title: Stereotactic body radiation therapy for oligometastases to the lung: a phase 2 study.
abstract: OBJECTIVE
  To assess, in a phase 2 study, the efficacy and toxicity of stereotactic body radiation therapy for oligometastases to the lung in inoperable patients.
  
  
  METHODS
  Patients with lung metastases were included in this study if (1) the primary tumor was controlled; (2) patients were ineligible for or refused surgery and chemotherapy; and (3) patients had 5 or fewer metastatic lesions in no more than 2 organs. Large peripheral tumors were treated with a dose of 60 Gy (3 fractions), small peripheral tumors with 30 Gy (1 fraction), central tumors received 60 Gy (5 fractions), and mediastinal tumors or tumors close to the esophagus received 56 Gy (7 fractions).
  
  
  RESULTS
  Thirty patients with 57 metastatic lung tumors from various primary cancers were analyzed. The median follow-up was 36 months (range, 4-60 months). At 2 years, local control for the 11 central tumors was 100%, for the 23 peripheral tumors treated to 60 Gy it was 91%, and for the 23 tumors treated in a single 30-Gy fraction it was 74% (P=.13). This resulted in an overall local control rate at 1 year of 79%, with a 2-sided 80% confidence interval of 67% to 87%. Because the hypothesized value of 70% lies within the confidence interval, we cannot reject the hypothesis that the true local control rate at 1 year is ≤70%, and therefore we did not achieve the goal of the study: an actuarial local control of the treated lung lesions at 1 year of 90%. The 4-year overall survival rate was 38%. Grade 3 acute toxicity occurred in 5 patients. Three patients complained of chronic grade 3 toxicity, including pain, fatigue, and pneumonitis, and 3 patients had rib fractures.
  
  
  CONCLUSIONS
  The local control was promising, and the 4-year overall survival rate was 38%. The treatment was well tolerated, even for central lesions.
authors: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. Electronic address: j.nuyttens@erasmusmc.nl.
authors: Joost J
authors: JJ
authors: Nuyttens
authors: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors: Noëlle C M G
authors: NC
authors: van der Voort van Zyp
authors: Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors: Cornelis
authors: C
authors: Verhoef
authors: Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors: A
authors: A
authors: Maat
authors: Department of Pulmonology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors: Robertus J
authors: RJ
authors: van Klaveren
authors: Clinical Trial Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors: Bronno
authors: B
authors: van der Holt
authors: Department of Pulmonology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors: Joachim
authors: J
authors: Aerts
authors: Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors: Mischa
authors: M
authors: Hoogeman
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome