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Harris CM, Singleton MP, Samulski T, Clark LH. Primary peritoneal clear cell carcinoma arising in the setting of abdominal wall Endometriosis: A case report and review of the literature. Gynecol Oncol Rep 2024; 53:101370. [PMID: 38590931 PMCID: PMC10999830 DOI: 10.1016/j.gore.2024.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/10/2024] Open
Abstract
•Primary peritoneal clear cell carcinoma can arise from endometriotic implants within the abdomen and pelvis.•Immunohistochemistry can be used to confirm primary disease site. Endometriotic origin can be inferred based on clinical history and intraoperative findings suggestive of endometriosis.•While no standardized treatment exists, consideration should be given to cytoreductive surgery with adjuvant chemotherapy. Adjuvant radiation can also be considered for local control.
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Affiliation(s)
- Cameron M. Harris
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Miller P. Singleton
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Theresa Samulski
- Department of Pathology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Leslie H. Clark
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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Lai TS, Francoeur A, Manrriquez E, Venkat P, Chang A, Douek M, Bahrami S, Raman SS, Memarzadeh S. Percutaneous interstitial brachytherapy ablation for targeting oligometastatic gynecologic cancers. Brachytherapy 2024:S1538-4721(24)00006-0. [PMID: 38453533 DOI: 10.1016/j.brachy.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Treatment of recurrent oligometastatic gynecologic malignancy may involve targeted surgery, thermal ablation, or CT-guided high-dose-rate interstitial brachytherapy ablation (CT-HDR-IBTA). The purpose of this study was to describe the safety and efficacy of CT-HDR-IBTA for oligometastatic gynecologic malignancies. METHODS With institutional review board approval (IRB) approval and compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliance, we searched our database to assemble a single-arm study cohort of all patients with oligometastatic gynecologic cancers who underwent CT-HDR-IBTA from 2012-2022 with follow-up. The electronic record was reviewed to determine relevant clinicopathological variables including patient demographics, prior treatments, clinical course, local control, and local and distant recurrence with follow-up imaging. RESULTS The study cohort comprised 37 lesions in 34 patients treated with CT-HDR-IBTA for recurrent oligometastatic uterine (n = 17), cervix (n = 1), or ovarian cancer (n = 16) with an average lesion size of 2.5 cm with an average patient age of 61.4 years. Each lesion was treated with an average radiation dose of 23.8 Gy in 1.8 fractions and a median follow-up time of 24.0 months. The primary efficacy of CT HDR ITBA was 73% with a median progression-free survival of 8.0 months (95% CI 3.6-12.8 months) and with 58% of patients still alive at 43 months with median overall survival not reached. The rate of Grade 1 adverse events was 22% without any Grade 2, 3 or 4 events. CONCLUSIONS CT HDR IBTA was safe and effective for treating oligometastatic gynecologic cancers in a heavily pretreated cohort.
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Affiliation(s)
- Tiffany S Lai
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA.
| | - Alex Francoeur
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA
| | | | - Puja Venkat
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Albert Chang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Michael Douek
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Simin Bahrami
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Steven S Raman
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Sanaz Memarzadeh
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA
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Deodato F, Ferro M, Bonome P, Pezzulla D, Romano C, Buwenge M, Cilla S, Morganti AG, Macchia G. Stereotactic body radiotherapy (SIB-VMAT technique) to dominant intraprostatic lesion (DIL) for localized prostate cancer: a dose-escalation trial (DESTROY-4). Strahlenther Onkol 2024; 200:239-249. [PMID: 38180492 DOI: 10.1007/s00066-023-02189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE DESTROY-4 (DOSE-ESCALATION STUDY OF STEREOTACTIC BODY RADIATION THERAPY) was a Phase I trial aimed to evaluate the safety and the feasibility of escalating doses of stereotactic body radiation therapy (SBRT) on MRI-defined Dominant Intraprostatic Lesion (DIL) in low- and intermediate-risk pCa patients using a simultaneous integrated boost-volumetric arc therapy (SIB-VMAT) technique. METHODS Eligible patients included those with low- and intermediate-risk prostate carcinoma (NCCN risk classes) and an International Prostatic Symptoms Score (IPSS) ≤ 15. No restriction about DIL and prostate volumes was set. Pretreatment preparation required an enema and the placement of intraprostatic gold fiducials. SBRT was delivered in five consecutive daily fractions. For the first three patients, the DIL radiation dose was set at 8 Gy per fraction up to a total dose of 40 Gy (PTV1) and was gradually increased in succeeding cohorts to total doses of 42.5 Gy, 45.0 Gy, 47.5 Gy, and finally, 50.0 Gy, while keeping the prescription of 35 Gy/7 Gy per fraction for the entire prostate gland. Dose-limiting toxicity (DLT) was defined as grade 3 or worse gastrointestinal (GI) or genitourinary (GU) toxicity occurring within 90 days of follow-up (Common Terminology Criteria of Adverse Events scale 4.0). Patients completed quality-of-life questionnaires at defined intervals. RESULTS Twenty-four patients with a median age of 75 (range, 58-89) years were enrolled. The median follow-up was 26.3 months (8.9-84 months). 66.7% of patients were classified as intermediate-risk groups, while the others were low-risk groups, according to the NCCN guidelines. Enrolled patients were treated as follows: 8 patients (40 Gy), 5 patients (42.5 Gy), 4 patients (45 Gy), 4 patients (47.5 Gy), and 3 patients (50 Gy). No severe acute toxicities were observed. G1 and G2 acute GU toxicities occurred in 4 (16%) and 3 patients (12.5%), respectively. Two patients (8.3%) and 3 patients (12.5%) experienced G1 and G2 GI toxicities, respectively. Since no DLTs were observed, 50 Gy in five fractions was considered the MTD. The median nadir PSA was 0.20 ng/mL. A slight improvement in QoL values was registered after the treatment. CONCLUSION This trial confirms the feasibility and safety of a total SIB-VMAT dose of 35 Gy on the whole gland and 50 Gy on DIL in 5 fractions daily administered in a well-selected low- and intermediate-risk prostate carcinoma population. A phase II study is ongoing to confirm the tolerability of the schedule and assess the efficacy.
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Affiliation(s)
- Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Milena Ferro
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy.
| | - Paolo Bonome
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
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Cilla S, Campitelli M, Antonietta Gambacorta M, Michela Rinaldi R, Deodato F, Pezzulla D, Romano C, Fodor A, Laliscia C, Trippa F, De Sanctis V, Ippolito E, Ferioli M, Titone F, Russo D, Balcet V, Vicenzi L, Di Cataldo V, Raguso A, Giuseppe Morganti A, Ferrandina G, Macchia G. Machine-learning prediction of treatment response to stereotactic body radiation therapy in oligometastatic gynecological cancer: A multi-institutional study. Radiother Oncol 2024; 191:110072. [PMID: 38142932 DOI: 10.1016/j.radonc.2023.110072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to develop and validate different machine-learning (ML) prediction models for the complete response of oligometastatic gynecological cancer after SBRT. MATERIAL AND METHODS One hundred fifty-seven patients with 272 lesions from 14 different institutions and treated with SBRT with radical intent were included. Thirteen datasets including 222 lesions were combined for model training and internal validation purposes, with an 80:20 ratio. The external testing dataset was selected as the fourteenth Institution with 50 lesions. Lesions that achieved complete response (CR) were defined as responders. Prognostic clinical and dosimetric variables were selected using the LASSO algorithm. Six supervised ML models, including logistic regression (LR), classification and regression tree analysis (CART) and support vector machine (SVM) using four different kernels, were trained and tested to predict the complete response of uterine lesions after SBRT. The performance of models was assessed by receiver operating characteristic curves (ROC), area under the curve (AUC) and calibration curves. An explainable approach based on SHapley Additive exPlanations (SHAP) method was deployed to generate individual explanations of the model's decisions. RESULTS 63.6% of lesions had a complete response and were used as ground truth for the supervised models. LASSO strongly associated complete response with three variables, namely the lesion volume (PTV), the type of lesions (lymph-nodal versus parenchymal), and the biological effective dose (BED10), that were used as input for ML modeling. In the training set, the AUCs for complete response were 0.751 (95% CI: 0.716-0.786), 0.766 (95% CI: 0.729-0.802) and 0.800 (95% CI: 0.742-0.857) for the LR, CART and SVM with a radial basis function kernel, respectively. These models achieve AUC values of 0.727 (95% CI: 0.669-0.795), 0.734 (95% CI: 0.649-0.815) and 0.771 (95% CI: 0.717-0.824) in the external testing set, demonstrating excellent generalizability. CONCLUSION ML models enable a reliable prediction of the treatment response of oligometastatic lesions receiving SBRT. This approach may assist radiation oncologists to tailor more individualized treatment plans for oligometastatic patients.
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Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy.
| | - Maura Campitelli
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | | | | | - Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Fabio Trippa
- Radiation Oncology Center, S Maria Hospital, Terni, Italy
| | | | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Roma, Italy
| | - Martina Ferioli
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Titone
- Department of Radiation Oncology, University Hospital Udine, Udine, Italy
| | | | - Vittoria Balcet
- Radiation Oncology Department, Ospedale degli Infermi, Biella, Italy
| | - Lisa Vicenzi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, University of Florence, Firenze, Italy
| | - Arcangela Raguso
- Radiation Oncology Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, S. Giovanni Rotondo, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
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Macchia G, Cilla S, Pezzulla D, Campitelli M, Laliscia C, Lazzari R, Draghini L, Fodor A, D'Agostino GR, Russo D, Balcet V, Ferioli M, Vicenzi L, Raguso A, Di Cataldo V, Perrucci E, Borghesi S, Ippolito E, Gentile P, De Sanctis V, Titone F, Delle Curti CT, Huscher A, Gambacorta MA, Ferrandina G, Morganti AG, Deodato F. Efficacy of stereotactic body radiotherapy and response prediction using artificial intelligence in oligometastatic gynaecologic cancer. Gynecol Oncol 2024; 184:16-23. [PMID: 38271773 DOI: 10.1016/j.ygyno.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE We present a large real-world multicentric dataset of ovarian, uterine and cervical oligometastatic lesions treated with SBRT exploring efficacy and clinical outcomes. In addition, an exploratory machine learning analysis was performed. METHODS A pooled analysis of gynecological oligometastases in terms of efficacy and clinical outcomes as well an exploratory machine learning model to predict the CR to SBRT were carried out. The CR rate following radiotherapy (RT) was the study main endpoint. The secondary endpoints included the 2-year actuarial LC, DMFS, PFS, and OS. RESULTS 501 patients from 21 radiation oncology institutions with 846 gynecological metastases were analyzed, mainly ovarian (53.1%) and uterine metastases(32.1%).Multiple fraction radiotherapy was used in 762 metastases(90.1%).The most frequent schedule was 24 Gy in 3 fractions(13.4%). CR was observed in 538(63.7%) lesions. The Machine learning analysis showed a poor ability to find covariates strong enough to predict CR in the whole series. Analyzing them separately, in uterine cancer, if RT dose≥78.3Gy, the CR probability was 75.4%; if volume was <13.7 cc, the CR probability became 85.1%. In ovarian cancer, if the lesion was a lymph node, the CR probability was 71.4%; if volume was <17 cc, the CR probability rose to 78.4%. No covariate predicted the CR for cervical lesions. The overall 2-year actuarial LC was 79.2%, however it was 91.5% for CR and 52.5% for not CR lesions(p < 0.001). The overall 2-year DMFS, PFS and OS rate were 27.3%, 24.8% and 71.0%, with significant differences between CR and not CR. CONCLUSIONS CR was substantially associated to patient outcomes in our series of gynecological cancer oligometastatic lesions. The ability to predict a CR through artificial intelligence could also drive treatment choices in the context of personalized oncology.
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Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Molise, Italy.
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Molise, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Molise, Italy
| | - Maura Campitelli
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Italy
| | - Roberta Lazzari
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe R D'Agostino
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | | | - Vittoria Balcet
- UOC Radioterapia, Nuovo Ospedale degli Infermi, Biella, Italy
| | - Martina Ferioli
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, 40138, Italy
| | - Lisa Vicenzi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Arcangela Raguso
- UOC Radioterapia, Fondazione "Casa Sollievo della Sofferenza", IRCCS, S. Giovanni Rotondo, Foggia, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, University of Florence, Firenze, Italy
| | | | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana sud est, Arezzo, Toscana, Italy
| | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Roma, Italy
| | - Piercarlo Gentile
- Radiation Oncology Unit, UPMC Hillman Cancer Center San Pietro FBF, Roma, Italy
| | - Vitaliana De Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Roma, Italy
| | - Francesca Titone
- Department of Radiation Oncology, University Hospital Udine, Italy
| | - Clelia Teresa Delle Curti
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy
| | - Alessandra Huscher
- Fondazione Poliambulanza, U.O. di Radioterapia Oncologica "Guido Berlucchi", Brescia, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore Roma, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Alessio G Morganti
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, 40138, Italy; Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Molise, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore Roma, Italy
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Fotopoulou C, Eriksson AG, Yagel I, Chang SJ, Lim MC. Surgery for Recurrent Epithelial Ovarian Cancer. Curr Oncol Rep 2024; 26:46-54. [PMID: 38091202 PMCID: PMC10858815 DOI: 10.1007/s11912-023-01480-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW To review evidence around the value and challenges of surgery for recurrent epithelial ovarian cancer (ROC). Both cytoreductive and palliative aspects will be addressed RECENT FINDINGS: Prospective and retrospective evidence demonstrates a significantly longer remission derived from the combination of surgical and systemic modalities as opposed to systemic treatment alone in carefully selected ROC-patients who have relapsed more than 6 months from the end of their 1st line platinum-based chemotherapy. Nevertheless, this benefit appears to be limited when total macroscopic tumor clearance is not achieved. Selection algorithms to identify optimal surgical candidates are of paramount importance to prevent surgical morbidity without the equivalent oncological benefit. In the palliative setting, the risks and benefits of salvage surgery need to be counterbalanced with the advances of conservative techniques for optimal care. Well-defined selection algorithms to identify those who will benefit from surgery in the relapsed setting appear to be the key to oncologic and surgical success.
