title: Clinical outcome of hypofractionated stereotactic radiotherapy for abdominal lymph node metastases.
abstract: OBJECTIVE
  We report the medium-term clinical outcome of hypofractionated stereotactic body radiotherapy (SBRT) in a series of patients with either a solitary metastasis or oligometastases from different tumors to abdominal lymph nodes.
  
  
  METHODS
  Between January 2006 and June 2009, 19 patients with unresectable nodal metastases in the abdominal retroperitoneal region were treated with SBRT. Of the patients, 11 had a solitary nodal metastasis and 8 had a dominant nodal lesion as part of oligometastatic disease, defined as up to five metastases. The dose prescription was 45 Gy to the clinical target volume in six fractions. The prescription had to be downscaled by 10% to 20% in 6 of 19 cases to keep within dose/volume constraints. The first 11 patients were treated with three-dimensional conformal techniques and the last 8 by volumetric intensity-modulated arc therapy. Median follow-up was 1 year.
  
  
  RESULTS
  Of 19 patients, 2 had a local progression at the site of SBRT; both also showed concomitant tumor growth at distant sites. The actuarial rate of freedom from local progression was 77.8% ± 13.9% at both 12 and 24 months. Eleven patients showed progressive local and/or distant disease at follow-up. The 12- and 24-month progression-free survival rates were 29.5% ± 13.4% and 19.7% ± 12.0%, respectively. The number of metastases (solitary vs. nonsolitary oligometastases) emerged as the only significant variable affecting progression-free survival (p < 0.0004). Both acute and chronic toxicities were minimal.
  
  
  CONCLUSIONS
  Stereotactic body radiotherapy for metastases to abdominal lymph nodes was shown to be feasible with good clinical results in terms of medium-term local control and toxicity rates. Even if most patients eventually show progressive disease at other sites, local control achieved by SBRT may be potentially significant for preserving quality of life and delaying further chemotherapy.
authors.affiliation: Radiation Oncology Department, IRCCS Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Bignardi
authors.forename: Piera
authors.initials: P
authors.lastname: Navarria
authors.forename: Pietro
authors.initials: P
authors.lastname: Mancosu
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.forename: Angelo
authors.initials: A
authors.lastname: Tozzi
authors.forename: Simona
authors.initials: S
authors.lastname: Castiglioni
authors.forename: Carlo
authors.initials: C
authors.lastname: Carnaghi
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Tronconi
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
mesh_terms: D000005:Abdomen; D000328:Adult; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012187:Retroperitoneal Space; D014057:Tomography, X-Ray Computed