Volumetric burden of metastatic lesions drives outcomes in patients with extracranial oligometastatic disease

Abstract Background We hypothesized that the total volume of metastases at initial oligometastatic (OM) presentation to stereotactic body radiation therapy (SBRT) is an important prognostic factor that can refine the definition of OM disease. Methods Patients with extracranial oligometastatic cancer...

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Autores principales:	Yilin Cao, Hanbo Chen, Arjun Sahgal, Darby Erler, Serena Badellino, Tithi Biswas, Roi Dagan, Matthew C. Foote, Alexander V. Louie, Ian Poon, Umberto Ricardi, Kristin J. Redmond
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	metastasis‐directed therapy oligometastatic disease oligometastatic outcomes SBRT volume of metastases Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/2b77a8a34ba44e4b9f4d8e0722cd4baf
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spelling	oai:doaj.org-article:2b77a8a34ba44e4b9f4d8e0722cd4baf2021-11-22T09:08:48ZVolumetric burden of metastatic lesions drives outcomes in patients with extracranial oligometastatic disease2045-763410.1002/cam4.4332https://doaj.org/article/2b77a8a34ba44e4b9f4d8e0722cd4baf2021-11-01T00:00:00Zhttps://doi.org/10.1002/cam4.4332https://doaj.org/toc/2045-7634Abstract Background We hypothesized that the total volume of metastases at initial oligometastatic (OM) presentation to stereotactic body radiation therapy (SBRT) is an important prognostic factor that can refine the definition of OM disease. Methods Patients with extracranial oligometastatic cancer (≤5 lesions) treated with SBRT were included in an international multi‐institutional database. Multivariable Cox and competing risks regression models were used to determine the relationship between distant progression‐free survival (DPFS), widespread progression (WSP), and overall survival (OS) with the total planning target volume (PTV) at initial OM presentation to SBRT. All models were adjusted for histology, pre‐SBRT systemic therapy, osseous‐only lesions, and number of metastases. Results In total, 961 patients were included. The median follow‐up was 24.4 months (IQR: 13.8–37.5). Total PTV had a significant effect on DPFS in the first 18 months after SBRT and was most profound in the first 6 months, when each twofold increase in total PTV conferred a 40.6% increased risk of distant progression (p < 0.001). Each twofold increase in total PTV increased the risk of WSP by 45.4% in the first 6 months (p < 0.001). Total PTV had a significant effect on OS in the first 2 years after SBRT, with each twofold PTV change increasing the risk of death by 60.7% during the first 6 months (p < 0.001) and by 34% thereafter (p < 0.001). Exploratory gross tumor volume (GTV) analysis confirmed the PTV‐based observations. Conclusion The total volumetric burden of metastases at initial OM presentation to SBRT is strongly and independently prognostic for the risk of distant and widespread progression and survival. We propose that this metric should drive the definition of OM disease and guide treatment decision‐making.Yilin CaoHanbo ChenArjun SahgalDarby ErlerSerena BadellinoTithi BiswasRoi DaganMatthew C. FooteAlexander V. LouieIan PoonUmberto RicardiKristin J. RedmondWileyarticlemetastasis‐directed therapyoligometastatic diseaseoligometastatic outcomesSBRTvolume of metastasesNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancer Medicine, Vol 10, Iss 22, Pp 8091-8099 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	metastasis‐directed therapy oligometastatic disease oligometastatic outcomes SBRT volume of metastases Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	metastasis‐directed therapy oligometastatic disease oligometastatic outcomes SBRT volume of metastases Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Yilin Cao Hanbo Chen Arjun Sahgal Darby Erler Serena Badellino Tithi Biswas Roi Dagan Matthew C. Foote Alexander V. Louie Ian Poon Umberto Ricardi Kristin J. Redmond Volumetric burden of metastatic lesions drives outcomes in patients with extracranial oligometastatic disease
description	Abstract Background We hypothesized that the total volume of metastases at initial oligometastatic (OM) presentation to stereotactic body radiation therapy (SBRT) is an important prognostic factor that can refine the definition of OM disease. Methods Patients with extracranial oligometastatic cancer (≤5 lesions) treated with SBRT were included in an international multi‐institutional database. Multivariable Cox and competing risks regression models were used to determine the relationship between distant progression‐free survival (DPFS), widespread progression (WSP), and overall survival (OS) with the total planning target volume (PTV) at initial OM presentation to SBRT. All models were adjusted for histology, pre‐SBRT systemic therapy, osseous‐only lesions, and number of metastases. Results In total, 961 patients were included. The median follow‐up was 24.4 months (IQR: 13.8–37.5). Total PTV had a significant effect on DPFS in the first 18 months after SBRT and was most profound in the first 6 months, when each twofold increase in total PTV conferred a 40.6% increased risk of distant progression (p < 0.001). Each twofold increase in total PTV increased the risk of WSP by 45.4% in the first 6 months (p < 0.001). Total PTV had a significant effect on OS in the first 2 years after SBRT, with each twofold PTV change increasing the risk of death by 60.7% during the first 6 months (p < 0.001) and by 34% thereafter (p < 0.001). Exploratory gross tumor volume (GTV) analysis confirmed the PTV‐based observations. Conclusion The total volumetric burden of metastases at initial OM presentation to SBRT is strongly and independently prognostic for the risk of distant and widespread progression and survival. We propose that this metric should drive the definition of OM disease and guide treatment decision‐making.
format	article
author	Yilin Cao Hanbo Chen Arjun Sahgal Darby Erler Serena Badellino Tithi Biswas Roi Dagan Matthew C. Foote Alexander V. Louie Ian Poon Umberto Ricardi Kristin J. Redmond
author_facet	Yilin Cao Hanbo Chen Arjun Sahgal Darby Erler Serena Badellino Tithi Biswas Roi Dagan Matthew C. Foote Alexander V. Louie Ian Poon Umberto Ricardi Kristin J. Redmond
author_sort	Yilin Cao
title	Volumetric burden of metastatic lesions drives outcomes in patients with extracranial oligometastatic disease
title_short	Volumetric burden of metastatic lesions drives outcomes in patients with extracranial oligometastatic disease
title_full	Volumetric burden of metastatic lesions drives outcomes in patients with extracranial oligometastatic disease
title_fullStr	Volumetric burden of metastatic lesions drives outcomes in patients with extracranial oligometastatic disease
title_full_unstemmed	Volumetric burden of metastatic lesions drives outcomes in patients with extracranial oligometastatic disease
title_sort	volumetric burden of metastatic lesions drives outcomes in patients with extracranial oligometastatic disease
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/2b77a8a34ba44e4b9f4d8e0722cd4baf
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Volumetric burden of metastatic lesions drives outcomes in patients with extracranial oligometastatic disease

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