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Affiliation(s)
- Christina Fotopoulou
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
| | - Ane Gerda Eriksson
- Department of Gynecological Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Itai Yagel
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Shiba Medical Centre, Tel Aviv, Israel
| | - Suk-Joon Chang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer and Center for Clinical Trials, National Cancer Center, Goyang, South Korea
- Rare & Pediatric Cancer Branch and Immuno-Oncology Branch, Division of Rare and Refractory Cancer, Research Institute, National Cancer Center, Goyang, South Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
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Kim YB, Byun HK, Wee CW, Kim H, Kim S, Yang G, Kim J, Park SJ, Lee JY. Study protocol for prospective multi-institutional phase III trial of standard of care therapy with or without stereotactic ablative radiation therapy for recurrent ovarian cancer (SABR-ROC). BMC Cancer 2023; 23:1014. [PMID: 37864152 PMCID: PMC10588104 DOI: 10.1186/s12885-023-11407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/15/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Efforts have been made to investigate the role of salvage radiotherapy (RT) in treating recurrent ovarian cancer (ROC). Stereotactic ablative radiation therapy (SABR) is a state-of-the-art therapy that uses intensity modulation to increase the fractional dose, decrease the number of fractions, and target tumors with high precision. METHODS The SABR-ROC trial is a phase 3, multicenter, randomized, prospective study to evaluate whether the addition of SABR to the standard of care significantly improves the 3-year overall survival (OS) of patients with ROC. Patients who have completed the standard treatment for primary epithelial ovarian cancer are eligible. In addition, patients with number of metastases ≤ 10 and maximum diameter of each metastatic site of gross tumor ≤ 5 cm are allowed. Randomization will be stratified by (1) No. of the following clinical factors met, platinum sensitivity, absence of ascites, normal level of CA125, and ECOG performance status of 0-1; 0-3 vs. 4; (2) site of recurrence; with vs. without lymph nodes; and (3) PARP inhibitor; use vs. non-use. The target number of patients to be enrolled in this study is 270. Participants will be randomized in a 1:2 ratio. Participants in Arm 2 will receive SABR for recurrent lesions clearly identified in imaging tests as well as the standard of care (Arm 1) based on treatment guidelines and decisions made in multidisciplinary discussions. The RT fraction number can range from 1 to 10, and the accepted dose range is 16-45 Gy. The RT Quality Assurance (QA) program consists of a three-tiered system: general credentialing, trial-specific credentialing, and individual case reviews. DISCUSSION SABR appears to be preferable as it does not interfere with the schedule of systemic treatment by minimizing the elapsed days of RT. The synergistic effect between systemic treatment and SABR is expected to reduce the tumor burden by eradicating gross tumors identified through imaging with SABR and controlling microscopic cancer with systemic treatment. It might also be beneficial for quality-of-life preservation in older adults or heavily treated patients. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov (NCT05444270) on June 29th, 2022.
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Affiliation(s)
- Yong Bae Kim
- Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
| | - Hwa Kyung Byun
- Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Chan Woo Wee
- Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Hojin Kim
- Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Seyoung Kim
- Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Gowoon Yang
- Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Jina Kim
- Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Sang Joon Park
- Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Jung-Yun Lee
- Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
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8
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Macchia G, Pezzulla D, Campitelli M, Laliscia C, Fodor A, Bonome P, Draghini L, Ippolito E, De Sanctis V, Ferioli M, Titone F, Balcet V, Di Cataldo V, Russo D, Vicenzi L, Cossa S, Lucci S, Cilla S, Deodato F, Gambacorta MA, Scambia G, Morganti AG, Ferrandina G. Efficacy and Safety of Stereotactic Body Radiation Therapy in Oligometastatic Uterine Cancer (MITO-RT2/RAD): A Large, Real-World Study in Collaboration With Italian Association of Radiation Oncology, Multicenter Italian Trials in Ovarian Cancer, and Mario Negri Gynecologic Oncology Group Groups. Int J Radiat Oncol Biol Phys 2023; 117:321-332. [PMID: 37150261 DOI: 10.1016/j.ijrobp.2023.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/04/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE This retrospective, multicenter study analyzes the efficacy and safety of stereotactic body radiation therapy in a large cohort of patients with oligometastatic/persistent/recurrent uterine cancer. METHODS AND MATERIALS Clinical and radiation therapy data from several radiation therapy centers treating patients by stereotactic body radiation therapy between March 2006 and October 2021 were collected. Objective response rate was defined as complete and partial response, and clinical benefit included objective response rate plus stable disease. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer and Common Terminology Criteria for Adverse Events scales were used to grade toxicities. Primary endpoints were the rate of complete response to stereotactic body radiation therapy, and the 2-year actuarial local control rate "per-lesion" basis. Secondary endpoints were progression-free survival and overall survival, as well as toxicity. RESULTS In the study, 157 patients with oligometastatic/persistent/recurrent uterine cancer bearing 272 lesions treated by stereotactic body radiation therapy at 14 centers were analyzed. Lymph node metastases (137, 50.4%) were prevalent, followed by parenchyma lesions (135, 49.6%). Median total dose was 35 Gy (10-75.2), in 5 fractions (range, 1-10). Complete and partial responses were 174 (64.0%), and 54 (19.9%), respectively. Stable disease was registered in 29 (10.6%), and 15 (5.5%) lesions progressed. Type of lesion (lymph node), volume (≤13.7 cc) and total dose (BED10 >59.5 Gy) were significantly associated with a higher probability of achieving complete response. Patients achieving complete response (CR) "per-lesion" basis experienced a 2-year actuarial local control rate of 92.4% versus 33.5% in lesions not achieving complete response (NCR; P < .001). Moreover, the 2-year actuarial progression-free survival rate in patients with CR was 45.4%, and patients with NCR had a 2-year rate of 17.6% (P < .001). Finally, patients who had a CR had a 2-year overall survival rate of 82.7%, compared with 56.5% for NCR patients (P <.001). Severe acute toxicity was around 2%, including one toxic death due to gastric perforation, and severe late toxicity around 4%. CONCLUSIONS The efficacy of stereotactic body radiation therapy in this setting was confirmed. The low toxicity profile and the high local control rate in complete responder patients encourage the wider use of this approach.
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Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy.
| | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Maura Campitelli
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Bonome
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | | | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Roma, Italy
| | - Vitaliana De Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Roma, Italy
| | - Martina Ferioli
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum. Bologna University, Bologna, Italy
| | - Francesca Titone
- Department of Radiation Oncology, University Hospital Udine, Udine, Italy
| | - Vittoria Balcet
- Radiation Oncology Department, Ospedale degli Infermi, Biella
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, University of Florence, Firenze, Italy
| | | | - Lisa Vicenzi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Sabrina Cossa
- UOC Radioterapia, Fondazione "Casa Sollievo della Sofferenza," IRCCS, S. Giovanni Rotondo, Foggia, Italy
| | - Simona Lucci
- Department of Radiation Oncology, University Hospital Udine, Udine, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise, Campobasso, Molise, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore Roma, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore Roma, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum. Bologna University, Bologna, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Macchia G, Titone F, Restaino S, Arcieri M, Pellecchia G, Andreetta C, Driul L, Vizzielli G, Pezzulla D. Is It Time to Reassess the Role of Radiotherapy Treatment in Ovarian Cancer? Healthcare (Basel) 2023; 11:2413. [PMID: 37685447 PMCID: PMC10486999 DOI: 10.3390/healthcare11172413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
With a 5-year survival rate of fewer than 50%, epithelial ovarian carcinoma is the most fatal of the gynecologic cancers. Each year, an estimated 22,000 women are diagnosed with the condition, with 14,000 dying as a result, in the United States. Over the last decade, the advent of molecular and genetic data has enhanced our understanding of the heterogeneity of ovarian cancer. More than 80% of women diagnosed with advanced illness have an initial full response to rigorous therapy at diagnosis, including surgery and platinum-based chemotherapy. Unfortunately, these responses are infrequently lasting, and the majority of women with ovarian cancer suffer recurrent disease, which is often incurable, despite the possibility of future response and months of survival. And what therapeutic weapons do we have to counter it? For many years, radiation therapy for ovarian tumors was disregarded as an effective treatment option due to its toxicity and lack of survival benefits. Chemotherapy is widely used following surgery, and it has nearly completely supplanted radiation therapy. Even with the use of more modern and efficient chemotherapy regimens, ovarian cancer failures still happen. After receiving first-line ovarian cancer chemotherapy, over 70% of patients show evidence of recurrence in the abdomen or pelvis. It is necessary to reinterpret the function of radiation therapy in light of recent technological developments, the sophistication of radiation procedures, and the molecular and biological understanding of various histological subtypes. This review article focuses on the literature on the use of radiation in ovarian tumors as well as its rationale and current indications.
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Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy; (G.M.); (D.P.)
| | - Francesca Titone
- Radiation Oncology Unit, Department of Oncology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Stefano Restaino
- Department of Maternal and Child Health, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (S.R.); (M.A.); (G.P.); (L.D.); (G.V.)
| | - Martina Arcieri
- Department of Maternal and Child Health, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (S.R.); (M.A.); (G.P.); (L.D.); (G.V.)
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, 98122 Messina, Italy
| | - Giulia Pellecchia
- Department of Maternal and Child Health, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (S.R.); (M.A.); (G.P.); (L.D.); (G.V.)
- Medical Area Department (DAME), University of Udine, 33100 Udine, Italy
| | - Claudia Andreetta
- Medical Oncology Unit, Department of Oncology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy;
| | - Lorenza Driul
- Department of Maternal and Child Health, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (S.R.); (M.A.); (G.P.); (L.D.); (G.V.)
- Medical Area Department (DAME), University of Udine, 33100 Udine, Italy
| | - Giuseppe Vizzielli
- Department of Maternal and Child Health, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (S.R.); (M.A.); (G.P.); (L.D.); (G.V.)
- Medical Area Department (DAME), University of Udine, 33100 Udine, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy; (G.M.); (D.P.)
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Caivano D, Bonome P, Pezzulla D, Rotondi M, Sigillo RC, De Sanctis V, Valeriani M, Osti MF. Stereotactic body radiation therapy for the treatment of lymph node metastases: a retrospective mono-institutional study in a large cohort of patients. Front Oncol 2023; 13:1163213. [PMID: 37601675 PMCID: PMC10435736 DOI: 10.3389/fonc.2023.1163213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/29/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Lymph node metastases (NMs) are a common site of tumor spread that can occur at different times of the disease. Stereotactic body radiation therapy (SBRT) can be a therapeutic option for the treatment of NMs in the setting of oligometastatic disease (OMD). The aim of this study was to evaluate as primary end points the local control (LC) and secondary end points the locoregional nodal control (LRNC), distant nodal control (DNC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS), and concurrently to assess the predictive factors of response. Methods This is a retrospective study that analyzes a group of patients treated with SBRT on NMs from different primary tumors, with a of maximum five metastasis. Treated lesions were divided into four groups: oligometastatics, oligorecurrents, oligoprogressives, and oligopersistents. Results From 2007 to 2021, 229 NMs were treated in 174 patients with different primary tumor. The schedule most represented was 30 Gy in five fractions. The LC was obtained in 90% of NMs treated by SBRT with rates at 1, 3, and 5 years of 93%, 86%, and 86%, respectively. The LRNC was reached in 84% of cases with rates at 1, 3, and 5 years of 88%, 83%, and 77%, respectively. The DNC was obtained in 87% of cases with rates at 1, 3, and 5 years of 92%, 82%, and 78%, respectively. The DMFS was obtained in 38% of cases with rates at 1, 3, and 5 years of 57%, 40%, and 30%, respectively. The rate of PFS were 44%, 23%, and 13% at 1, 3, and 5 years, respectively. The rates at 1, 3, and 5 years of OS were 78%, 48%, and 36%, respectively. Conclusion SBRT is an option for the treatment of NMS, with high rates of LC, improving survival, and with a good safety and tolerance. Tumor volume, tumor burden, lesion site, and doses can be predictive factors of response; however, multi-institutional studies with a greater number of patients could be helpful to better select patients and understand the right integrations between ablative treatment and systemic therapies.
