Predictors of local control after single-dose stereotactic image-guided intensity-modulated radiotherapy for extracranial metastases Journal Article
| Authors: | Greco, C.; Zelefsky, M. J.; Lovelock, M.; Fuks, Z.; Hunt, M.; Rosenzweig, K.; Zatcky, J.; Kim, B.; Yamada, Y. |
| Article Title: | Predictors of local control after single-dose stereotactic image-guided intensity-modulated radiotherapy for extracranial metastases |
| Abstract: | Purpose: To report tumor local control after treatment with single-dose image-guided intensity-modulated radiotherapy (SD-IGRT) to extracranial metastatic sites. Methods and Materials: A total of 126 metastases in 103 patients were treated with SD-IGRT to prescription doses of 18-24 Gy (median, 24 Gy) between 2004 and 2007. Results: The overall actuarial local relapse-free survival (LRFS) rate was 64% at a median follow-up of 18 months (range, 2-45 months). The median time to failure was 9.6 months (range, 1-23 months). On univariate analysis, LRFS was significantly correlated with prescription dose (p = 0.029). Stratification by dose into high (23 to 24 Gy), intermediate (21 to 22 Gy), and low (18 to 20 Gy) dose levels revealed highly significant differences in LRFS between high (82%) and low doses (25%) (p < 0.0001). Overall, histology had no significant effect on LRFS (p = 0.16). Renal cell histology displayed a profound dose-response effect, with 80% LRFS at the high dose level (23 to 24 Gy) vs. 37% with low doses (≤22 Gy) (p = 0.04). However, for patients who received the high dose level, histology was not a statistically significant predictor of LRFS (p = 0.90). Target organ (bone vs. lymph node vs. soft tissues) (p = 0.5) and planning target volume size (p = 0.55) were not found to be associated with long-term LRFS probability. Multivariate Cox regression analysis confirmed prescription dose to be a significant predictor of LRFS (p = 0.003). Conclusion: High-dose SD-IGRT is a noninvasive procedure resulting in high probability of local tumor control. Single-dose IGRT may be effectively used to locally control metastatic deposits regardless of histology and target organ, provided sufficiently high doses (> 22 Gy) of radiation are delivered. Copyright © 2011 Elsevier Inc. |
| Keywords: | adult; cancer survival; aged; aged, 80 and over; bone neoplasms; disease-free survival; middle aged; survival rate; human cell; major clinical study; dose response; liver neoplasms; bone metastasis; cancer radiotherapy; radiation dose; follow-up studies; lymph node metastasis; lymphatic metastasis; colorectal cancer; melanoma; metastasis; neoplasm recurrence, local; breast cancer; lung non small cell cancer; lung neoplasms; radiotherapy dosage; radiotherapy; pathology; bladder cancer; histology; kidney neoplasms; prostate cancer; sarcoma; colorectal neoplasms; prostatic neoplasms; soft tissue; prescription; gastrointestinal toxicity; survival time; liver metastasis; lung small cell cancer; imrt; intensity-modulated radiotherapy; physical therapy; tumors; radiotherapy, intensity-modulated; tumor burden; lymph node; radiation injuries; remission induction; bile duct carcinoma; thyroid cancer; dermatitis; local control; stereotactic treatment; phase 1 clinical trial; cancer control; metastases; kidney cancer; regression analysis; univariate analysis; analysis of variance; kidney metastasis; non invasive procedure; chordoma; soft tissue neoplasms; low dose; adrenal gland neoplasms; soft tissue metastasis; renal cell; image-guided; after-treatment; metastatic sites; high dose; colorectal metastasis; radiculopathy; cox regression analysis; image-guided radiotherapy; kidney cell; single-dose; neuritis; planning target volumes; single fraction; dose levels; high dose levels; high probability; image guided radiotherapy; local tumor control; median time to failures; target organs; local relapse free survival; prostate metastasis; single dose image guided intensity modulated radiotherapy |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 79 |
| Issue: | 4 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2011-03-15 |
| Start Page: | 1151 |
| End Page: | 1157 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2009.12.038 |
| PUBMED: | 20510537 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Export Date: 23 June 2011" - "CODEN: IOBPD" - "Source: Scopus" |
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