High-Dose Stereotactic Radiation Effective for Small Lung Metastases

High-dose stereotactic radiation effective for small lung metastases
Last Updated: 2009-03-25 12:42:59 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Results of a prospective, phase I/II trial indicate that high-dose stereotactic body radiation therapy provides good local control, with minimal toxicity, of up to three metastatic lung tumors with cumulative lesion diameter less than 7 cm.
"Stereotactic body radiation therapy involves a brief, intensified regimen of tightly focused external radiotherapy targeting one or more discrete extracranial lesions," Dr. Tracey E. Schefter, at the University of Colorado Denver, and co-investigators explain in their report, published online by the Journal of Clinical Oncology.
Stereotactic body radiation therapy was delivered in 3 fractions for a total dose of 48 to 60 Gy. The trial included 38 patients with 63 lung metastases; 50 lesions in 30 patients who survived for more than 6 months were assessable for local control. Median follow-up for assessable lesions was 15.4 months (range 6 to 48 months).
Actuarial local control at 1 and 2 years was 100% and 96%, the authors note. Local progression was observed in only one lesion.
Median survival was 19 months, and 2-year overall survival rates were 39%.
There were three cases of grade 3 toxicity, including one case of pneumonitis and two instances involving the chest wall and skin. Four patients developed grade 2 radiation dermatitis, and all patients developed grade 1 pneumonitis, defined as asymptomatic radiographic changes, within 3 to 6 months after stereotactic radiotherapy.
Dr. Schefter and colleagues note that, to ensure patient accrual for a trial of a newly emerging therapy, several of the patients had unfavorable disease characteristics and relatively high overall disease burden.
They conclude that stereotactic body radiation therapy "might be able to sterilize a limited burden of oligometastatic disease and achieve a long progression-free interval in patients with more favorable prognostic features."
J Clin Oncol 2009;27.

Source : http://www.medscape.com/viewarticle/590117