•We present the largest French, multicenter, retrospective study on oligometastatic patients treated with SBRT for an adrenal metastasis.•A total of 110 patients treated for 121 adrenal lesions were ...included. Non-small-cell lung cancer was the predominant histologic type (55.4 %). 82 % of patients had at least 2 metastatic sites. The median PTV was 70 cm3 with a median prescription dose of 40 Gy. The mean Biologically Effective Dose (BED)10 dose was 74.2 Gy. Local control at 1 and 2 years was 85.9 % and 72.5 % respectively. The median Overall survival and Progression free survival were 31.6 and 8.5 months respectively. Local control was significantly improved by systemic treatment one month before or after SBRT (p = 0.009) and by a BED10 greater than or equal to 50 Gy (p = 0.003).•Tolerance was excellent, no grade 3 and 4 toxicities were described due to SBRT.
The adrenal gland is a common site of metastasis with a rate of up to 27% in autopsy series. The incidence of these metastases is increasing due to greater use of Positron Emission Tomography scans and improved overall survival of patients with metastatic cancers. Stereotactic body radiation therapy (SBRT) is a non-invasive treatment option for metastasis. The aim of this study is to assess prognostic factors influencing local control, progression-free and overall survival in oligometastatic patients treated with SBRT for an adrenal metastasis.
In this multicentric retrospective study, we included patients with adrenal metastases treated with SBRT between 2010 and 2021 in eleven french centers. All primary tumors were included.
A total of 110 patients treated for 121 adrenal lesions were included. Non-small-cell lung cancer was the predominant histologic type (55.4 %). Eighty-two percent of patients had at least 2 metastatic sites. The median Planning Target Volume was 70 cm3 with a median prescription dose of 40 Gray (Gy). The mean Biologically Effective Dose (BED) 10 dose was 74.2 Gy. Local control at 1 and 2 years was 85.9 % and 72.5 % respectively. The median overall survival and progression-free survival were 31.6 and 8.5 months respectively. Local control was significantly improved by systemic treatment one month before or after SBRT (p = 0.009) and by a BED10 greater than or equal to 50 Gy (p = 0.003).
In multivariate analysis, oligometastatic presentation (p = 0.009) and a metachronous metastatic presentation (p = 0.008) were independent factors for progression-free survival.
Tolerance was excellent, no grade 3 and 4 toxicities were described due to SBRT.
Stereotactic radiotherapy of adrenal metastases makes possible a local control of more than 85% at one year and was well tolerated. The factors influencing survival in oligometastatic patients still need to be found in order to better select those who benefit the most from this type of treatment.
•Research of ablative radiotherapy on castration resistant oligometastatic prostate cancer has been insufficientlyevaluated.•The survival rates at 2 and 3 years of 93 % and 81.4% are high.•The median ...PFS in our series is 12.6 months, which tends to confirm the good prognosis in oligometastatic situation, even in the context of castration resistance prostate cancer.•No correlation between ISUP grade at diagnosis, duration of hormone-sensitivity phase, PSA level, and PFS was found.•Results suggested that the introduction of new treatments could be postponed without jeopardizing the patient’s prognosis, but selection criteria must be clarified.
Oligometastases aredefined as a number of detectable metastases less or equal to 5. In castrate-resistant oligo metastatic prostate Cancer (CR oligoM PC), Metastases-Directed Ablative radiotherapy (MDRT) is poorly investigated. Our study retrospectively reviewed the cases of CR oligoM PC treated with MDRT in 8 French high-volume radiotherapy centers.
OS and PFS are defined as the delay between the first day of MDRT and death (OS) or progression according to PCWG criteria (PFS). OS and PFS are evaluated according to Kaplan Meyer, curves are compared with log rank test. Logistic regression was used to identify predictive factors for outcome: bone versus node metastasis, ISUP grade, PSA doubling Time (PSADT) at the time of MDRT, time to castration resistance.
107 patients were included in the study, among those 197 metastases received MDRT. For the overall population, the median follow-up was 25.2 months (1,4–145). OS was 93 % at 2 years and 81,4% at 3 years. At 2 years, 100 % of patients with node-only metastasis were alive versus 88,7% among those who have bone metastases (p = 0,72). The median PFS was 12,6 months (IC 95 % 9,6; 17), with no difference among patients with node only disease versus the rest of the cohort.
The PFS was 18,2 months (10,0; 32,4) in patients with PSADT >6 months versus 10,7 months (8,9; 14,3) when PSADT was inferior to 6 months. However, this difference did not reach significant.
We did not find a correlation neither between ISUP grade (1–2 versus 3–4-5) and PFS, nor between hormone-sensitivity duration and PFS.
Patients receiving MDRT for CR oligoM PC have a good prognosis with 81,6% OS at 3 years. PSA DT longer than 6 months could be related to better PFS. MDRT strategy could postpone the onset of new systemic treatment with median PFS >1 year.
The purpose of this study was to assess the prognostic value of different parameters on pretreatment fluorodeoxyglucose ((18)F)-FDG positron emission tomography-computed tomography (PET-CT) in ...patients with localized oesophageal cancer.
We retrospectively reviewed 83 cases of localised oesophageal cancer treated in our institution. Patients were treated with curative intent and have received chemoradiotherapy alone or followed by surgery. Different prognostic parameters were correlated to survival: cancer-related factors, patient-related factors and parameters derived from PET-CT (maximum standardized uptake value SUV max, metabolically active tumor volume either measured with an automatic segmentation software "fuzzy locally adaptive bayesian": MATVFLAB or with an adaptive threshold method MATVseuil and total lesion glycolysis TLGFLAB and TLGseuil).
The median follow-up was 21.8 months (range: 0.16-104). The median overall survival was 22 months (95% confidence interval 95%CI: 15.2-28.9). There were 67 deaths: 49 associated with cancer and 18 from intercurrent causes. None of the tested factors was significant on overall survival. In univariate analysis, the following three factors affected the specific survival: MATVFLAB (P=0.025), TLGFLAB (P=0.04) and TLGseuil (P=0.04). In multivariate analysis, only MATVFLAB had a significant impact on specific survival (P=0.049): MATVFLAB<18 cm(3): 31.2 months (95%CI: 21.7-not reached) and MATVFLAB>18 cm(3): 20 months (95%CI: 11.1-228.9).
The metabolically active tumour volume measured with the automatic segmentation software FLAB on baseline PET-CT was a significant prognostic factor, which should be tested on a larger cohort.
The implementation of intensity-modulated radiotherapy (IMRT) in a centre requires regular critical review of medical practices and feedback to optimize the subsequent management of patients.
We ...reviewed and determined through a retrospective single-centre study recurrence sites of 167 consecutive patients treated for head and neck squamous cell carcinoma excluding skin or sinuses. Patients had mostly stage III or IV locally advanced cancer (n=123).
Locoregional control rates at 1 and 2 years were respectively 87.9% (95% confidence interval 95%CI: 81.6%-92.1%) and 77.6% (95%CI: 70.1%-83.5). Among 55 relapses, 20 patients (36.4%) had treatment failures. Patients treated with 70 Gy relapsed mainly in high risk volume (78%). Those treated with 66 Gy recurred regionally outside the irradiated volume (n=4) or in the irradiated high risk volume (n=3) or had isolated metastatic failure (n=3). Those irradiated with 50 Gy had regional relapse outside the irradiated volume (n=2) or isolated metastatic relapse (n=2). We noticed respectively 5.4%, 10.2% and 4.2% isolated metastatic, local, cervical lymph node relapse.
Our results are consistent with data from the literature. Corrective actions were performed to enhance our practices.
Study of the pattern of relapse for locally advanced oesophageal cancer and analysis of the local recurrences according to irradiated volume.
We performed a monocentric retrospective study of ...patients treated in the integrated centre of oncology (Angers, France). Two treatment strategies were used: concurrent chemoradiation alone or followed by surgery. Recurrences were classified as: locoregional, either isolated or associated with distant metastasis, and metastatic only. Locoregional relapses were subclassified as in-field, out-field, or mixed.
Between March 2004 and October 2011, 168 patients were treated: 130 by chemoradiation, and 38 by chemoradiation followed by surgery. The median supero-inferior margins added to the gross tumour volume in order to create the planning tumour volume was 5cm (range: 0.5-21). Sixty-two percent of patients (n=104) relapsed: 82 locoregional relapses (49%), including 45 isolated relapses (27%) and 37 associated with distant metastasis relapses (22%), and 22 metastatic relapses (13%). From the 82 locoregional relapses, only four isolated relapses were exclusively out-field.
With 5cm supero-inferior margins added to gross tumour volume, less than 3% of patients had an isolated out-field recurrence. However, half of the patients suffered in-field local recurrence and one third had metastases. These findings advocate for a limited prophylactic nodal irradiation. Trials are ongoing to assess dose escalation or surgery in order to increase local control.
Évaluer l’efficacité et la toxicité de la radiothérapie en conditions stéréotaxiques comme traitement des métastases cérébrales de différents cancers primitifs, associée ou non à une irradiation ...encéphalique.
Trente-trois patients atteints de métastases cérébrales (dont 45,5 % de cancers primitifs pulmonaires) ont été traités par irradiation en conditions stéréotaxiques par CyberKnife®. La dose prescrite variait de 21 (en complément d’une irradiation encéphalique prophylactique) à 33Gy, en trois fractions. Les critères étudiés étaient le contrôle local, la survie globale, la survie sans progression, et la toxicité.
