Outcomes after high-dose radiation in the management of neuroendocrine neoplasms.

<h4>Background</h4>Neuroendocrine neoplasms (NENs) comprise a rare and heterogenous group of cancers, for which the role of radiation therapy continues to evolve. The purpose of this study is to analyze oncologic outcomes after the use of high-dose radiation in management of NENs at a te...

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Autores principales:	Katherine S Chen, Courtney Lawhn-Heath, Spencer Behr, Roxanna Juarez, Julia Whitman, Alan Paciorek, Eric K Nakakura, Nicholas Fidelman, Mary Uan-Sian Feng, Emily K Bergsland, Mekhail Anwar
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a51e61d9a56949b782014ffb3a6b6958
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spelling	oai:doaj.org-article:a51e61d9a56949b782014ffb3a6b69582021-12-02T20:11:08ZOutcomes after high-dose radiation in the management of neuroendocrine neoplasms.1932-620310.1371/journal.pone.0252574https://doaj.org/article/a51e61d9a56949b782014ffb3a6b69582021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252574https://doaj.org/toc/1932-6203<h4>Background</h4>Neuroendocrine neoplasms (NENs) comprise a rare and heterogenous group of cancers, for which the role of radiation therapy continues to evolve. The purpose of this study is to analyze oncologic outcomes after the use of high-dose radiation in management of NENs at a tertiary hospital.<h4>Materials and methods</h4>We performed a retrospective review of patients who received high-dose radiation with intent to cure or provide durable local control (defined as biologically effective dose (BED) ≥40, α/β = 10) for a localized or metastatic NEN from 2006 to 2019. Evaluation of disease status after radiation was performed according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria when possible. Patients were grouped by differentiation (well-differentiated (WD) or poorly-differentiated (PD)) and stage (localized/locally advanced disease (L) or metastatic (M)) in analysis of probabilities of progression after radiation.<h4>Results</h4>45 patients completed a radiation course with BED ≥40 for a NEN (median BED 72). With a median follow-up of 24 months after radiation, the 2-year actuarial rates of local relapse-free survival, new metastasis-free survival, progression-free survival, and overall survival after radiation were 98%, 45%, 41%, and 69%, respectively. 25 patients (56%) developed new metastases after completion of radiation, including 33% (n = 3) of patients with WD-L disease, 44% (n = 8) of WD-M, 77% (n = 10) of PD-L, and 80% (n = 4) of PD-M, with progressively shorter median times to progression (26, 9, 8, and 3 months, respectively; p = 0.093). Of the 25 patients evaluable by RECIST, 68% (n = 17) achieved either a complete or partial best response in the irradiated lesion.<h4>Conclusions</h4>These data suggest that focal, high-dose radiation has a role in the management of selected patients with NENs. Local failure is rare in patients with both well-differentiated and poorly-differentiated disease, although the predominant pattern of failure remains development of new metastases.Katherine S ChenCourtney Lawhn-HeathSpencer BehrRoxanna JuarezJulia WhitmanAlan PaciorekEric K NakakuraNicholas FidelmanMary Uan-Sian FengEmily K BergslandMekhail AnwarPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252574 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Katherine S Chen Courtney Lawhn-Heath Spencer Behr Roxanna Juarez Julia Whitman Alan Paciorek Eric K Nakakura Nicholas Fidelman Mary Uan-Sian Feng Emily K Bergsland Mekhail Anwar Outcomes after high-dose radiation in the management of neuroendocrine neoplasms.
description	<h4>Background</h4>Neuroendocrine neoplasms (NENs) comprise a rare and heterogenous group of cancers, for which the role of radiation therapy continues to evolve. The purpose of this study is to analyze oncologic outcomes after the use of high-dose radiation in management of NENs at a tertiary hospital.<h4>Materials and methods</h4>We performed a retrospective review of patients who received high-dose radiation with intent to cure or provide durable local control (defined as biologically effective dose (BED) ≥40, α/β = 10) for a localized or metastatic NEN from 2006 to 2019. Evaluation of disease status after radiation was performed according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria when possible. Patients were grouped by differentiation (well-differentiated (WD) or poorly-differentiated (PD)) and stage (localized/locally advanced disease (L) or metastatic (M)) in analysis of probabilities of progression after radiation.<h4>Results</h4>45 patients completed a radiation course with BED ≥40 for a NEN (median BED 72). With a median follow-up of 24 months after radiation, the 2-year actuarial rates of local relapse-free survival, new metastasis-free survival, progression-free survival, and overall survival after radiation were 98%, 45%, 41%, and 69%, respectively. 25 patients (56%) developed new metastases after completion of radiation, including 33% (n = 3) of patients with WD-L disease, 44% (n = 8) of WD-M, 77% (n = 10) of PD-L, and 80% (n = 4) of PD-M, with progressively shorter median times to progression (26, 9, 8, and 3 months, respectively; p = 0.093). Of the 25 patients evaluable by RECIST, 68% (n = 17) achieved either a complete or partial best response in the irradiated lesion.<h4>Conclusions</h4>These data suggest that focal, high-dose radiation has a role in the management of selected patients with NENs. Local failure is rare in patients with both well-differentiated and poorly-differentiated disease, although the predominant pattern of failure remains development of new metastases.
format	article
author	Katherine S Chen Courtney Lawhn-Heath Spencer Behr Roxanna Juarez Julia Whitman Alan Paciorek Eric K Nakakura Nicholas Fidelman Mary Uan-Sian Feng Emily K Bergsland Mekhail Anwar
author_facet	Katherine S Chen Courtney Lawhn-Heath Spencer Behr Roxanna Juarez Julia Whitman Alan Paciorek Eric K Nakakura Nicholas Fidelman Mary Uan-Sian Feng Emily K Bergsland Mekhail Anwar
author_sort	Katherine S Chen
title	Outcomes after high-dose radiation in the management of neuroendocrine neoplasms.
title_short	Outcomes after high-dose radiation in the management of neuroendocrine neoplasms.
title_full	Outcomes after high-dose radiation in the management of neuroendocrine neoplasms.
title_fullStr	Outcomes after high-dose radiation in the management of neuroendocrine neoplasms.
title_full_unstemmed	Outcomes after high-dose radiation in the management of neuroendocrine neoplasms.
title_sort	outcomes after high-dose radiation in the management of neuroendocrine neoplasms.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/a51e61d9a56949b782014ffb3a6b6958
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Outcomes after high-dose radiation in the management of neuroendocrine neoplasms.

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