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Affiliation(s)
- Donatella Caivano
- Department of Medical and Surgical Sciences and Translational Medicine - Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy
- Radiotherapy, Santa Maria Goretti Hospita, Latina, Italy
| | - Paolo Bonome
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Margherita Rotondi
- Department of Radiation Oncology, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Riccardo Carlo Sigillo
- Department of Radiation Oncology, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Vitaliana De Sanctis
- Department of Radiation Oncology, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Valeriani
- Department of Radiation Oncology, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Radiation Oncology, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Sherwani Z, Parikh S, Yegya-Raman N, McKenna K, Deek M, Jabbour S, Hathout L. Stereotactic Body Radiation Therapy in Gynecologic Oligometastases: An Effective but Underutilized Approach. Cancers (Basel) 2023; 15:3526. [PMID: 37444636 DOI: 10.3390/cancers15133526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Historically, the role of radiation in gynecological metastatic disease involved palliation for pain or bleeding. Stereotactic Body Radiation Therapy (SBRT) has shown survival benefits in oligometastatic disease from varying primary histologies in recent randomized trials. However, gynecologic primary oligometastases have been underrepresented in these trials. Recent studies across gynecological malignancy types have similarly shown favorable outcomes and acceptable toxicities from treating recurrent or oligometastatic gynecologic cancer (ROMGC) patients with definitive radiation therapy. The largest body of literature reported on the use of SBRT in ovarian cancer, which was found to be an effective option, especially in the setting of chemo-resistant disease. Despite the encouraging outcomes using SBRT in oligometastatic gynecologic malignancies, SBRT remains underutilized given the lack of randomized studies studying ROMGC with long term follow-up. While waiting for future prospective trials to establish the role of SBRT as the standard of care in ROMGC patients, this review focuses on reporting the advantages and drawbacks of this technique and examines the current literature to help guide patient centered treatment decisions.
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Affiliation(s)
- Zohaib Sherwani
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
| | - Shreel Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
| | - Nikhil Yegya-Raman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kelly McKenna
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
| | - Matthew Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
| | - Salma Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
| | - Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
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Gauduchon T, Kfoury M, Lorusso D, Floquet A, Ventriglia J, Salaun H, Moubarak M, Rivoirard R, Polastro L, Favier L, You B, Berton D, de la Motte Rouge T, Mansi L, Abdeddaim C, Prulhiere K, Lancry Lecomte L, Provansal M, Dalban C, Ray-Coquard I. PARP inhibitors (PARPi) prolongation after local therapy for oligo-metastatic progression in relapsed ovarian cancer patients. Gynecol Oncol 2023; 173:98-105. [PMID: 37105063 DOI: 10.1016/j.ygyno.2023.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND PARP inhibitors (PARPi) have revolutionized the management of high-grade epithelial ovarian cancer (HGOC) treatment. However, a significant number of patients relapse or progress under PARPi, leading to the introduction of a new line of systemic therapy such as chemotherapy. In patients with a limited number of metastatic sites at progression, -referred to as an oligometastatic progression- a potential indication for local therapy followed by re-introduction or continuation of PARPi treatment rather than initiating a new line of chemotherapy could be proposed. However, the impact of such strategies on progression free survival (PFS) in these patients remains unknown. METHODS This international multicenter retrospective study evaluated the efficacy of PARPi continuation or re-introduction in patients with HGOC after local treatment for oligometastatic progression. The main objective was to assess PFS under PARPi after local therapy (PFS post-LT). Secondary objectives included safety and overall survival (OS). RESULTS 74 patients were identified in 20 centers between April 2020 and November 2021. 65% of patients were BRCA mutated and 92% had received ≥2 lines of prior systemic chemotherapy before the initial introduction of PARPi. Main progression sites were lymph nodes (42%), peritoneum (27%), liver (16%), other visceral (16%) and abdominal wall (4%). Local therapies included radiotherapy (45%), surgery (43%), both (7%), percutaneous thermal ablation (4%) or chemoembolization (1%). Median PFS post-LT was 11.5 months [95% CI 7.4; 17.2]. After a median follow up of 14.8 months, 6 patients (8.1%) discontinued PARPi due to toxicity. The 1-year overall survival rate was 90.7% [95% CI 79.1; 96.0]. CONCLUSIONS With close to one year without progression or introduction of a new line of systemic therapy, this study reports the feasibility and potential benefit of this original strategy in patients with oligometastatic progression under PARPi.
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Affiliation(s)
| | - Maria Kfoury
- Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Domenica Lorusso
- Gynecologic Oncology, Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Anne Floquet
- Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Jole Ventriglia
- Medical Oncology, IRCCS National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | | | - Malak Moubarak
- Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Romain Rivoirard
- Medical Oncology, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Laura Polastro
- Medical Oncology, Institut Jules Bordet, Brussels, Belgium
| | - Laure Favier
- Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Benoit You
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Groupement Hospitalier Sud, GINECO, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, EA 3738 CICLY, Lyon, France
| | - Dominique Berton
- Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | - Laura Mansi
- Medical Oncology, Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Besançon, France
| | | | | | | | | | - Cécile Dalban
- Department of Biostatistics, Direction de Recherche Clinique et de l'innovation du Centre Léon Bérard, Lyon 69008, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est Inserm, Lyon 69008, France.
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13
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Facondo G, Vullo G, De Sanctis V, Rotondi M, Sigillo RC, Valeriani M, Osti MF. Clinical Outcomes of Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Patients with Lymph Node Metastases from Gynecological Cancers. J Pers Med 2023; 13:jpm13020229. [PMID: 36836463 PMCID: PMC9965700 DOI: 10.3390/jpm13020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND To evaluate clinical outcomes of stereotactic body radiation therapy (SBRT) as a local treatment for lymph node metastases from gynecological cancers. METHODS Between November 2007 and October 2021, we retrospectively analyzed 29 lymph node metastases in 22 oligometastatic/oligoprogressive patients treated with SBRT. The Kaplan-Meier method was used to estimate the rates survival. Univariate analysis for prognostic factors were performed with the log-rank test, and Cox proportional hazards regression was used to estimate hazard ratios (HR). RESULTS Median age was 62 years (IQR, 50-80 years). Median follow-up was 17 months (IQR 10.5-31 months). The median survival was 22 months (CI 95%: 4.2-39.7, IQR: 12.5-34.5 months). Six months, one year and two year overall survival (OS) were 96.6%, 85.2%, and 48.7%, respectively. Median local control (LC) was not reached. Six months, 1one year and 2 year were 93.1%, 87.9%, and 79.9%, respectively. Distant metastasis free survival (DMFS) at one year, and two year was 53% and 37.1%, respectively Four patients (18%) experienced acute G1-G2 toxicities. No G3-4 acute toxicity was reported, and no late toxicity was observed. CONCLUSIONS SBRT for lymph node recurrence offers excellent in-field tumor control with safe profile and low toxicities. Size, number of oligometastases, and time primary tumor to RT seem to be significant prognostic factors.
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Bae BK, Cho WK, Lee JW, Kim TJ, Choi CH, Lee YY, Park W. Role of salvage radiotherapy for recurrent ovarian cancer. Int J Gynecol Cancer 2023; 33:66-73. [PMID: 36137577 DOI: 10.1136/ijgc-2022-003834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE This study aimed to report clinical outcomes of salvage radiotherapy for recurrent ovarian cancer and identify predictors of clinical outcomes. METHODS We retrospectively reviewed data of patients who received salvage radiotherapy for recurrent ovarian cancer between January 2011 and June 2021. Stereotactic body radiotherapy, involved-field radiotherapy with conventional fractionation, and non-involved-field radiotherapy with conventional fractionation were included in this study. Local failure-free survival, progression-free survival, chemotherapy-free survival, and overall survival were assessed. Additionally, potential prognostic factors for survival were analyzed. RESULTS A total of 79 patients were included with 114 recurrent lesions. The median follow-up was 18.3 months (range 1.7-83). The 2-year local failure-free survival, progression-free survival, chemotherapy-free survival, and overall survival rates were 80.7%, 10.6%, 21.2%, and 74.7%, respectively. Pre-radiotherapy platinum resistance (hazard ratio (HR) 3.326, p<0.001) and short pre-radiotherapy CA-125 doubling time (HR 3.664, p<0.001) were associated with poor chemotherapy-free survival. The 1-year chemotherapy-free survival rates of patients with both risk factors, a single risk factor, and no risk factor were 0%, 20.4%, and 53.5%, respectively. The difference between risk groups was statistically significant: low risk versus intermediate risk (p<0.001) and intermediate risk versus high risk (p<0.001). CONCLUSIONS Salvage radiotherapy for recurrent ovarian cancer resulted in local control with improved chemotherapy-free survival in carefully selected patients. Our results suggest that the consideration of pre-radiotherapy platinum resistance and pre-radiotherapy CA-125 doubling time could help with patient selection.
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Affiliation(s)
- Bong Kyung Bae
- Department of Radiation Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (Republic of)
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (Republic of)
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (Republic of)
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (Republic of)
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (Republic of)
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (Republic of)
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Gangnam-gu, Seoul, Korea (Republic of)
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Stefanovic M, Calvet G, Pérez-Montero H, Esteve A, Bujalance MV, Navarro-Martín A, Fernández MDA, González FF, Borras SM, Borbalas AL, Fernandez MN, Garau MM, Calduch AL, Edo FG. Stereotactic body radiation therapy in the treatment of cancer patients with oligometastatic disease: a real world study. Clin Transl Oncol 2023; 25:199-206. [PMID: 36068449 DOI: 10.1007/s12094-022-02923-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is a treatment modality with curative intent for oligometastatic cancer patients, commonly defined by a low-burden metastatic disease with 1-5 systemic metastases. Better knowledge of the clinical profile and prognostic factors in oligometastatic cancer patients could help to improve the selection of candidates who may obtain most benefits from SBRT. The objective of this study was to describe the clinical data and outcome in term of overall survival (OS) of patients with oligometastatic disease treated with SBRT over a 6-year period. METHODS From 2013 to 2018, 284 solid tumor cancer patients with 1-5 oligometastases underwent SBRT at a large university-affiliated oncological center in Barcelona, Spain. Variables related to the patient profile, tumor, oligometastatic disease, and treatment were evaluated. RESULTS A total of 327 metastatic tumors were treated with SBRT. In 65.5% of cases, metachronous tumors were diagnosed at least 1 year after diagnosis of the primary tumor. The median age of the patients was 73.9 years and 66.5% were males. The median follow-up was 37.5 months. The most common primary tumors were lung and colorectal cancer, with lung and bone as the most commonly treated metastatic sites. Ninety-three percent of patients showed a Karnofsky score (KPS) between 80 and 100. Adenocarcinoma was the most common histological type. The median overall survival was 53.4 months, with 1-, 2- and 5-year survival rates of 90.5%, 73.9% and 43.4%, respectively. Overall survival rates of breast (67.6 months, 95% CI 56.4-78.9), urological (63.3 months, 95% CI 55.8-70.8), and colorectal (50.8 months, 95% CI 44.2-57.4) tumors were higher as compared with other malignancies (20 months, 95% CI 11.2-28.8 months) (p < 0.001). Patients with Karnofsky score (KPS) of 90 and 100 showed a significantly better survival than those with impaired performance status (p = 0.001). CONCLUSION SBRT appears to be well tolerated and safe approach in oligometastatic patients. Patients with good performance status and with primary breast, urological and colorectal cancer have higher OS compared with other malignancies. More studies are necessary to evaluate the prognostic factors in oligometastatic disease (OMD) in order to select patients who could benefit more from this therapeutic approach.
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Affiliation(s)
- Milica Stefanovic
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain. .,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.
| | - Gemma Calvet
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Héctor Pérez-Montero
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Anna Esteve
- Badalona Applied Research Group in Oncology (B·ARGO), Oncology Data Analytics Program (ODAP), Institut Català d'Oncologia (ICO), Institut Català d'Oncologia (ICO Badalona), Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Montse Ventura Bujalance
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Arturo Navarro-Martín
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Maria Dolores Arnaiz Fernández
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Ferran Ferrer González
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Susanna Marin Borras
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Alicia Lozano Borbalas
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Miriam Nuñez Fernandez
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Miquel Macia Garau
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Anna Lucas Calduch
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Ferran Guedea Edo
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
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Barcellini A, Mangili G, Fodor A, Secondino S, Zerbetto F, Charalampopoulou A, Pignata S, Orlandi E, Bergamini A. Granulosa cell tumors (GCTs) of the ovary: What is the role of radiotherapy? Crit Rev Oncol Hematol 2023; 181:103889. [PMID: 36503888 DOI: 10.1016/j.critrevonc.2022.103889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/19/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
Granulosa cell tumors of the ovary have an indolent behavior and a good prognosis, but a high incidence of local recurrence after surgery. The best treatment in the recurrent setting is unclear and randomized clinical trials on the management in the recurrent setting are lacking. The role of radiotherapy is controversial in adjuvant settings and unknown in case of relapse after surgery. This review aims to summarize the level of evidence of the role of radiation treatments for granulosa cell tumors of the ovary.
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Affiliation(s)
- Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia.
| | - Giorgia Mangili
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Secondino
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Flavia Zerbetto
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexandra Charalampopoulou
- Radiobiology Unit, Research and Development Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Alice Bergamini
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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17
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Barcellini A, Charalampopoulou A, De Cecco L, Fodor A, Rabaiotti E, Candotti G, Secondino S, Facoetti A, Locati LD, Pignata S, Orlandi E, Mangili G. Ovarian Cancer Radiosensitivity: What Have We Understood So Far? Life (Basel) 2022; 13. [PMID: 36675955 DOI: 10.3390/life13010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Radiotherapy has been increasingly considered as an active treatment to combine with other approaches (i.e., surgery, chemotherapy, and novel target-based drugs) in ovarian cancers to palliate symptoms and/or to prolong chemotherapy-free intervals. This narrative review aimed to summarize the current knowledge of the radiosensitivity/radioresistance of ovarian cancer which remains the most lethal gynecological cancer worldwide. Indeed, considering the high rate of recurrence in and out of the radiotherapy fields, in the era of patient-tailored oncology, elucidating the mechanisms of radiosensitivity and identifying potential radioresistance biomarkers could be crucial in guiding clinical decision-making.
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18
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Shen J, Tao Y, He L, Guan H, Zhen H, Liu Z, Zhang F. Clinical application of radiotherapy in patients with oligometastatic ovarian cancer: a sharp tool to prolong the interval of systemic treatment. Discov Oncol 2022; 13:82. [PMID: 36006491 PMCID: PMC9411494 DOI: 10.1007/s12672-022-00540-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With the advances of radiation technology, treatment of oligometastatic disease, with limited metastatic burden, have more chances to achieve long-term local control. Here we aim to evaluate the efficacy and safety of radiotherapy (RT) in oligometastatic ovarian cancer patients. METHODS A retrospective analysis collecting 142 patients (189 lesions) with oligometastatic ovarian cancer were included in the study. All pateints received radiotherapy and the curative effect and response rate were evaluated by diagnostic imaging after 1-3 months of radiotherapy with RECIST. Endpoints were the rate of complete response (CR), chemotherapy-free interval (CFI), local control (LC) rate and overall survival (OS) rate. Toxicity was evaluated by the Radiation Therapy Oncology Group (RTOG). Logistic and Cox regression were used for the uni- and multivariate analysis of factors influencing survival outcomes. RESULTS From 2013.1.1 to 2020.12.30, a total of 142 ovarian cancer patients (189 oligometastasis lesions) were included in the analysis. Prescribed doses to an average GTV of 3.10 cm were 1.8-8 Gy/fraction, median BED (28-115, a/b = 10 Gy), 5-28 fractions. For 179 evaluable lesions, the cases of CR, partial response (PR), stable disease (SD) and progressive disease (PD) after radiotherapy were 22,39,38 and 80 respectively. The disease control rate (DCR): CR + PR + SD was 55.31%, and the objective response rate (ORR): CR + PR was 34.08%. No patient developed grade 3 or higher side effect. The median CFI was 14 months (1-99 months), and the LC rate was 69.7%, 54.3% and 40.9% in 1 year, 2 years and 5 years respectively. GTV < 3 cm before treatment, platinum sensitivity, time from the last treatment ≥ 6 months, single lesion and BED(a/b = 10 Gy) ≥ 60 are the factors of good LC (p < 0.05). The total OS of 1 year, 2 years and 5 years were 67.1%, 52.6% and 30.3%, respectively. Single lesion (HR 0.598, 95%CI 0.405-0.884), DCR (HR 0.640, 95% CI 0.448-0.918) and ORR(HR 0.466, 95% CI 0.308-0.707) were the significant factors influencing 5-year OS. CONCLUSION For patients with oligometastatic ovarian cancer, radiotherapy has high LC, long chemotherapy-free interval, and survival benefits. Subgroup analysis shows that patients with single lesion and good local treatment results have higher overall survival rate, suggesting that active treatment is also beneficial for oligometastatic ovarian cancer patients.
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Affiliation(s)
- Jing Shen
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Yinjie Tao
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Lei He
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Hui Guan
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Hongnan Zhen
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
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Palluzzi E, Marchetti C, Cappuccio S, Avesani G, Macchia G, Gambacorta MA, Cocciolillo F, Scambia G, Fagotti A. Management of oligometastatic ovarian cancer recurrence during PARP inhibitor maintenance. Int J Gynecol Cancer 2022; 32:ijgc-2022-003543. [PMID: 35868655 DOI: 10.1136/ijgc-2022-003543] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The benefit of surgery and maintenance treatment with PARP inhibitors (PARPi) has been clearly demonstrated in ovarian cancer. Also, the efficacy and safety of stereotactic body radiotherapy has been shown in patients with metastatic, persistent, and recurrent disease. The aim of this study is to evaluate the management of oligometastatic progression during PARPi maintenance treatment. METHODS This is an observational, retrospective, single-arm study conducted from June 2017 to December 2020 in patients with recurrent ovarian cancer with oligometastatic progression under PARPi maintenance treatment and receiving surgery or stereotactic body radiotherapy for such recurrence. PARPi treatment was continued until further progression of the disease. The primary objective of the study was the median prolongation of the treatment-free interval-p (without platinum) after local treatment. RESULTS A total of 186 patients with ovarian cancer were treated with PARPi at recurrence. Of these, 30 (16%) developed oligometastatic progression. The median age was 49.5 years (range 35-73). Olaparib, niraparib and rucaparib were administered to 33%, 60%, and 7% of patients, respectively. The median prolongation of the treatment-free interval-p of patients treated with surgery or stereotactic body radiotherapy was 6 and 10 months, respectively (p=0.53). The median treatment-free interval-p of patients treated with surgery or stereotactic body radiotherapy at the time of oligometastatic progression was 32 and 29 months, respectively (p=0.44). At the time of this publication, 50% of patients are still on treatment with PARPi following progression. CONCLUSIONS Patients with recurrent ovarian cancer who have oligometastic progression during PARPi maintenance may continue to benefit from PARPi if combined with local treatment.
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Affiliation(s)
- Eleonora Palluzzi
- Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Claudia Marchetti
- Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Cappuccio
- Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Avesani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Gabriella Macchia
- Dipartimento Servizi e Laboratori, Direzione Scientifica, Gemelli Molise Hospital, Radiotherapy Unit, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Maria Antonietta Gambacorta
- Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Fabrizio Cocciolillo
- Nuclear Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Giovanni Scambia
- Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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20
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Pasqualetti F, Trippa F, Aristei C, Borghesi S, Colosimo C, Cantarella M, Mazzola R, Ingrosso G. Stereotactic radiotherapy for oligometastases in the lymph nodes. Rep Pract Oncol Radiother 2022; 27:46-51. [PMID: 35402021 PMCID: PMC8989441 DOI: 10.5603/rpor.a2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Even though systemic therapy is standard treatment for lymph node metastases, metastasis-directed stereotactic radiotherapy (SRT ) seems to be a valid option in oligometastatic patients with a low disease burden. Positron emission tomography-computed tomography (PET-CT ) is the gold standard for assessing metastases to the lymph nodes; co-registration of PET-CT images and planning CT images are the basis for gross tumor volume (GTV ) delineation. Appropriate techniques are needed to overcome target motion. SRT schedules depend on the irradiation site, target volume and dose constraints to the organs at risk (OARs) of toxicity. Although several fractionation schemes were reported, total doses of 48–60 Gy in 4–8 fractions were proposed for mediastinal lymph node SRT, with the spinal cord, esophagus, heart and proximal bronchial tree being the dose limiting OAR s. Total doses ranged from 30 to 45 Gy, with daily fractions of 7–12 Gy for abdominal lymph nodes, with dose limiting OARs being the liver, kidneys, bowel and bladder. SRT on lymph node metastases is safe; late side effects, particularly severe, are rare.
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Affiliation(s)
- Francesco Pasqualetti
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Fabio Trippa
- Radiation Oncology Centre, S. Maria Hospital, Terni, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | - Caterina Colosimo
- Operative Unit of Radiotherapy, Department of Oncology, San Luca Hospital, Lucca, Italy
| | | | - Rosario Mazzola
- Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
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Abstract
Gynecological cancers have particularly benefited from the increasing use of imaging to guide radiation treatment planning for both external beam radiation and brachytherapy. While the different gynecological cancers have varying use of imaging, certain trends predominate. CT represents an economical choice for evaluating initial disease extent or potential metastasis at follow-up, particularly for endometrial and ovarian cancers. F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is particularly useful for assessing the initial disease extent and longer term treatment response of squamous predominant cancers, including cervical, vaginal, and vulvar cancers. With its excellent pelvic soft tissue discrimination, MRI provides the greatest assistance in evaluating the local extent of gynecological tumors, including initial evaluation for non-operative endometrial and vulvar cancer, and assessment before, after and during brachytherapy for cervix, locally recurrent endometrial, and primary vaginal cancers. With more limited availability of MRI, ultrasound can also help guide brachytherapy, particularly during procedures. The benefits of using imaging to better spare bone marrow or earlier assessment of treatment response are topics still being explored, in particular for cervical cancer. As imaging along with radiation oncology technologies continue to evolve and develop, such as with MRI-linacs and ultra high dose rate (FLASH) radiation, we may continue to see increasing use of imaging for advancing gynecological radiation oncology.
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Shenker R, Stephens SJ, Davidson B, Chino J. Role of stereotactic body radiotherapy in gynecologic radiation oncology. Int J Gynecol Cancer 2022; 32:372-379. [DOI: 10.1136/ijgc-2021-002466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/15/2021] [Indexed: 12/25/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT, also referred to as stereotactic ablative radiotherapy (SABR)) has been used in the treatment of primary and metastatic solid tumors, and increasingly so in gynecologic oncology. This review article aims to summarize the current literature describing the utility of SBRT in the primary, recurrent, and limited metastatic settings for gynecologic malignancies. The use of SBRT in both retrospective and prospective reports has been associated with adequate control of the treated site, particularly in the setting of oligometastatic disease. It is not, however, recommended as an alternative to brachytherapy for intact disease unless all efforts to use brachytherapy are exhausted. While phase I and II trials have established the relative safety and potential toxicities of SBRT, there remains a dearth of phase III randomized evidence, including the use of immunotherapy, in order to better establish the role of this technique as a method of improving more global outcomes for our patients with gynecologic cancers.
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Corrigan KL, Yoder A, De B, Lin L, Jhingran A, Joyner MM, Eifel PJ, Colbert LE, Lu KH, Klopp AH. Long-term survival following definitive radiation therapy for recurrence or oligometastases in gynecological malignancies: A landmark analysis. Gynecol Oncol 2022; 164:550-7. [PMID: 34974906 DOI: 10.1016/j.ygyno.2021.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Radiation therapy (RT) may improve outcomes for patients with oligometastatic cancer. We sought to determine if there are long-term survivors treated with definitive RT for recurrent or oligometastatic gynecological cancer (ROMGC), and to evaluate the clinical and disease characteristics of these patients. METHODS We performed a landmark analysis in 48 patients with ROMGC who survived for ≥5 years following definitive RT of their metastasis. Patient characteristics were extracted from the medical record. DFS was modeled using the Kaplan-Meier method. RESULTS This cohort included 20 patients (42%) with ovarian cancer, 16 (33%) with endometrial cancer, 11 (23%) with cervical cancer, and one (2%) with vaginal cancer. The sites of ROMGC were the pelvic (46%), para-aortic (44%), supraclavicular (7%), mediastinal (4%), axillary (4%) lymph nodes and the lung (5.5%). Median total RT dose and fractionation were 62.1 Gy and 2.1 Gy/fraction; one patient was treated with SBRT. 32 patients (67%) received chemoradiation; these patients had higher rates of median DFS than those treated with RT alone (93 vs. 34 months, P = 0.05). At median follow-up of 11.7 years, 11 (23%) patients had progression of disease. 20 (42%) patients had died, 9 (19%) died from non-gynecologic cancer and 8 (17%) from gynecologic cancer (three were unknown). 25 (52%) patients were alive and disease-free (10 initially had endometrial cancer [63% of these patients], eight had cervical cancer [73%], six had ovarian cancer [30%], one had vaginal cancer [100%]). CONCLUSIONS Long-term survival is possible for patients treated with definitive RT for ROMG, however randomized data are needed to identify which patients derive the most benefit.
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Macchia G, Nardangeli A, Laliscia C, Fodor A, Draghini L, Gentile PC, D’Agostino GR, Balcet V, Bonome P, Ferioli M, Autorino R, Vicenzi L, Raguso A, Borghesi S, Ippolito E, Di Cataldo V, Cilla S, Perrucci E, Campitelli M, Gambacorta MA, Deodato F, Scambia G, Ferrandina G. Stereotactic body radiotherapy in oligometastatic cervical cancer (MITO-RT2/RAD study): a collaboration of MITO, AIRO GYN, and MaNGO groups. Int J Gynecol Cancer 2022; 32:732-739. [DOI: 10.1136/ijgc-2021-003237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectiveThis retrospective, multicenter study analyzes the efficacy and safety of stereotactic body radiotherapy in a large cohort of patients with oligometastatic/persistent/recurrent cervical cancer.MethodsA standardized data collection from several radiotherapy centers that treated patients by stereotactic body radiotherapy between March 2006 and February 2021 was set up. Clinical and stereotactic body radiotherapy parameters were collected. Objective response rate was defined as a composite of complete and partial response, while clinical benefit included objective response rate plus stable disease. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer and Common Terminology Criteria for Adverse Events scales were used to grade toxicities. The primary endpoints were the rate of complete response to stereotactic body radiotherapy, and the 2 year actuarial local control rate on a ‘per lesion’ basis. The secondary end points were progression-free survival and overall survival, as well as toxicity.ResultsA total of 83 patients with oligometastatic/persistent/recurrent cervical cancer bearing 125 lesions treated by stereotactic body radiotherapy at 15 different centers were selected for analysis. Of the sites of metastatic disease, lymph node metastases were most common (55.2%), followed by parenchyma lesions (44.8%). Median total dose was 35 Gy (range 10–60), in five fractions (range 1–10), with a median dose/fraction of 7 Gy (range 4–26). Complete, partial, and stable response were found in 73 (58.4%), 29 (23.2%), and 16 (12.8%) lesions, respectively, reaching 94.4% of the clinical benefit rate. Forty-six (55.4%) patients had a complete response. Patients achieving complete response on a ‘per lesion’ basis experienced a 2 year actuarial local control rate of 89.0% versus 22.1% in lesions not achieving complete response (p<0.001). The 2 year actuarial progression-free survival rate was 42.5% in patients with complete response versus 7.8% in patients with partial response or stable or progressive disease (p=0.001). The 2 year actuarial overall survival rate was 68.9% in patients with complete response versus 44.3% in patients with partial response or stable or progressive disease (p=0.015). Fifteen patients (18.1%) had mild acute toxicity, totaling 29 side events. Late toxicity was documented in four patients (4.8%) totaling seven adverse events.ConclusionOur analysis confirmed the efficacy of stereotactic body radiotherapy in oligometastatic/persistent/recurrent cervical cancer patients. The low toxicity profile encourages the wider use of stereotactic body radiotherapy in this setting.
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Sun S, Sun W, Xiang Q, Yang C, Chen M, Mei Z, Yang H, Zeng Z, Cao H, Tian Y, Zhang G, Qiu H. Persistent response of an ovarian cancer patient after a short-term single-agent immunotherapy: a case report. Anticancer Drugs 2022; 33:e756-e759. [PMID: 34338238 PMCID: PMC8670358 DOI: 10.1097/cad.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/02/2021] [Indexed: 12/24/2022]
Abstract
Epithelial ovarian cancer is extremely difficult to treat due to its high recurrence rate and acquired tolerance to chemotherapy. Immune checkpoint inhibitors (ICIs) are expected to be promising solutions for treatment failure. However, the low response rate to a single ICI agent was demonstrated in approximately all published clinical trials. Surprisingly patients with complete response were also noticed as an anecdote. Proper indicators of treatment response were urgently required. Programmed death- ligand 1 expression levels in the tumor tissues provide relatively limited discrimination. Tumor mutation burden (TMB) serves as a more reliable parameter. Here we presented an ovarian cancer case with multiple gene mutations and high TMB, who benefited from a short-term treatment of pembrolizumab and experienced a long-lasting complete response of 2 years till now. The patient was irradiated in the pelvic before pembrolizumab. Our study demonstrated that ICIs might provide survival benefits for ovarian cancer with high TMB and that pelvic radiation might have synergistical effects with immunotherapy.
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Affiliation(s)
| | - Wenjie Sun
- Department of Radiation and Medical Oncology
| | | | - Chunxu Yang
- Department of Radiation and Medical Oncology
| | - Min Chen
- Department of Radiation and Medical Oncology
| | - Zijie Mei
- Department of Radiation and Medical Oncology
| | - Hui Yang
- Department of Radiation and Medical Oncology
| | - Zihang Zeng
- Department of Radiation and Medical Oncology
| | | | - Yueli Tian
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Gong Zhang
- Department of Radiation and Medical Oncology
| | - Hui Qiu
- Department of Radiation and Medical Oncology
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Bizzarri N, Nero C, Sillano F, Ciccarone F, D’Oria M, Cesario A, Fragomeni SM, Testa AC, Fanfani F, Ferrandina G, Lorusso D, Fagotti A, Scambia G. Building a Personalized Medicine Infrastructure for Gynecological Oncology Patients in a High-Volume Hospital. J Pers Med 2021; 12:jpm12010003. [PMID: 35055317 PMCID: PMC8778422 DOI: 10.3390/jpm12010003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
Gynecological cancers require complex intervention since patients have specific needs to be addressed. Centralization to high-volume centers improves the oncological outcomes of patients with gynecological cancers. Research in gynecological oncology is increasing thanks to modern technologies, from the comprehensive molecular characterization of tumors and individual pathophenotypes. Ongoing studies are focusing on personalizing therapies by integrating information across genomics, proteomics, and metabolomics with the genetic makeup and immune system of the patient. Hence, several challenges must be faced to provide holistic benefit to the patient. Personalized approaches should also recognize the unmet needs of each patient to successfully deliver the promise of personalized care, in a multidisciplinary effort. This may provide the greatest opportunity to improve patients' outcomes. Starting from a narrative review on gynecological oncology patients' needs, this article focuses on the experience of building a research and care infrastructure for personalized patient management.
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Affiliation(s)
- Nicolò Bizzarri
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
| | - Camilla Nero
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
- Correspondence:
| | - Francesca Sillano
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
| | - Francesca Ciccarone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
| | - Marika D’Oria
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
| | - Alfredo Cesario
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
| | - Simona Maria Fragomeni
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
| | - Antonia Carla Testa
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriella Ferrandina
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Domenica Lorusso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
| | - Anna Fagotti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
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Cerda VR, Lu D, Scott M, Kim KH, Rimel BJ, Kamrava M. Evaluation of patterns of progression on poly (ADP-ribose) polymerase inhibitor (PARPi) maintenance in ovarian cancer: a cross-sectional study. Int J Gynecol Cancer 2021; 32:153-158. [PMID: 34911701 DOI: 10.1136/ijgc-2021-003053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite improvement in progression-free survival with poly (ADP-ribose) polymerase inhibitors (PARPi) as maintenance therapy for ovarian cancer, many patients will eventually progress on therapy. Oligoprogression is uniquely suited to considerations of local consolidation therapy in this setting, but not commonly used in ovarian cancer. In this study we evaluated the proportion of patients on PARPi maintenance who developed limited sites of disease, the location of progression, and their natural history. METHODS From January 2006 to December 2020, natural language processing software (DEEP6AI) was used to identify 58 patients with ovarian cancer treated with PARPi maintenance after complete or partial response after surgery and platinum-based chemotherapy at our institution. Patients were assessed for presence and location of recurrence based on radiologic findings. RESULTS The median patient age was 65 (IQR 57-71) years. Patients had a median of two lines of chemotherapy prior to starting PARPi. With a median follow-up of 48 (range 12-149) months, 32 (55%) patients had a recurrence on maintenance olaparib and 11 (34%) patients developed oligoprogression (≤3 sites). For the 11 patients with oligoprogression, three patients developed recurrence in one site, five in two sites, and three in three sites. The sites of oligoprogression were pelvic/periaortic nodal (27%), peritoneal (27%), liver (27%), lung/mediastinal (14%), and brain (5%). The median progression-free survival for the entire cohort was 6.0 months (95% CI 4.2 to 7.8); median overall survival was not met. There were no significant differences in overall survival (p=0.81) or progression-free survival (p=0.95) between patients with and without oligoprogression. CONCLUSIONS One-third of patients on PARPi maintenance experienced oligoprogression defined as limited to ≤3 sites. These patients may benefit from local consolidation therapy. A larger dataset is needed to validate these findings to assess if trials investigating local therapy for these patients is of value.
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Affiliation(s)
- Victoria R Cerda
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Diana Lu
- Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marla Scott
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kenneth H Kim
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Bobbie Jo Rimel
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mitchell Kamrava
- Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Cuccia F, Pastorello E, Vitale C, Nicosia L, Mazzola R, Figlia V, Giaj-Levra N, Ricchetti F, Rigo M, Attinà G, Ceccaroni M, Ruggieri R, Alongi F. The use of SBRT in the management of oligometastatic gynecological cancer: report of promising results in terms of tolerability and clinical outcomes. J Cancer Res Clin Oncol 2021; 147:3613-3618. [PMID: 34545423 DOI: 10.1007/s00432-021-03802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of stereotactic radiotherapy (SBRT) for oligometastases is supported by several literature studies, but in the setting of gynecological malignancies, this scenario remains quite unexplored. This study reports a preliminary assessment of clinical outcomes in a cohort of 40 patients with oligometastatic gynecological neoplasms. METHODS Radiotherapy was delivered in 3-10 fractions with VMAT-IGRT technique. Toxicity was retrospectively collected according to CTCAE v4.0. Data were retrospectively collected and analyzed. Univariate and multivariate analyses were performed for assessing any potential predictive factor for clinical outcomes. RESULTS A total of 63 oligometastases were treated from December 2014 to February 2021. Median age was 63 years (range 30-89). Most frequent primary tumors were ovarian cancer in 42.5% and endometrium cancer in 42.5%. With a median follow-up of 27 months (range 6-69), no local failures were observed, our progression-free survival rates were 43.6% and 23% at one and 2 years, respectively, while 1 and 2-year overall survival rates were both 70%. No acute or late G ≥ 2 adverse events were observed. CONCLUSIONS In our experience, SBRT for oligometastatic gynecological malignancies resulted in promising results in terms of clinical outcomes, with excellent local control and no evidence of severe toxicity, highlighting the effectiveness of this therapeutic option. Prospective studies to further explore this approach in this setting are advocated.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Edoardo Pastorello
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Claudio Vitale
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy.
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Giorgio Attinà
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Marcello Ceccaroni
- Gynecology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
- University of Brescia, Brescia, Italy
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Henke LE, Stanley JA, Robinson C, Srivastava A, Contreras JA, Curcuru A, Green OL, Massad LS, Kuroki L, Fuh K, Hagemann A, Mutch D, McCourt C, Thaker P, Powell M, Markovina S, Grigsby PW, Schwarz JK, Chundury A. Phase I Trial of Stereotactic MRI-Guided Online Adaptive Radiation Therapy (SMART) for the Treatment of Oligometastatic Ovarian Cancer. Int J Radiat Oncol Biol Phys 2021; 112:379-389. [PMID: 34474109 DOI: 10.1016/j.ijrobp.2021.08.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/18/2021] [Accepted: 08/24/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Stereotactic body radiation therapy is increasingly used to treat a variety of oligometastatic histologies, but few data exist for ovarian cancer. Ablative stereotactic body radiation therapy dosing is challenging in sites like the abdomen, pelvis, and central thorax due to proximity and motion of organs at risk. A novel radiation delivery method, stereotactic magnetic-resonance-guided online-adaptive radiation therapy (SMART), may improve the therapeutic index of stereotactic body radiation therapy through enhanced soft-tissue visualization, real-time nonionizing imaging, and ability to adapt to the anatomy-of-the-day, with the goal of producing systemic-therapy-free intervals. This phase I trial assessed feasibility, safety, and dosimetric advantage of SMART to treat ovarian oligometastases. METHODS AND MATERIALS Ten patients with recurrent oligometastatic ovarian cancer underwent SMART for oligometastasis ablation. Initial plans prescribed 35 Gy/5 fractions with goal 95% planning target volume coverage by 95% of prescription, with dose escalation permitted, subject to strict organ-at-risk dose constraints. Daily adaptive planning was used to protect organs-at-risk and/or increase target dose. Feasibility (successful delivery of >80% of fractions in the first on-table attempt) and safety of this approach was evaluated, in addition to efficacy, survival metrics, quality-of-life, prospective timing and dosimetric outcomes. RESULTS Ten women with seventeen ovarian oligometastases were treated with SMART, and 100% of treatment fractions were successfully delivered. Online adaptive plans were selected at time of treatment for 58% of fractions, due to initial plan violation of organs-at-risk constraints (84% of adapted fractions) or observed opportunity for planning target volume dose escalation (16% of adapted fractions), with a median on-table time of 64 minutes. A single Grade ≥3 acute (within 6 months of SMART) treatment-related toxicity (duodenal ulcer) was observed. Local control at 3 months was 94%; median progression-free survival was 10.9 months. Median Kaplan-Meier estimated systemic-therapy-free survival after radiation completion was 11.5 months, with concomitant quality-of-life improvements. CONCLUSIONS SMART is feasible and safe for high-dose radiation therapy ablation of ovarian oligometastases of the abdomen, pelvis, and central thorax with minimal toxicity, high rates of local control, and prolonged systemic-therapy-free survival translating into improved quality-of-life.
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Affiliation(s)
- Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jennifer A Stanley
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
| | - Amar Srivastava
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jessika A Contreras
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Austen Curcuru
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Olga L Green
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - L Stewart Massad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Lindsay Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Katherine Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Andrea Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - David Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Carolyn McCourt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Premal Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Matthew Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Anupama Chundury
- Department of Radiation Oncology, Rutgers University, New Brunswick, New Jersey
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Portelance L, Corradini S, Erickson B, Lalondrelle S, Padgett K, van der Leij F, van Lier A, Jürgenliemk-Schulz I. Online Magnetic Resonance-Guided Radiotherapy (oMRgRT) for Gynecological Cancers. Front Oncol 2021; 11:628131. [PMID: 34513656 PMCID: PMC8429611 DOI: 10.3389/fonc.2021.628131] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 07/12/2021] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy (RT) is increasingly being used in gynecological cancer management. RT delivered with curative or palliative intent can be administered alone or combined with chemotherapy or surgery. Advanced treatment planning and delivery techniques such as intensity-modulated radiation therapy, including volumetric modulated arc therapy, and image-guided adaptive brachytherapy allow for highly conformal radiation dose delivery leading to improved tumor control rates and less treatment toxicity. Quality on-board imaging that provides accurate visualization of target and surrounding organs at risk is a critical feature of these advanced techniques. As soft tissue contrast resolution is superior with magnetic resonance imaging (MRI) compared to other imaging modalities, MRI has been used increasingly to delineate tumor from adjacent soft tissues and organs at risk from initial diagnosis to tumor response evaluation. Gynecological cancers often have poor contrast resolution compared to the surrounding tissues on computed tomography scan, and consequently the benefit of MRI is high. One example is in management of locally advanced cervix cancer where adaptive MRI guidance has been broadly implemented for adaptive brachytherapy. The role of MRI for external beam RT is also steadily increasing. MRI information is being used for treatment planning, predicting, and monitoring position shifts and accounting for tissue deformation and target regression during treatment. The recent clinical introduction of online MRI-guided radiation therapy (oMRgRT) could be the next step in high-precision RT. This technology provides a tool to take full advantage of MRI not only at the time of initial treatment planning but as well as for daily position verification and online plan adaptation. Cervical, endometrial, vaginal, and oligometastatic ovarian cancers are being treated on MRI linear accelerator systems throughout the world. This review summarizes the current state, early experience, ongoing trials, and future directions of oMRgRT in the management of gynecological cancers.
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Affiliation(s)
- Lorraine Portelance
- Sylvester Comprehensive Cancer Center, Radiation Oncology Department, University of Miami, Miami, FL, United States
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Susan Lalondrelle
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research London, London, United Kingdom
| | - Kyle Padgett
- Sylvester Comprehensive Cancer Center, Radiation Oncology Department, University of Miami, Miami, FL, United States
| | - Femke van der Leij
- Department of Radiation Oncology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Astrid van Lier
- Department of Radiation Oncology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Ina Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
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Chen X, Chen H, Poon I, Erler D, Badellino S, Biswas T, Dagan R, Foote M, Louie AV, Ricardi U, Sahgal A, Redmond KJ. Late metastatic presentation is associated with improved survival and delayed wide-spread progression after ablative stereotactic body radiotherapy for oligometastasis. Cancer Med 2021; 10:6189-6198. [PMID: 34432390 PMCID: PMC8446561 DOI: 10.1002/cam4.4133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/25/2022] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is increasingly used to treat oligometastatic disease (OMD), but the effect of metastasis timing on patient outcomes remains uncertain. Methods An international database of patients with OMD treated with SBRT was assembled with rigorous quality assurance. Early versus late metastases were defined as those diagnosed ≤24 versus >24 months from the primary tumor. Overall survival (OS), progression‐free survival (PFS), and incidences of wide‐spread progression (WSP) were estimated using multivariable Cox proportional hazard models stratified by primary tumor types. Results The database consists of 1033 patients with median follow‐up of 24.1 months (0.3–104.7). Late metastatic presentation (N = 427) was associated with improved OS compared to early metastasis (median survival 53.6 vs. 33.0 months, hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.47–0.72, p < 0.0001). Patients with non‐small cell lung cancer (NSCLC, N = 255, HR 0.49, 95% CI: 0.33–0.74, p = 0.0005) and colorectal cancer (N = 235, HR 0.50, 95% CI: 0.30–0.84, p = 0.008) had better OS if presenting with late metastasis. Late metastasis correlated with longer PFS (median 17.1 vs. 9.0 months, HR 0.71, 95% CI: 0.61–0.83, p < 0.0001) and lower 2‐year incidence of WSP (26.1% vs. 43.6%, HR 0.60, 95% CI: 0.49–0.74, p < 0.0001). Fewer WSP were observed in patients with NSCLC (HR 0.52, 95% CI: 0.33–0.83, p = 0.006) and kidney cancer (N = 63, HR 0.37, 95% CI: 0.14–0.97, p = 0.044) with late metastases. Across cancer types, greater SBRT target size was a significant predictor for worse OS. Conclusion Late metastatic presentation is associated with improved survival and delayed progression in patients with OMD treated with SBRT.
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Affiliation(s)
- Xuguang Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Darby Erler
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | | | - Tithi Biswas
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA
| | - Matthew Foote
- Department of Radiation Oncology, University of Queensland, Princess Alexandra Hospital, Queensland, Australia
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | | | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
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32
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Macchia G, Jereczek-Fossa BA, Lazzari R, Cerrotta A, Deodato F, Ippolito E, Aristei C, Gambacorta MA, Scambia G, Valentini V, Ferrandina G. Efficacy and safety of stereotactic body radiotherapy (SBRT) in oligometastatic/persistent/recurrent ovarian cancer: a prospective, multicenter phase II study (MITO-RT3/RAD). Int J Gynecol Cancer 2021; 32:939-943. [PMID: 34155084 DOI: 10.1136/ijgc-2021-002709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) has shown promising results in the clinical setting of oligometastatic, persistent, or recurrent disease in several malignancies including ovarian cancer. PRIMARY OBJECTIVE The MITO-RT3/RAD trial is a prospective, multicenter phase II study aimed at identifying potential predictors of response and clinical outcome after SBRT treatment. STUDY HYPOTHESIS Radiotherapy delivered by pre-defined SBRT treatment schedules and shared constraints could improve the rate of complete response. TRIAL DESIGN All patients accrued will be treated with a radiotherapy dose in the range of 30-50 Gy by 1, 3, or 5 SBRT daily fractions to all sites of active metastatic disease according to diagnostic imaging. Schedules of treatment and dose prescription have been established before considering target sites and healthy organ dose constraints. Follow-up and monitoring of side effects will be carried out every 3 months for the first year with imaging and clinical evalutation, and every 4 months within the second year; thereafter, surveillance will be carried out every 6 months. The best response on a per lesion basis will be evaluated by computed tomographic (CT) scan, positron emission tomography/CT, or magnetic resonance imaging in case of brain lesions, every 3 months. MAJOR INCLUSION/EXCLUSION CRITERIA The study includes patients with oligometastatic, persistent, or recurrent ovarian cancer for which salvage surgery or other local therapies are not feasible due to any relative contra-indication to further systemic therapy because of serious co-morbidities, previous severe toxicity, unavailability of potentially active systemic therapy, or patient refusal. PRIMARY ENDPOINT The primary endpoint of the study is the clinical complete response rate to SBRT by imaging on a per lesion basis. SAMPLE SIZE Approximately 205 lesions will be treated (90 lymph nodes and 115 parenchyma lesions). ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS Fifty-two centers have expressed their intention to participate. Enrollment should be completed by March 2023 and analysis will be completed in September 2023. TRIAL REGISTRATION NCT04593381.
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Affiliation(s)
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milano, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Roberta Lazzari
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - Annamaria Cerrotta
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Campobasso, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Roma, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Maria Antonietta Gambacorta
- Istituto di Radiologia, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy.,Unità Operativa Complessa di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Vincenzo Valentini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy.,Unità Operativa Complessa di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
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33
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Cohen JG, Chang AJ. Use of stereotactic body radiotherapy in gynecologic cancers: Local control with systemic treatment implications. Gynecol Oncol 2021; 159:599-600. [PMID: 33279016 DOI: 10.1016/j.ygyno.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Joshua G Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Albert J Chang
- Division of Brachytherapy, Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
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34
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Hutten RJ, Huang YJ, Gaffney DK. Stereotactic body radiotherapy for the treatment of gynecologic malignancies: Passing fancy or here to stay? Gynecol Oncol 2021; 161:642-4. [PMID: 33867142 DOI: 10.1016/j.ygyno.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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35
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Campitelli M, Lazzari R, Piccolo F, Ferrazza P, Marsella AR, Macchia G, Fodor A, Santoni R, Tagliaferri L, Cerrotta A, Aristei C. Brachytherapy or external beam radiotherapy as a boost in locally advanced cervical cancer: a Gynaecology Study Group in the Italian Association of Radiation and Clinical Oncology (AIRO) review. Int J Gynecol Cancer 2021; 31:1278-1286. [PMID: 33632703 DOI: 10.1136/ijgc-2020-002310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/04/2022] Open
Abstract
This review analyzes the experience and trends in external beam radiotherapy for delivering a boost in locally advanced cervical cancer, identifying whether radiation therapy modalities impact clinical outcomes with the ultimate aim of evaluating alternatives to brachytherapy. Three independent Italian radiation oncologists conducted a literature search on different external beam radiotherapy boost modalities in locally advanced cervical cancer. The search yielded 30 studies. Eight dosimetric studies, evaluating target coverage and dose to organs at risk, and nine clinical investigations, reporting clinical outcomes, were analyzed. Dosimetric studies comparing external beam radiotherapy boost with brachytherapy produced divergent results, while clinical studies were limited by their retrospective nature, heterogeneous doses, radiation schedules, volumes and techniques, diverse follow-up times, and small cohorts of patients. Evidence emerged that high-tech external beam radiotherapy seemed no better than image-guided brachytherapy for delivering a boost in locally advanced cervical cancer. Prospective clinical studies comparing high-tech external beam radiotherapy and image-guided brachytherapy should be encouraged.
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Affiliation(s)
- Maura Campitelli
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Rome, Italy
| | - Roberta Lazzari
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
| | - Federica Piccolo
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | | | | | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Riccardo Santoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, UNIROMA2, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Rome, Italy
| | - Annamaria Cerrotta
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Umbria, Italy
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36
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Fiorentino A, Gregucci F, Desideri I, Fiore M, Marino L, Errico A, Di Rito A, Borghetti P, Franco P, Greto D, Donato V. Radiation treatment for adult rare cancers: Oldest and newest indication. Crit Rev Oncol Hematol 2021; 159:103228. [PMID: 33508447 DOI: 10.1016/j.critrevonc.2021.103228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 12/10/2020] [Accepted: 01/16/2021] [Indexed: 11/17/2022] Open
Abstract
AIM Aim of this analysis is to review the role of RT in the management of several rare tumors for adult patients. METHODS Collection data regarding RT and rare tumors was made by Pubmed. RESULTS For mucosal melanomas, RT is prescribed, being associated with lower local recurrence rate. For trachea tumors, RT was used as adjuvant or salvage treatment for unresectable disease. For pNET, RT can be a suitable option for post-surgical or unresectable/borderline. For bronchopulmonary neuroendocrine tumors the role of adjuvant treatments is uncertain. For hepatobiliary and ovarian malignancy, stereotactic body RT (SBRT) is a promising approach. For soft tissue sarcoma, perioperative treatments are indicated, and a growing role of SBRT in oligometastatic disease is recognized. For endocrine tumors, adjuvant RT has demonstrated benefits through reducing recurrence risk. CONCLUSION The radiotherapy is a frequent indication in adult rare cancers; thus the role of Radiation Oncologist must not be neglected.
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Affiliation(s)
- Alba Fiorentino
- Radiation Oncology Department, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Radiation Oncology Department, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy.
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Italy
| | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Lorenza Marino
- Radiation Oncology Department, Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy
| | - Angelo Errico
- Radiotherapy Oncology Department, R. Dimiccoli Hospital, Barletta, Italy
| | - Alessia Di Rito
- Radiotherapy Oncology Department, IRCCS "Giovanni Paolo II", Bari, Italy
| | - Paolo Borghetti
- Radiation Oncology Department University and Spedali Civili, Brescia, Italy
| | | | - Daniela Greto
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Italy
| | - Vittorio Donato
- Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
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Smile TD, Reddy CA, Qiao-Guan G, Winter WI, Stephans KL, Woody NM, Balagamwala EH, Amarnath SR, Magnelli A, AlHilli MM, Michener CM, Mahdi H, DeBernardo RL, Rose PG, Cherian SS. Stereotactic body radiotherapy for the treatment of oligometastatic gynecological malignancy in the abdomen and pelvis: A single-institution experience. J Radiosurg SBRT 2021; 7:189-197. [PMID: 33898082 PMCID: PMC8055243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE/OBJECTIVES Metastasis-directed therapy with stereotactic body radiotherapy (SBRT) in the setting of oligometastatic disease is a rapidly evolving paradigm given ongoing improvements in systemic therapies and diagnostic modalities. However, SBRT to targets in the abdomen and pelvis is historically associated with concerns about toxicity. The purpose of this study was to evaluate the safety and efficacy of SBRT to the abdomen and pelvis for women with oligometastases from primary gynecological tumors. MATERIALS/METHODS From our IRB-approved registry, all patients who were treated with SBRT between 2014 and 2020 were identified. Oligometastatic disease was defined as 1 to 5 discrete foci of clinical metastasis radiographically diagnosed by positron emission tomography (PET) and/or computerized tomography (CT) imaging. The primary endpoint was local control at 12 months. Local and distant control rates were estimated using the Kaplan-Meier method. Time intervals for development of local progression and distant progression were calculated based on follow up visits with re-staging imaging. Acute and late toxicity outcomes were determined based on Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. RESULTS We identified 34 women with 43 treated lesions. Median age was 68 years (range 32-82), and median follow up time was 12 months (range 0.2-54.0). Most common primary tumor sites were ovarian (n=12), uterine (n=11), and cervical (n=7). Median number of previous lines of systemic therapy agents at time of SBRT was 2 (range 0-10). Overall, SBRT was delivered to 1 focus of oligometastasis in 29 cases, 2 foci in 2 cases, 3 foci in 2 cases, and 4 foci in 1 case. All patients were treated comprehensively with SBRT to all sites of oligometastasis. Median prescription dose was 24 Gy (range 18-54 Gy) in 3 fractions (range 3-6) to a median prescription isodose line of 83.5% (range 52-95). Local control by lesion at 12 and 24 months was 92.5% for both time points. Local failure was observed in three treated sites among two patients, two of which were at 11 months in one patient, and the other at 30 months. Systemic control rate was 60.2% at 12 months. Overall survival at 12 and 24 months was 85% and 70.2%, respectively. Acute grade 2 toxicities included nausea (n=3), and there were no grade > 3 acute toxicities. Late grade 1 toxicities included diarrhea (n=1) and fatigue (n=1), and there were no grade > 2 toxicities. CONCLUSION SBRT to oligometastatic gynecologic malignancies in the abdomen and pelvis is feasible with encouraging preliminary safety and local control outcomes. This approach is associated with excellent local control and low rates of toxicity during our follow-up interval. Further investigations into technique, dose-escalation and utilization are warranted.
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Affiliation(s)
- Timothy D Smile
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - George Qiao-Guan
- College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - W Ian Winter
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ehsan H Balagamwala
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sudha R Amarnath
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Chad M Michener
- Gynecological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Haider Mahdi
- Gynecological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Peter G Rose
- Gynecological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sheen S Cherian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Butala AA, Patel RR, Manjunath S, Latif NA, Haggerty AF, Jones JA, Taunk NK. Palliative Radiation Therapy for Metastatic, Persistent, or Recurrent Epithelial Ovarian Cancer: Efficacy in the Era of Modern Technology and Targeted Agents. Adv Radiat Oncol 2021; 6:100624. [PMID: 33665491 PMCID: PMC7897761 DOI: 10.1016/j.adro.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/10/2020] [Accepted: 11/11/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Metastatic, persistent, or recurrent epithelial ovarian cancer (MPR-EOC) remains a significant threat to patient mortality despite advances in novel targeted agents. Radiation therapy (RT) is often used as a palliative option. We report outcomes of a large series of MPR-EOC patients treated with modern palliative RT (PRT) in an era of novel systemic therapies. METHODS AND MATERIALS A retrospective review was conducted of women treated with PRT for MPR-EOC between 2007 and 2019 at an academic institution. Clinical response rates were recorded at <1 month, 1 to 3 months, and >3 months. Radiographic responses were categorized by RECIST 1.1 criteria. Overall response rate (ORR) was the sum of complete and partial response. Linear regression analyses of baseline characteristics were conducted for statistical testing. RESULTS Eighty-six patients with PMR-OC received 120 courses of palliative RT. Median follow-up was 8.6 months. Median age was 61 (range, 22-82). Thirty-six percent of women received central nervous system (CNS)-directed RT. In addition, 43% received targeted therapies before RT. Clinical ORR within 1 month and at last follow-up for non-CNS lesions was 79% and 61% (69% and 88% for CNS lesions, respectively). High-grade serous lesions were more likely to have clinical response (P = .04). Biologically effective doses (BED) >39 Gy were associated with improved clinical response in CNS lesions (P = .049). Bony sites were associated with worse clinical (P = .004) response in non-CNS lesions compared with soft tissue or nodal sites. Acute or late grade 3+ toxicities with bevacizumab were low (8.7%/4.3%). CONCLUSIONS PRT offers excellent rates of response for symptomatic patients with MPR-EOC within 1 month of treatment, with durable responses beyond 3 months. High-grade serous lesions were associated with improved response in all patients. Higher BED and soft tissue or nodal sites were associated with improved response in CNS and non-CNS patients, respectively. Acute or late toxicities with bevacizumab and PRT were low. Prospective investigation is warranted to determine the optimal PRT regimen.
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Affiliation(s)
- Anish A. Butala
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Shwetha Manjunath
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nawar A. Latif
- Department of Gynecologic Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashley F. Haggerty
- Department of Gynecologic Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua A. Jones
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil K. Taunk
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Xiao L, Tang J, Li W, Xu X, Zhang H. Improved prognosis for recurrent epithelial ovarian cancer by early diagnosis and 125I seeds implantation during suboptimal secondary cytoreductive surgery: a case report and literature review. J Ovarian Res 2020; 13:141. [PMID: 33250044 PMCID: PMC7702710 DOI: 10.1186/s13048-020-00744-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
Background Epithelial ovarian cancer (EOC) has the worst prognosis in all of gynecologic malignant tumors because of its high recurrence and eventually chemo-resistance. Early diagnosis of recurrence is crucial to avoid diffuse dissemination. Failure of traditional treatment in recurrent epithelial ovarian cancer remains a challenge for clinicians. On the other hand, 125I brachytherapy has been accepted as a useful and hopeful treatment for multiple advanced cancers in recent years. However, its success in advanced epithelial ovarian cancer is limited. Here we report a case of recurrent ovarian cancer who had been early diagnosis of isolated recurrence and successfully treated with 125I seeds implantation during suboptimal cytoreductive surgery. Case presentation A 59-year-old woman presented with recurrent epithelial ovarian cancer who have had a history of ovarian cancer stage IIIB and an R0 resection had been achieved nearly 2 years before presented in our hospital. She underwent suboptimal secondary cytoreductive surgery after four cycles of chemotherapy with little effectiveness and severe chemotherapy-related side effects. Approximately 70% of the cancer-bulk was resected during surgery. For residual lesion which fixed around the right ureter and right external iliac vessel, 125I seeds implantation was performed. Postoperatively, the patient was treated with two cycles of combination chemotherapy with paclitaxel and carboplatin. The patient was free of disease at 26 months’ follow-up period. Conclusion In recurrent EOC patients with unresectable isolated lesion, salvage 125I seeds implantation are feasible and may contribute to survival.
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Affiliation(s)
- Lin Xiao
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Junying Tang
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wenbo Li
- Department of Nuclear medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xuexun Xu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hao Zhang
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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Yegya-Raman N, Cao CD, Hathout L, Girda E, Richard SD, Rosenblum NG, Taunk NK, Jabbour SK. Stereotactic body radiation therapy for oligometastatic gynecologic malignancies: A systematic review. Gynecol Oncol 2020; 159:573-580. [PMID: 32917412 DOI: 10.1016/j.ygyno.2020.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/08/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) for oligometastatic gynecologic malignancies. METHOD A comprehensive search of the PubMed, Medline, and EMBASE databases was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. "Oligometastatic" was defined as a limited number of uncontrolled/untreated metastatic lesions (typically ≤ 5), including regional nodal metastases. Primary outcomes were response rate (complete response or partial response), local control of oligometastatic lesions, and toxicity. RESULTS Of 716 screened records, 17 studies (13 full length articles, 4 conference abstracts) were selected and analyzed as 16 unique studies. A total of 667 patients were treated with ~1071 metastatic lesions identified. Primary sites included ovarian (57.6%), cervical (27.1%), uterine (11.1%), vaginal (0.4%), vulvar (0.3%), and other/unspecified (3.4%). Most patients (65.4%) presented with a single metastatic lesion. Metastatic lesion sites included the abdomen (44.2%), pelvis (18.8%), thorax (15.5%), neck (4.6%), central nervous system (4.3%), bone (1.6%), and other/unspecified (11%). Of the lesions, 64% were nodal. Response rate (among 8 studies) ranged from 49% to 97%, with 7/8 studies reporting > 75% response rate. Local control ranged from 71% to 100%, with 14/16 studies reporting ≥ 80% local control. No grade ≥ 3 toxicities were observed in 9/16 (56%) studies. Median progression-free survival (PFS) (among 10 studies) ranged from 3.3 months to 21.7 months. Disease progression most commonly occurred outside of the SBRT radiation field (79% to 100% of failures). CONCLUSIONS SBRT for oligometastatic gynecologic malignancies is associated with favorable response and local control rates but a high rate of out-of-field progression and heterogeneous PFS. Additional study into rational combinations of SBRT and systemic therapy appears warranted to further improve patient outcomes.
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Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Connie D Cao
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Eugenia Girda
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Scott D Richard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Norman G Rosenblum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Neil K Taunk
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA.
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Gadducci A, Aletti GD, Landoni F, Lazzari R, Mangili G, Olivas P, Pignata S, Salutari V, Sartori E, Scambia G, Zannoni GF, Sabbatini R, Lorusso D. Management of ovarian cancer: guidelines of the Italian Medical Oncology Association (AIOM). Tumori 2020; 107:100-109. [PMID: 33106117 DOI: 10.1177/0300891620966382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Ovarian cancer is the most lethal gynecologic malignancy. Over 5200 new cases of this tumor are diagnosed yearly in Italy, resulting in more than 3600 deaths. In terms of molecular biology, five different ovarian cancer subtypes should be distinguished. METHOD This article summarizes the evidence-based guidelines that the Italian Medical Oncology Association (AIOM) has developed with a multidisciplinary panel of experts, including pathologists, gynecologic oncologists, medical oncologists, and radiotherapists, with the support of methodologists, to help clinicians involved in the management of patients with ovarian cancer in their daily clinical practice. RESULTS The most relevant randomized clinical trials regarding surgery, chemotherapy, and molecularly targeted agents (bevacizumab and PARP inhibitors) in early, advanced, and recurrent disease have been critically analyzed. The levels of evidence and strength of recommendation have been reported for any issue. CONCLUSION Women with a clinical suspicion of ovarian cancer should be centralized in referral centers. The BRCA test should be requested for all women with nonmucinous and nonborderline tumors, regardless of age and family history. BRCA testing could be preferentially performed on neoplastic tissue. In the presence of a positive tumor test, a genetic test should always be performed on a blood sample to differentiate between germline mutations, which require counseling and genetic testing of family members, and somatic mutations.
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Affiliation(s)
- Angiolo Gadducci
- Dipartimento di Medicina Clinica e Sperimentale, Divisione di Ginecologia e Ostetricia, Università di Pisa, Pisa, Italy
| | - Giovanni D Aletti
- Divisione di Ginecologia Oncologica, IRCCS, Istituto Europeo di Oncologia, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
| | - Fabio Landoni
- Dipartimento di Medicina e Chirurgia, Università di Milano, Bicocca, Monza, Italy
| | - Roberta Lazzari
- Divisione di Radioterapia, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paola Olivas
- Istituto Nazionale Tumori di Napoli, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Istituto Nazionale Tumori di Napoli, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Vanda Salutari
- Ginecologia Oncologica, Fondazione Policlinico Universitario Gemelli, IRCCS, Rome, Italy
| | - Enrico Sartori
- Dipartimento Ostetrico-Ginecologico-Neonatologico, Università degli Studi di Brescia, Brescia, Italy
| | - Giovanni Scambia
- Ginecologia Oncologica, Fondazione Policlinico Universitario Gemelli, IRCCS, Rome, Italy
| | - Gian Franco Zannoni
- Unità Operativa di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Sabbatini
- Oncologia Medica, Azienda Ospedaliero Universitaria, Policlinico di Modena, Modena, Italy
| | - Domenica Lorusso
- Ginecologia Oncologica, Fondazione Policlinico Universitario Gemelli, IRCCS, Rome, Italy
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Franzese C, Comito T, Tripoli A, Franceschini D, Clerici E, Navarria P, Badalamenti M, D'agostino G, Loi M, Mancosu P, Reggiori G, Tomatis S, Scorsetti M. Phase II trial of high dose stereotactic body radiation therapy for lymph node oligometastases. Clin Exp Metastasis 2020; 37:565-73. [PMID: 32556682 DOI: 10.1007/s10585-020-10047-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
Lymph nodes are common sites of oligometastases for several primaries. Stereotactic body radiation therapy (SBRT) represents an effective treatment but no consensus exists regarding dose and fractionation. Aim of this trial was to evaluate safety and efficacy of high-dose SBRT. We included patients with 1 to 3 lymph node metastases. Primary end-point was safety, while secondary end-points were in-field local control (LC), out-field lymph nodal progression free survival (LPFS), distant metastasis free survival (DMFS), progression free survival (PFS) and overall survival (OS). 64 lesions in 52 patients were treated from 2015 to 2019. Most common primary tumor was genitourinary cancer (75%), in particular prostate cancer (65.4%). With a median follow-up of 24.4 months (range 3-49), treatment was very well tolerated, with only 4 (7.7%) patients reporting acute side effects, all classified as grade 1, in the form of pain, fatigue, nocturia and dysuria. No toxicity ≥ grade 2 were reported. Rates of LC at 1, 2 and 3 years were 97.9%, 82.1% and 82.1%. Male sex (HR 0.12, p value 0.014) was associated with improved LC. LPFS at 1, 2 and 3 years were 69.6%, 49.6% and 46.1%, respectively, and DMFS was 81.74%, 67.5% and 58.5%, respectively. Presence of lesions in other organs was correlated with inferior DMFS (HR 3.82, p = 0.042). PFS at 1, 2 and 3 years were 67.4%, 42.4% and 31.86%, respectively. OS at 1, 2 and 3 years were 97.3%, 94.2%, 84%, respectively and significantly correlated with in-field recurrence (HR 8.72, p = 0.000). Our prospective trial confirms safety and efficacy of SBRT in the management of lymph node metastases. Registered Clinical trial NCT02570399.
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Ferrandina G, Aristei C, Biondetti PR, Cananzi FCM, Casali P, Ciccarone F, Colombo N, Comandone A, Corvo' R, De Iaco P, Dei Tos AP, Donato V, Fiore M, Franchi, Gadducci A, Gronchi A, Guerriero S, Infante A, Odicino F, Pirronti T, Quagliuolo V, Sanfilippo R, Testa AC, Zannoni GF, Scambia G, Lorusso D. Italian consensus conference on management of uterine sarcomas on behalf of S.I.G.O. (Societa' italiana di Ginecologia E Ostetricia). Eur J Cancer 2020; 139:149-168. [PMID: 32992154 DOI: 10.1016/j.ejca.2020.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/10/2020] [Accepted: 08/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Uterine sarcomas are very rare tumours with different histotypes, molecular features and clinical outcomes; therefore, it is difficult to carry out prospective clinical trials, and this often results in heterogeneous management of patients in the clinical practice. AIM We planned to set up an Italian consensus conference on these diseases in order to provide recommendations on treatments and quality of care in our country. RESULTS Early-stage uterine sarcomas are managed by hysterectomy + bilateral salpingo-oophorectomy according to menopausal status and histology; lymphadenectomy is not indicated in patients without bulky nodes, and morcellation must be avoided. The postoperative management is represented by observation, even though chemotherapy can be considered in some high-risk patients. In early-stage low-grade endometrial stromal sarcoma and adenosarcomas without sarcomatous overgrowth, hormonal adjuvant treatment can be offered based on hormone receptor expression. In selected cases, external beam radiotherapy ± brachytherapy can be considered to increase local control only. Patients with advanced disease involving the abdomen can be offered primary chemotherapy (or hormonal therapy in the case of low-grade endometrial stromal sarcoma and adenosarcoma without sarcomatous overgrowth), even if potentially resectable in the absence of residual disease in order to test the chemosensitivity (or hormonosensitivity); debulking surgery can be considered in patients with clinical and radiological response. Chemotherapy is based on anthracyclines ± ifosfamide or dacarbazine. Palliative radiotherapy can be offered for symptom control, and stereotactic radiotherapy can be used for up to five isolated metastatic lesions. CONCLUSIONS Treatment of uterine sarcoma should be centralised at referral centres and managed in a multidisciplinary setting.
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Affiliation(s)
- Gabriella Ferrandina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italy
| | - Pietro Raimondo Biondetti
- Department of Radiology, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Milan, Italy
| | | | - Paolo Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesca Ciccarone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy
| | - Nicoletta Colombo
- Gynecologic Cancer Program, University of Milan-Bicocca and European Institute of Oncology, IRCCS, Milan, Italy
| | - Alessandro Comandone
- Division of Medical Oncology, Humanitas Gradenigo Hospital, Turin, Italy; ASL Città di Torino, Turin, Italy
| | - Renzo Corvo'
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Health Science Department (DISSAL), University of Genoa, Genoa, Italy
| | - Pierandrea De Iaco
- Unit of Oncologic Gynecology, Department of Obstetrics and Gynecology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Treviso General Hospital Treviso, Padova, Italy; University of Padua, Padova, Italy
| | - Vittorio Donato
- Radiation Oncology Division, Oncology and Specialty Medicine Department, San Camillo-Forlanini Hospital, Roma, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Alessandro Gronchi
- Chair Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - Amato Infante
- UOC COVID-2, Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Franco Odicino
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Università degli Studi di Brescia, Italy
| | - Tommaso Pirronti
- UOC COVID-2, Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy; Catholic University of Sacred Hearth, Department of Radiology, Rome, Italy
| | - Vittorio Quagliuolo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Sanfilippo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonia Carla Testa
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy
| | - Gian Franco Zannoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Woman, Child and Public Health Sciences, Gynecopathology and Breast Pathology Unit, Rome, Italy; Pathological Anatomy Institute, Catholic University of Sacred Hearth, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy.
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy
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Trippa F, Draghini L, di Marzo A, Anselmo P, Arcidiacono F, Terenzi S, Sivolella S, Bassetti A, Sdrobolini A, Maranzano E. Long-term palliation of lymph node oligometastatic ovarian carcinoma after repeated stereotactic body radiotherapy: case report. Tumori 2020; 106:NP63-NP66. [PMID: 32912066 DOI: 10.1177/0300891620952852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Oligometastatic disease has emerged as an intermediate state between localized and systemic cancer. Improvements in diagnostic modalities such as functional imaging allow a greater frequency of oligometastases diagnosis. Patients with selected oligometastatic epithelial ovarian carcinoma (EOC) may be treated with metastasis-directed stereotactic body radiotherapy (SBRT) rather than chemotherapy. CASE DESCRIPTION We describe a 58-year-old woman who underwent surgery and chemotherapy for an EOC. The patient underwent 3 chemotherapy lines for recurrence of disease, but had allergic reactions and serious hematologic toxicity. During follow-up, lymph node oligometastases were diagnosed and treated with repeated SBRT because the patient refused further chemotherapy. No side effects were observed after each course of SBRT and the patient obtained complete response of all irradiated sites. CONCLUSIONS SBRT is a promising treatment approach for recurrent oligometastatic EOC with a high control rate and irrelevant iatrogenic toxicity. The possibility to repeat SBRT courses when new oligometastases are encountered in other sites resulted in an adequate long-term palliation approach.
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Affiliation(s)
- Fabio Trippa
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | - Lorena Draghini
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | | | - Paola Anselmo
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | | | - Sara Terenzi
- Radiotherapy Oncology Centre, "Santa Maria" Hospital, Terni, Italy
| | - Silvio Sivolella
- Nuclear Medicine Centre, "San Giovanni Battista" Hospital, Foligno, Italy
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Deodato F, Ferro M, Cilla S, Ianiro A, Buwenge M, Re A, Sallustio G, Valentini V, Morganti AG, Macchia G. Stereobody radiotherapy for nodal recurrences in oligometastatic patients: a pooled analysis from two phase I clinical trials. Clin Exp Metastasis 2020; 37:519-29. [PMID: 32495238 DOI: 10.1007/s10585-020-10039-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
Stereotactic body radiotherapy (SBRT) has been shown to achieve high local control rates in limited metastatic burden of disease. Few papers reported on the efficacy of SBRT in nodal oligometastases. The primary aim of the present paper was to analyze the treatment outcome in this setting. Data from DESTROY-1 and SRS-DESTROY-2 phase I clinical trials were reviewed and analyzed. These trials were based on a 5 fractions and a single fraction regimens, respectively. End-points of this analysis were toxicity rates, overall response rate (ORR), and local control (LC). Patients treated between December 2003 and January 2018, with any metastatic site, and primary tumor type and histology were included. One hundred-eighty-one patients (M/F: 93/88; median age: 67, range 37-88) treated with SBRT on 253 nodal lesions were analyzed. Initially, the used technique was 3D-CRT (20.9%), while subsequently treatments were delivered by VMAT (79.1%). The total dose to the PTV ranged between 12 Gy/single fraction to 50 Gy/5 fractions. With a median follow-up of 21 months (2-124), no grade 3 acute or late toxicity was recorded. ORR based on functional imaging was 92.5% with a complete response rate of 76%. Two- and three-year actuarial LC were 81.6% and 76.0%, respectively. Our large pooled analysis confirms the efficacy and safety of SBRT/SRS in patients with nodal metastases and identifies clinical and treatment variables able to predict complete response and local control rate.
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Kowalchuk RO, Waters MR, Richardson KM, Spencer K, Larner JM, Irvin WP, Kersh CR. Stereotactic body radiation therapy in the treatment of ovarian cancer. Radiat Oncol 2020; 15:108. [PMID: 32404167 PMCID: PMC7222303 DOI: 10.1186/s13014-020-01564-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study evaluates the outcomes and toxicity of stereotactic body radiation therapy (SBRT) in ovarian cancer. METHODS This retrospective analysis considered all patients treated with SBRT from 2009 to 2018 with a primary ovarian tumor. Follow-up included PET-CT and CT scans at 2-3 month intervals. Statistical analysis primarily consisted of univariate analysis, Cox proportional hazards analysis, and the Kaplan-Meier method. RESULTS The study included 35 patients with 98 treatments for lymph nodes (51), local recurrence (21), and de novo solid metastases (26). Median biologically effective dose (BED), gross tumor volume, and planning target volume were 38.40 Gy, 10.41 cc, and 25.21 cc, respectively. 52 lesions showed complete radiographic response, and two-year local control was 80%. Median overall survival (OS) was 35.2 months, and two-year progression-free survival (PFS) was 12%. On univariate analysis, Eastern Cooperative Oncology Group performance status > 0 was predictive of decreased OS (p = 0.0024) and PFS (p = 0.044). Factors predictive of local failure included lower BED (p = 0.016), treatment for recurrence (p = 0.029), and higher pre-treatment SUV (p = 0.026). Kaplan-Meier analysis showed BED ≤35 Gy (p < 0.005) and treatment for recurrence (p = 0.01) to be predictive of local failure. On Cox proportional hazards analysis, treatment of lymph nodes was predictive of complete radiographic response (hazard ratio (HR) = 4.95), as was higher BED (HR = 1.03). Toxicity included 27 cases of grade < 3 toxicity, and one grade 5 late toxicity of GI bleed from a radiation therapy-induced duodenal ulcer. CONCLUSIONS SBRT provides durable local control with minimal toxicity in ovarian cancer, especially with BED > 35 Gy and treatment for lymph nodes.
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Affiliation(s)
- Roman O Kowalchuk
- University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA.
| | - Michael R Waters
- University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA
| | - K Martin Richardson
- University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA
| | - Kelly Spencer
- University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA
| | - James M Larner
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - William P Irvin
- Department of Gynecologic Oncology, Riverside Regional Medical Center, Newport News, USA
| | - Charles R Kersh
- University of Virginia / Riverside, Radiosurgery Center, Newport News, VA, USA
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Jacobson G, Galvan-Turner V. Rethinking the Role of Radiation Therapy in the Management of Epithelial Ovarian Cancer. Diagnostics (Basel) 2020; 10:diagnostics10040211. [PMID: 32290467 PMCID: PMC7235852 DOI: 10.3390/diagnostics10040211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 12/22/2022] Open
Abstract
Radiation has been relegated to a palliative role in the management of epithelial ovarian cancer (EOC). Contemporary radiation techniques, including intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and image-guided radiation therapy, enable conformal treatment that controls local disease with minimal morbidity. Recent studies from multiple institutions support the role of radiation in the ablative treatment of oligometastatic disease and control of locally recurrent and metastatic disease. Effective local treatment with radiation complements the role of systemic therapy in the management of EOC; reduces symptoms and disease burden, and may contribute to a prolonged drug free interval.
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Affiliation(s)
- Geraldine Jacobson
- Department of Radiation Oncology, West Virginia University, Morgantown, WV 26505-9234, USA
- Correspondence: ; Tel.: +1-304-293-7227
| | - Valerie Galvan-Turner
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, WV 26505-9234, USA;
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Leung E, Gladwish A, Sahgal A, Lo SS, Kunos CA, Lanciano RM, Mantz CA, Guckenberger M, Zagar TM, Mayr NA, Chang AR, Jorcano S, Biswas T, Pontoriero A, Albuquerque KV. Survey of current practices from an international task force for gynecological stereotactic ablative radiotherapy. Radiat Oncol 2020; 15:24. [PMID: 32000833 PMCID: PMC6993370 DOI: 10.1186/s13014-020-1469-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background Stereotactic Ablative Radiotherapy (SABR) is an effective treatment that improves local control for many tumours. However, the role of SABR in gynecological cancers (GYN) has not been well-established. We hypothesize that there exists considerable variation in GYN-SABR practice and technique. The goal of this study is to describe clinical and technical factors in utilization of GYN-SABR among 11 experienced radiation oncologists. Materials and methods A 63 question survey on GYN-SABR was sent to 11 radiation oncologists (5 countries) who have published original research, conducted trials or have an established program at their institutions. Responses were combined and analyzed at a central institution. Results Most respondents indicated that salvage therapy (non-irradiated or re-irradiated field) for nodal (81%) and primary recurrent disease (91%) could be considered standard options for SABR in the setting of inability to administer brachytherapy. All other indications should be considered on clinical trials. Most would not offer SABR as a boost in primary treatment off-trial without absolute contraindications to brachytherapy. Multi-modality imaging is often (91%) used for planning including PET, CT contrast and MRI. There is a wide variation for OAR tolerances however small bowel is considered the dose-limiting structure for most experts (91%). Fractionation schedules range from 3 to 6 fractions for nodal/primary definitive and boost SABR. Conclusions Although SABR has become increasingly standard in other oncology disease sites, there remains a wide variation in both clinical and technical factors when treating GYN cancers. Nodal and recurrent disease is considered a potential indication for SABR whereas other indications should be offered on clinical trials. This study summarizes SABR practices among GYN radiation oncologists while further studies are needed to establish consensus guidelines for GYN-SABR treatment.
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Affiliation(s)
- E Leung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - A Gladwish
- Royal Victoria Hospital, Barrie, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S S Lo
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - C A Kunos
- National Cancer Institute, Rockville, MD, USA
| | - R M Lanciano
- Delaware County Memorial Hospital/Philadelphia Cyberknife, Drexel Hill, PA, USA
| | - C A Mantz
- 21st Century Oncology, Fort Myers, FL, USA
| | | | - T M Zagar
- Northeastern Radiation Oncology, Glen Falls, NY, USA
| | - N A Mayr
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - A R Chang
- Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - S Jorcano
- Instituto Oncologico Teknon, Barcelona, Spain
| | - T Biswas
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - K V Albuquerque
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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