title: Feasibility and toxicity of hypofractionated image guided radiation therapy for large volume limited metastatic disease.
abstract: OBJECTIVE
  Hypofractionated image guided radiation therapy (HIGRT) is increasingly used for limited metastases. Reported studies have mostly treated small volume tumors. Here, we report the toxicity and oncologic outcomes following treatment of large volume metastases.
  
  
  METHODS
  HIGRT patients treated from October 2005 to March 2010 were reviewed. Gross tumor volumes (GTV) and planning target volumes (PTV) were obtained from planning software. A metastasis was considered large volume if the treated PTV exceeded 50 cc. Patients were treated with either 10-fraction (4-5 Gy per fraction) or 3-5 fraction (8-14 Gy per fraction) regimens. Toxicity was obtained from both prospectively collected databases and retrospectively from patient charts.
  
  
  RESULTS
  Sixty-four patients with 93 treated lesions >50 cc were identified. The median GTV and PTV volumes were 41 and 119 cc, respectively. The median number of treated large volume lesions was 1, and a maximum of 3 large volume lesions were treated in a single patient. Primary malignancies included non-small cell lung cancer, renal cell, colorectal, breast, bladder, pituitary, small cell lung cancer, sarcoma, head-and-neck cancer, and hepatocellular cancer. Treated sites included lung (n = 33), regional lymph nodes (n = 20), bone (n = 17), adrenal (n = 9), and liver (n = 6). The most frequently used treatment regimen was 50 Gy in 5 Gy fractions. The median follow-up was 27 months for surviving patients. Treated lesion control was 78%. Low rates of acute and late grade 3 or higher toxicity were reported, with 3 and 5 patients experiencing each, respectively.
  
  
  CONCLUSIONS
  HIGRT to large volume oligometastatic disease is tolerable and feasible with promising tumor control. Local radiation therapy should be considered in patients with large volume, limited metastatic disease.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Corbin
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Ranck
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hasselle
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Golden
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois.
authors.forename: Julien
authors.initials: J
authors.lastname: Partouche
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois.
authors.forename: Tianming
authors.initials: T
authors.lastname: Wu
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Chmura
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois.
authors.forename: Ralph R
authors.initials: RR
authors.lastname: Weichselbaum
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina. Electronic address: joseph.salama@duke.edu.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama