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SBRT for lung oligometastases: Who is the perfect candidate?
Pierina Navarria1, Fiorenza De Rose1, Anna Maria Ascolese1
1Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Rozzano (Milano), Italy.
Aim:
To analyze the literature data about lung oligometastatic patients who underwent SBRT with regard to doses, fractionation, outcomes, response assessment and prognostic factors, trying to define "the right patient" for the local treatment.
Background:
"Oligometastatic disease" is defined as a state in which metastases are limited in number and site and characterized by unusual cancer biology and behavior. In this setting local therapy could have a potential curative role. Recently, technological advances in Radiation Oncology permitted the introduction of Stereotactic Body Radiation Therapy (SBRT), a novel treatment modality that delivers ablative dose of radiation to the extra-cranial sites with high precision using single or a small number of fractions.
Materials And Methods:
We performed a literature search using Medical Subject Heading terms "stereotactic body radiation therapy" and "lung metastases", considering a period of 10 years.
Results:
Many non-randomized studies have shown that SBRT for lung oligometastases is safe and effective, with local control rates of about 80%. To date SBRT represents an alternative and competitive option in patients with lung oligometastatic disease who refuse surgical treatment or unsuitable for surgery. Based on published studies, SBRT might have major benefit for a patient with breast histology, disease-free interval ≥12 months, control of the primary tumor, small lesions, limited number of lesions and higher radiation dose delivered.
Conclusions:
Well-designed collaborative trials are necessary to draw final conclusions. To date, the discussion within a multidisciplinary team becomes crucial to perform a careful patients' selection in the setting of oligometastatic disease.
Insights
Stereotactic Body Radiation Therapy (SBRT) is a safe and effective treatment for lung oligometastases, achieving 80% local control. Patient selection is key for optimal outcomes in this limited metastatic setting.
Area of Science:
- Radiation Oncology
- Medical Physics
- Oncology
Background:
- Oligometastatic disease involves a limited number of metastases with unique cancer biology.
- Local therapy, including Stereotactic Body Radiation Therapy (SBRT), may offer a curative role.
- SBRT uses high-precision, ablative radiation doses in few fractions for extra-cranial sites.
Purpose of the Study:
- To review literature on SBRT for lung oligometastases.
- To analyze doses, fractionation, outcomes, and prognostic factors.
- To identify optimal patient selection criteria for SBRT.
Main Methods:
- Literature search using "stereotactic body radiation therapy" and "lung metastases" keywords.
- Analysis focused on studies published over the last 10 years.
Main Results:
- SBRT for lung oligometastases is safe and effective, with local control rates around 80%.
- SBRT is a viable alternative for patients unsuitable for surgery.
- Potential benefits observed for breast histology, disease-free interval ≥12 months, primary tumor control, and smaller lesion burden.
Conclusions:
- Further collaborative trials are needed for definitive conclusions.
- Multidisciplinary team discussion is crucial for careful patient selection.
- SBRT shows promise as a local treatment for select oligometastatic patients.