Le suivi médian était de 39,9 mois. La durée médiane de survie était de 72,9 mois et la celle de survie sans progression médiane de 31,9 mois. Nous avons comparé les durées de survie selon que le cancer primitif était pulmonaire ou non. Il y avait une différence significative de survie globale (médiane de 33 mois contre 108,2 mois ; p=0,0341) mais pas de taux de contrôle local (p=0,5862) ni sur la survie sans progression (médiane de 28,6 mois contre 50,3 mois ; p=0,1756). Nous avons comparé les durées de survie en fonction de la réalisation préalable ou non d’une irradiation encéphalique de 25Gy (en majorité pour les cancers primitifs pulmonaires). Il y avait une différence quasi significative de survie globale (médiane de 33 mois contre 163,2 mois ; p=0,0536) en défaveur de l’irradiation panencéphalique mais non significatif en termes de survie sans progression (médiane de 29,3 mois contre 50,4 mois ; p=0,6516). Il y avait également une tendance à la réduction de la survenue de nouvelles métastases cérébrales par la réalisation de l’irradiation prophylactique (p=0,06). Seuls quatre patients ont souffert d’une toxicité de grade 1, aucun de grade 2 ou plus.
La radiothérapie en conditions stéréotaxiques est une technique efficace pour le traitement des métastases cérébrales avec une excellente survie dans cette série. Les métastases de primitif pulmonaire semblent de pronostic moins favorable. L’irradiation encéphalique préalable semble impacter plutôt négativement mais non significativement la survie globale mais pourrait réduire l’apparition de nouvelles métastases.
Évaluer la valeur pronostique de différents facteurs préthérapeutiques définis avec la tomographie par émission de positons au (18F)-fluorodésoxyglucose (TEP-FDG) pour le cancer de l’œsophage ...localisé.
Nous avons réalisé une étude rétrospective monocentrique à partir des dossiers de 83 patients atteints de cancers de l’œsophage traités à visée curative. La chimioradiothérapie a été soit exclusive, soit suivie de chirurgie. Les critères constitutifs, carcinologiques et dérivés de la TEP-FDG (maximum standardized uptake value SUVmax, volume tumoral métabolique de la lésion primitive metabolically active tumour volume défini soit avec le logiciel « fuzzy locally adaptive bayesian » MATVFLAB, soit avec un seuillage MATVseuil, et le total lesion glycolysis TLGFLAB et TLGseuil) ont été corrélés avec la survie.
La durée médiane de suivi était de 21,8 mois (0,16–104). La durée médiane de survie était de 22 mois (intervalle de confiance à 95 % IC95 % : 15,2–28,9). Il y a eu 67 décès, 49 liés au cancer et 18 à une autre cause. Aucun des facteurs testés n’avait un impact significatif sur la survie globale. Pour la survie spécifique, en analyse unifactorielle, le MATVFLAB (p=0,025), le TLGFLAB (p=0,04) et le TLGseuil (p=0,04) avaient un impact significatif. En analyse multifactorielle, seul le MATVFLAB avait un impact significatif (p=0,049) : MATVFLAB inférieur à 18 cm3 : 31,2 mois (IC95 % : 21,7–non atteint) et MATVFLAB supérieur à 18 cm3 : 20 mois (IC95 % : 11,1–228,9).
Sur la TEP-FDG initiale, le volume métabolique défini avec l’algorithme de segmentation automatique FLAB était un facteur pronostique intéressant qui mérite d’être évalué sur une cohorte plus importante de patients.
The purpose of this study was to assess the prognostic value of different parameters on pretreatment fluorodeoxyglucose (18F)-FDG positron emission tomography-computed tomography (PET-CT) in patients with localized oesophageal cancer.
We retrospectively reviewed 83 cases of localised oesophageal cancer treated in our institution. Patients were treated with curative intent and have received chemoradiotherapy alone or followed by surgery. Different prognostic parameters were correlated to survival: cancer-related factors, patient-related factors and parameters derived from PET-CT (maximum standardized uptake value SUV max, metabolically active tumor volume either measured with an automatic segmentation software “fuzzy locally adaptive bayesian”: MATVFLAB or with an adaptive threshold method MATVseuil and total lesion glycolysis TLGFLAB and TLGseuil).
The median follow-up was 21.8 months (range: 0.16–104). The median overall survival was 22 months (95% confidence interval 95%CI: 15.2–28.9). There were 67 deaths: 49 associated with cancer and 18 from intercurrent causes. None of the tested factors was significant on overall survival. In univariate analysis, the following three factors affected the specific survival: MATVFLAB (P=0.025), TLGFLAB (P=0.04) and TLGseuil (P=0.04). In multivariate analysis, only MATVFLAB had a significant impact on specific survival (P=0.049): MATVFLAB<18 cm3: 31.2 months (95%CI: 21.7–not reached) and MATVFLAB>18 cm3: 20 months (95%CI: 11.1–228.9).
The metabolically active tumour volume measured with the automatic segmentation software FLAB on baseline PET-CT was a significant prognostic factor, which should be tested on a larger cohort.
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