spine, and SBRT offers adequate toxicity profiles with good rates of local control. Future directions will involve optimizing dose and fractionation schedules for select histologies to improve rates of local control while limiting toxicity to normal structures.
Conclusions
SBRT offers an excellent management option for patients with oligometastases. However, additional research is still needed to optimize dose and fractionation schedules.
CasiraghiM., De PasT., MaisonneuveP.A 10-year single-center experience on 708 lung metastasectomies: the evidence of the “international registry of lung metastases.”J Thorac Oncol.2011; 6(8): 1373–1378.
3.
SimmondsP.C., PrimroseJ.N., ColquittJ.L.Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies.Br J Cancer.2006; 94(7): 982–999.
4.
SalamaJ.K., HasselleM.D., ChmuraS.J.Stereotactic body radiotherapy for multisite extracranial oligometastases: final report of a dose escalation trial in patients with 1 to 5 sites of metastatic disease.Cancer.2012; 118(11): 2962–2970.
5.
MilanoM.T., KatzA.W., MuhsA.G.A prospective pilot study of curative-intent stereotactic body radiation therapy in patients with 5 or fewer oligometastatic lesions.Cancer.2008; 112(3): 650–658.
6.
ShawE., ScottC., SouhamiL.Radiosurgery for the treatment of previously irradiated recurrent primary brain tumors and brain metastases: initial report of radiation therapy oncology group protocol (90-05).Int J Radiat Oncol Biol Phys.1996; 34(3): 647–654.
7.
ShawE., ScottC., SouhamiL.Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05.Int J Radiat Oncol Biol Phys.2000; 47(2): 291–298.
8.
BhatnagarA.K., FlickingerJ.C., KondziolkaD.Stereotactic radiosurgery for four or more intracranial metastases.Int J Radiat Oncol Biol Phys.2006; 64(3): 898–903.
9.
PottersL., KavanaghB., GalvinJ.M.American Society for Therapeutic Radiology and Oncology; American College of Radiology. American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the performance of stereotactic body radiation therapy.Int J Radiat Oncol Biol Phys.2010; 76(2): 326–332.
10.
RinneD., BaumR.P., HorG.Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients.Cancer.1998; 82(9): 1664–1671.
11.
SwetterS.M., CarrollL.A., JohnsonD.L.Positron emission tomography is superior to computed tomography for metastatic detection in melanoma patients.Ann Surg Oncol.2002; 9(7): 646–653.
12.
LoweV.J., FletcherJ.W., GobarL.Prospective investigation of positron emission tomography in lung nodules.J Clin Oncol.1998; 16(3): 1075–1084.
13.
van GeelA.N., Rm van Der SijpJ., SchmitzP.I.Which soft tissue sarcoma patients with lung metastases should not undergo pulmonary resection?Sarcoma.2002; 6(2): 57–60.
14.
WatanabeK., NagaiK., KobayashiA.Factors influencing survival after complete resection of pulmonary metastases from colorectal cancer.Br J Surg.2009; 96(9): 1058–1065.
15.
RashidO.M., TakabeK.The evolution of the role of surgery in the management of breast cancer lung metastasis.J Thoracic Dis.2012; 4(4): 420–424.
16.
Garcia FrancoC.E., TorreW., TamuraA.Long-term results after resection for bone sarcoma pulmonary metastases.Eur J Cardiothorac Surg.2010; 37(5): 1205–1208.
17.
MeimarakisG., AngeleM., StaehlerM.Evaluation of a new prognostic score (Munich score) to predict long-term survival after resection of pulmonary renal cell carcinoma metastases.Am J Surg.2011; 202(2): 158–167.
18.
BlomgrenH., LaxI., NaslundI.Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients.Acta Oncologica.1995; 34(6): 861–870.
19.
D'SouzaW.D., NazarethD.P., ZhangB.The use of gated and 4D CT imaging in planning for stereotactic body radiation therapy.Med Dosimetry.2007; 32(2): 92–101.
20.
