title: Stereotactic body radiotherapy for pulmonary metastases from soft-tissue sarcomas: excellent local lesion control and improved patient survival.
abstract: OBJECTIVE
  Patients with pulmonary metastases (PM) from soft-tissue sarcomas (STS) have historically been treated with surgery and/or chemotherapy. Since 2001, we have treated PM with stereotactic body radiation therapy (SBRT). We postulated that SBRT for PM from STS would yield excellent local control (LC) and overall survival (OS).
  
  
  METHODS
  Fifty-two patients with PM from STS, diagnosed between 1990 and 2006 at the University of Rochester, were retrospectively reviewed. Most patients received multimodality treatment comprising of surgery, chemotherapy, and/or radiation. SBRT used the Novalis ExacTrac patient positioning platform, vacuum bag immobilization, and relaxed end-expiratory breath hold techniques.
  
  
  RESULTS
  Leiomyosarcoma (23%), malignant fibrous histiocytoma (19%), and synovial sarcoma (15%) were the most common histologies. Forty-eight percent initially presented with PM, whereas 52% developed PM at a median of 0.7 (0.3-7.3) years after initial diagnosis. Median follow-up from diagnosis of PM was 0.9 (0.3-7.3) years. Fifteen patients underwent SBRT to 74 lesions. Median number of lesions treated was 4 (1-16) per patient and 3.5 (1-6) per session. Preferred dose and fractionation was 50 Gy in 5 Gy fractions. Three-year LC was 82%. No patients experienced Grade ≥ 3 toxicity. Median OS was 2.1 (0.8-11.5) years for patients treated with SBRT, and 0.6 (0.1-7.8) years for those who never received SBRT (p = 0.002).
  
  
  CONCLUSIONS
  SBRT provides excellent LC of PM and may extend OS. SBRT should be considered for all patients with PM from STS, particularly those who are not surgical candidates. Further investigation is warranted to establish criteria for the use of SBRT for STS patients with PM.
authors.affiliation: Department of Radiation Oncology, University of Rochester, Rochester, NY, USA.
authors.forename: Sughosh
authors.initials: S
authors.lastname: Dhakal
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Corbin
authors.forename: Michael T
authors.initials: MT
authors.lastname: Milano
authors.forename: Abraham
authors.initials: A
authors.lastname: Philip
authors.forename: Deepak
authors.initials: D
authors.lastname: Sahasrabudhe
authors.forename: Carolyn
authors.initials: C
authors.lastname: Jones
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D051677:Histiocytoma, Malignant Fibrous / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D006801:Humans; D007890:Leiomyosarcoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000473:pathology; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D013584:Sarcoma, Synovial / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult