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. 2023 Sep;149(12):10495-10503.
doi: 10.1007/s00432-023-04964-z. Epub 2023 Jun 6.

Total tumor volume as a predictor of survival in patients with multiple oligometastases treated with stereotactic ablative radiotherapy (SABR)

Ciro Franzese  1   2 , Veronica Vernier  3   4 , Davide Franceschini  4 , Tiziana Comito  4 , Pierina Navarria  4 , Elena Clerici  4 , Maria Ausilia Teriaca  4 , Maria Massaro  4 , Luciana Di Cristina  3   4 , Beatrice Marini  3   4 , Carmela Galdieri  4 , Pietro Mancosu  4 , Stefano Tomatis  4 , Marta Scorsetti  3   4
Affiliations

Total tumor volume as a predictor of survival in patients with multiple oligometastases treated with stereotactic ablative radiotherapy (SABR)

Ciro Franzese et al. J Cancer Res Clin Oncol. 2023 Sep.

Abstract

Background: Delivering stereotactic ablative radiotherapy (SABR) in patients with multiple oligometastases represents a challenge for clinical and technical reasons. We aimed to evaluate the outcome of patients affected by multiple oligometastases treated with SABR and the impact of tumor volume on survival.

Materials and methods: We included all the patients treated with single course SABR for 3 to 5 extracranial oligometastases. All patients were treated with the volumetric modulated arc therapy (VMAT) technique with ablative intent. End-points of the analysis were overall survival (OS), progression free survival (PFS), local control (LC) and toxicity.

Results: 136 patients were treated from 2012 to 2020 on 451 oligometastases. Most common primary tumor was colorectal cancer (44.1%) followed by lung cancer (11.8%). A total of 3, 4 and 5 lesions were simultaneously treated in 102 (75.0%), 26 (19.1%), and 8 (5.9%) patients, respectively. Median total tumor volume (TTV) was 19.1 cc (range 0.6-245.1). With a median follow-up of 25.0 months, OS at 1 and 3 years was 88.4% and 50.2%, respectively. Increasing TTV was independent predictive factor of worse OS (HR 2.37, 95% CI 1.18-4.78, p = 0.014) and PFS (HR 1.63, 95% CI 1.05-2.54; p = 0.028). Median OS was 80.6 months if tumor volume was ≤ 10 cc (1 and 3 years OS rate 93.6% and 77.5%, respectively), and 31.1 months if TTV was higher than 10 cc (1 and 3 years OS rate 86.7% and 42.3%, respectively). Rates of LC at 1 and 3 years were 89.3% and 76.5%. In terms of toxicity, no grade 3 or higher toxicity was reported both in the acute and late settings.

Conclusion: We demonstrated the impact of tumor volume on survival and disease control of patients affected by multiple oligometastases treated with single course SABR.

Keywords: Multiple; Oligometastases; Oligometastatic; Radiosurgery; SABR; SBRT; Stereotactic ablative radiotherapy; Stereotactic radiotherapy.

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Conflict of interest statement

All the authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves for overall survival of all the population and stratified according to tumor volume
Fig. 2
Fig. 2
Kaplan–Meier curves for progression free survival of all the population and stratified according to tumor volume
See this image and copyright information in PMC

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