HeinzerlingJ.H., AndersonJ.F., PapiezL.Four-dimensional computed tomography scan analysis of tumor and organ motion at varying levels of abdominal compression during stereotactic treatment of lung and liver.Int J Radiat Oncol Biol Phys.2008; 70(5): 1571–1578.
AhmedK.A., StauderM.C., MillerR.C.Stereotactic body radiation therapy in spinal metastases.Int J Radiat Oncol Biol Phys.2012; 82(5): e803–809.
23.
GrecoC., ZelefskyM.J., LovelockM.Predictors of local control after single-dose stereotactic image-guided intensity-modulated radiotherapy for extracranial metastases.Int J Radiat Oncol Biol Phys.2011; 79(4): 1151–1157.
24.
WersallP.J., BlomgrenH., LaxI.Extracranial stereotactic radiotherapy for primary and metastatic renal cell carcinoma.Radiother Oncol.2005; 77(1): 88–95.
25.
KangJ.K., KimM.S., KimJ.H.Oligometastases confined one organ from colorectal cancer treated by SBRT.Clin Exper Metastasis.2010; 27(4): 273–278.
26.
StinauerM.A., KavanaghB.D., SchefterT.E.Stereotactic body radiation therapy for melanoma and renal cell carcinoma: impact of single fraction equivalent dose on local control.Radiat Oncol.2011; 6: 34.
27.
RusthovenK.E., KavanaghB.D., CardenesH.Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases.J Clin Oncol.2009; 27(10): 1572–1578.
28.
HerfarthK.K., DebusJ., LohrF.Stereotactic single-dose radiation therapy of liver tumors: results of a phase I/II trial.J Clin Oncol.2001; 19(1): 164–170.
29.
HoyerM., RoedH., Traberg HansenA.Phase II study on stereotactic body radiotherapy of colorectal metastases.Acta Oncologica.2006; 45(7): 823–830.
30.
LeeM.T., KimJ.J., DinniwellR.Phase I study of individualized stereotactic body radiotherapy of liver metastases.J Clin Oncol.2009; 27(10): 1585–1591.
31.
ScorsettiM., ArcangeliS., TozziA.Is stereotactic body radiation therapy an attractive option for unresectable liver metastases? A preliminary report from a phase 2 trial.Int J Radiat Oncol Biol Phys.2013; 86(2): 336–342.
32.
TimmermanR., PapiezL., McGarryR.Extracranial stereotactic radioablation: results of a phase I study in medically inoperable stage I non-small cell lung cancer.Chest.2003; 124(5): 1946–1955.
33.
TimmermanR., PaulusR., GalvinJ.Stereotactic body radiation therapy for inoperable early stage lung cancer.JAMA.2010; 303(11): 1070–1076.
34.
RicardiU., FilippiA.R., GuarneriA.Stereotactic body radiation therapy for lung metastases.Lung Cancer.2012; 75(1): 77–81.
35.
YoonS.M., ChoiE.K., LeeS.W.Clinical results of stereotactic body frame based fractionated radiation therapy for primary or metastatic thoracic tumors.Acta Oncologica.2006; 45(8): 1108–1114.
36.
RusthovenK.E., KavanaghB.D., BurriS.H.Multi-institutional phase I/II trial of stereotactic body radiation therapy for lung metastases.J Clin Oncol.2009; 27(10): 1579–1584.
37.
OkunieffP., PetersenA.L., PhilipA.Stereotactic body radiation therapy (SBRT) for lung metastases.Acta Oncologica.2006; 45(7): 808–817.
38.
OnimaruR., ShiratoH., ShimizuS.Tolerance of organs at risk in small-volume, hypofractionated, image-guided radiotherapy for primary and metastatic lung cancers.Int J Radiat Oncol Biol Phys.2003; 56(1): 126–135.
39.
SivaS., MacManusM., BallD.Stereotactic radiotherapy for pulmonary oligometastases: a systematic review.J Thoracic Oncol.2010; 5(7): 1091–1099.
40.
SahgalA., MaL., WeinbergV.Reirradiation human spinal cord tolerance for stereotactic body radiotherapy.Int J Radiat Oncol Biol Phys.2012; 82(1): 107–116.
41.
