title: Volumetric intensity modulated arc therapy for stereotactic body radiosurgery in oligometastatic breast and gynecological cancers: feasibility and clinical results.
abstract: In the present study, the preliminary results of the first stereotactic body radiosurgery (SRS) experience with volumetric intensity modulated arc therapy (VMAT) in oligometastatic breast and recurrent gynecological tumors (OBRGT) are reported in terms of feasibility, toxicity and efficacy. Patients were treated in a head-first supine treatment position on a customized body frame immobilization shell. SRS-VMAT treatment plans were optimized using the ERGO++ treatment planning system. Response assessment was performed 8-12 weeks after treatment by morphologic imaging modalities, or if feasible, also by functional imaging. Thirty-six lesions in 24 consecutive patients (median age, 63 years; range, 40-81) were treated: 13.9% had primary or metastatic lung lesions, 30.5% had liver metastases, 36.1% had bone lesions, 16.7% had lymph node metastases and 2.8% had a primary vulvar melanoma. The median dose was 18 Gy (BED2 Gy, α/β: 10=50.4 Gy), the minimal dose was 12 Gy (BED2 Gy, α/β: 10=26.4 Gy) and the maximal dose was 28 Gy (BED2 Gy, α/β: 10=106.4 Gy). Seven patients (29.2%) experienced acute toxicity, which however was grade 2 in only 1 case. Moreover, only 3 patients (12.5%) developed late toxicity of which only 1 was grade 2. Objective response rate was 77.7% including 16 lesions achieving complete response (44.4%) and 12 lesions achieving partial response (33.3%). The median duration of follow-up was 15.5 months (range, 6-50). Recurrence/progression within the SRS-VMAT treated field was observed in 6 patients (total lesions=7) with a 2-year inside SRS-VMAT field disease control expressed on a per lesion basis of 69%. Recurrence/progression of disease outside the SRS-VMAT field was documented in 15 patients; the 2-year outside SRS-VMAT field metastasis‑free survival, expressed on a per patient basis, was 35%. Death due to disease was documented in 6 patients and the 2-year overall survival was 58%. Although the maximum tolerated dose was not reached, SRS-VMAT resulted in positive early clinical results in terms of tumor response, local control rate and toxicity.
authors.affiliation: Radiotherapy Oncology Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.affiliation: Radiotherapy Oncology Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Deodato
authors.affiliation: Medical Physics Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Cilla
authors.affiliation: Palliative Therapy Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Torre
authors.affiliation: Gynaecologic Oncology Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Corrado
authors.affiliation: Gynaecologic Oncology Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Legge
authors.affiliation: Department of Radiation, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Gambacorta
authors.affiliation: Department of Radiation, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Tagliaferri
authors.affiliation: Palliative Therapy Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: Samantha
authors.initials: S
authors.lastname: Mignogna
authors.affiliation: Department of Gynaecologic Oncology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: Department of Radiation, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.affiliation: Radiotherapy Oncology Unit, Fondazione di Ricerca e Cura ̔Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.affiliation: Gynaecologic Oncology Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ferrandina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D017321:Clinical Trials, Phase I as Topic; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D016896:Treatment Outcome