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Journal of Radiation Research Jun 2023Japanese national oncological experts convened to evaluate the efficacy and safety of particle beam therapy (PT) for pulmonary, liver and lymph node oligometastases...
Comprehensive analysis of Japanese nationwide cohort data of particle beam therapy for pulmonary, liver and lymph node oligometastases: particle beam therapy versus high-precision X-ray radiotherapy.
Japanese national oncological experts convened to evaluate the efficacy and safety of particle beam therapy (PT) for pulmonary, liver and lymph node oligometastases (P-OM, L-OM and LN-OM, respectively) and to conduct a statistically comparative analysis of the local control (LC) rate and overall survival (OS) rate of PT versus those of X-ray stereotactic body radiotherapy (X-SBRT) and X-ray intensity-modulated radiotherapy (X-IMRT). They conducted [1] an analysis of the efficacy and safety of metastasis-directed therapy with PT for P-OM, L-OM and LN-OM using a Japanese nationwide multi-institutional cohort study data set; [2] a systematic review of X-ray high-precision radiotherapy (i.e. X-SBRT/X-IMRT) and PT for P-OM, L-OM and LN-OM; and [3] a statistical comparison between LC and OS of the cohort data set in PT and that of the extracted historical data set in X-SBRT/X-IMRT from the preceding systematic review. Safety was evaluated as the incidence of grade ≥ 3 adverse events, while statistical comparisons of LC and OS were conducted by estimating the incidence rate ratios (IRR) for local progression and mortality, respectively. This study demonstrated that PT provided durable LC (3-year LC rate: 72.8-83.2%) with acceptable OS (3-year OS rate: 38.5-68.1%) and risk of severe toxicity incidence of 0.8-3.5% in radical metastasis-directed therapy for P-OM, L-OM and LN-OM. Compared to LC with X-SBRT or X-IMRT, LC with PT was potentially superior for P-OM; superior for L-OM; and equivalent for LN-OM. In particular, this study demonstrated that PT may be a new treatment option for L-OM tumors measuring > 5 cm.
Topics: Humans; Cohort Studies; East Asian People; Liver; Radiosurgery; Retrospective Studies; Treatment Outcome; X-Rays; Neoplasm Metastasis
PubMed: 37053162
DOI: 10.1093/jrr/rrad004 -
Minerva Urologica E Nefrologica = the... Oct 2020The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of...
INTRODUCTION
The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa).
EVIDENCE ACQUISITION
We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: ("prostate cancer" OR "prostate carcinoma" OR "prostate neoplasm" OR "prostate tumor") AND ("oligometastatic" OR "oligometastasis" OR "PSMA") AND ("surgery" OR "prostatectomy" OR "radical prostatectomy" OR "cytoreductive" OR "local treatment" OR "radiotherapy" OR "stereotactic" OR "stereotaxic") AND ("survival" OR "mortality").
EVIDENCE SYNTHESIS
After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomized studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomized controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomized phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear.
CONCLUSIONS
We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.
Topics: Humans; Male; Molecular Targeted Therapy; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prostatic Neoplasms
PubMed: 32550632
DOI: 10.23736/S0393-2249.20.03779-0 -
Cancer Treatment Reviews Nov 2019The concept of oligometastatic disease (OMD) has expanded the scope of potentially curative therapy for metastatic NSCLC. However, large uncertainties remain regarding...
BACKGROUND
The concept of oligometastatic disease (OMD) has expanded the scope of potentially curative therapy for metastatic NSCLC. However, large uncertainties remain regarding its definition and optimal management strategies. We therefore conducted a systematic review to investigate the value of various multimodality treatment concepts.
METHODS
We searched the available literature in Pubmed, Medline and EMBASE using the terms "oligomet*", "synchron*", "oligorec*", "metachr*" "NSCLC", "lung cancer" and "stage IV" and included studies reporting treatment regimens and outcomes on radically treated patients with either "synchronous", "metachronous" or "mixed" OMD. Only de-novo diagnosis of OMD was considered. The impact of patient and treatment characteristics on overall survival (OS) and time trends in patterns of care were investigated.
RESULTS
54 studies published between 1987 and 2018 were included. Despite a wide range of OMD definitions, 90.1% of patients were treated for a single metastasis. Systemic therapy was used as backbone treatment for most patients. Although surgery was the preferred local treatment in earlier studies, the use of stereotactic radiotherapy increased rapidly after 2011. No OS difference was observed between surgery or radiotherapy as the treatment of primary tumor or metastases, respectively. A time trend towards improved OS after 2011 could be detected.
CONCLUSIONS
While evidence in favor of radical treatment is emerging, most studies remain retrospective and mainly evaluate patients with singular metastases. While surgery, stereotactic radiotherapy and chemotherapy are the cornerstones of current treatment strategies, future clinical trials need to address the high risk of distant metastases by integrating targeted or immunotherapy.
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Neoplasm Metastasis
PubMed: 31522079
DOI: 10.1016/j.ctrv.2019.101892 -
Interactive Cardiovascular and Thoracic... Sep 2020Oesophageal cancer oligometastasis is a state of limited systemic disease characterized by ˂5 metastases. Without surgery average survival is 4-12 months. We sought... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Oesophageal cancer oligometastasis is a state of limited systemic disease characterized by ˂5 metastases. Without surgery average survival is 4-12 months. We sought to estimate patient prognosis following the surgical resection of oligometastatic disease from oesophageal cancer.
METHODS
Eligible studies were identified through systematic search of PubMed and the Cochrane Library (end-of-search date: 20 November 2019). We estimated cumulative 1-, 3- and 5-year, as well as overall survival using bootstrap methodology with 1 000 000 repetitions per outcome.
RESULTS
We investigated six studies involving 420 patients who underwent metastasectomy for oligometastasis from oesophageal cancer. Adenocarcinoma [77.3%; 95% confidence interval (CI) 62.8-87.3] was the most prevalent histological type followed by squamous cell carcinoma (22.7%; 95% CI 12.7-37.2). Metastatic lesions were typically synchronous (91.5%; 95% CI 87.5-94.1). Overall, 73.5% (95% CI 67.5-78.6) of the patients underwent resection of the primary and metastatic tumours synchronously. Neoadjuvant chemoradiotherapy was utilized in the majority of the patients (66.7%; 95% CI 49.5-80.3) followed by neoadjuvant chemotherapy (33.3%; 95% CI 19.6-50.5). The mean overall survival was 24.5 months (95% CI 14.4-34.6). One-year survival was 88.3% (95% CI 85.6-90.8). Three-year survival and 5-year survival were 36.3% (95% CI 15.3-7.3) and 23.8% (95% CI 12.0-35.7), respectively.
CONCLUSIONS
Patients undergoing surgical resection of oesophageal oligometastasis survive for more than 24 months. Therefore, loco-regional control of oligometastatic disease appears to improve survival by at least 100%.
Topics: Esophageal Neoplasms; Global Health; Humans; Metastasectomy; Survival Rate
PubMed: 32666121
DOI: 10.1093/icvts/ivaa116