ZelefskyM.J., GrecoC., MotzerR.Tumor control outcomes after hypofractionated and single-dose stereotactic image-guided intensity-modulated radiotherapy for extracranial metastases from renal cell carcinoma.Int J Radiat Oncol Biol Phys.2012; 82(5): 1744–1748.
42.
WangX.S., RhinesL.D., ShiuA.S.Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1-2 trial.Lancet Oncol.2012; 13(4): 395–402.
43.
NelsonJ.W., YooD.S., SampsonJ.H.Stereotactic body radiotherapy for lesions of the spine and paraspinal regions.Int J Radiat Oncol Biol Phys.2009; 73(5): 1369–1375.
GersztenP.C., BurtonS.A., OzhasogluC.Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution.Spine.2007; 32(2): 193–199.
46.
MuacevicA., KufeldM., RistC.Safety and feasibility of image-guided robotic radiosurgery for patients with limited bone metastases of prostate cancer.Urol Oncol.2013; 31(4): 455–460.
47.
BenedictS.H., YeniceK.M., FollowillD.Stereotactic body radiation therapy: the report of AAPM Task Group 101.Med Phys.2010; 37(8): 4078–4101.
48.
SahgalA., WhyneC.M., MaL.Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases.Lancet Oncol.2013; 14(8): e310–320.
49.
BoehlingN.S., GrosshansD.R., AllenP.K.Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases.J Neurosurg (Spine).2012; 16(4): 379–386.
50.
RoseP.S., LauferI., BolandP.J.Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases.J Clin Oncol.2009; 27(30): 5075–5079.
51.
CunhaM.V., Al-OmairA., AtenafuE.G.Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors.Int J Radiat Oncol Biol Phys.2012; 84(3): e343–349.
TakedaA., KuniedaE., OhashiT.Stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer and other primary cancers in comparison with primary lung cancer.Radiother Oncol.2011; 101(2): 255–259.
54.
FowlerJ.F.21 years of biologically effective dose.Br J Radiol.2010; 83(991): 554–568.
55.
ParkC., PapiezL., ZhangS.Universal survival curve and single fraction equivalent dose: useful tools in understanding potency of ablative radiotherapy.Int J Radiat Oncol Biol Phys.2008; 70(3): 847–852.
56.
AstrahanM.Some implications of linear-quadratic-linear radiation dose-response with regard to hypofractionation.Med Phys.2008; 35(9): 4161–4172.
57.
GuerreroM., LiX.A.Extending the linear-quadratic model for large fraction doses pertinent to stereotactic radiotherapy.Phys Med Biol.2004; 49(20): 4825–4835.
58.
WangJ.Z., HuangZ., LoS.S.A generalized linear-quadratic model for radiosurgery, stereotactic body radiation therapy, and high-dose rate brachytherapy.Sci Transl Med.2010; 2(39): 39ra48.
59.
WulfJ., HaedingerU., OppitzU.Stereotactic radiotherapy for primary lung cancer and pulmonary metastases: a noninvasive treatment approach in medically inoperable patients.Int J Radiat Oncol Biol Phys.2004; 60(1): 186–196.
60.
FumagalliI., BibaultJ.E., DewasS.A single-institution study of stereotactic body radiotherapy for patients with unresectable visceral pulmonary or hepatic oligometastases.Radiat Oncol.2012; 7: 164.
61.
McCammonR., SchefterT.E., GasparL.E.Observation of a dose-control relationship for lung and liver tumors after stereotactic body radiation therapy.Int J Radiat Oncol Biol Phys.2009; 73(1): 112–118.
62.
EschrichS., ZhangH., ZhaoH.Systems biology modeling of the radiation sensitivity network: a biomarker discovery platform.Int J Radiat Oncol Biol Phys.2009; 75(2): 497–505.
63.
AhmedK.A., BerglundA.E., HoffeS.E.Differences between colon cancer primaries and metastases utilizing a molecular assay for tumor radiosensitivity suggest implications for potential oligometastatic SBRT patient selection.Int J Radiat Oncol Biol Phys.2015; 92(4): 837–842.
