Efficacy and safety of stereotactic body radiation therapy for the treatment of pulmonary metastases from sarcoma: A potential alternative to resection.
OBJECTIVE
Oligometastatic sarcoma pulmonary metastases (PM) are typically treated with resection and/or chemotherapy. We hypothesize that stereotactic body radiotherapy (SBRT) can be an alternative to surgery that can achieve high rates of local control (LC) with limited toxicity.


METHODS
Thirty consecutive sarcoma patients received SBRT to 39 PM's from 2011 to 2015 at two university hospitals to a median dose of 50 Gy in 4-5 fractions with CyberKnife or linear accelerator. Patients underwent CT or PET/CT scans q3 months after SBRT.


RESULTS
77% received prior chemotherapy, 70% had 1-3 prior pulmonary resections, and 26% received prior thoracic radiotherapy. Median lesion size was 2.4 cm (range 0.5-8.1 cm). Median follow-up was 16 and 23 months for patients alive at last follow-up. At 12 and 24 months, LC was 94% and 86%, and OS was 76% and 43%. LC and OS did not differ by SBRT technique, fractionation regimen, lesion location, histology, or size (all P > 0.05). Three developed grade 2 chest-wall toxicity with no other grade ≥2 toxicities.


CONCLUSIONS
This is the largest series on SBRT for sarcoma PM's and demonstrates that SBRT is well-tolerated with excellent LC across tumor locations and sizes. SBRT should be considered in these patients, and prospective studies are warranted. J. Surg. Oncol. 2016;114:65-69. © 2016 Wiley Periodicals, Inc.
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Brian C
BC
Baumann
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Suneel N
SN
Nagda
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
James D
JD
Kolker
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
William P
WP
Levin
Department of Orthopaedic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Kristy L
KL
Weber
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Abigail T
AT
Berman
Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Arthur
A
Staddon
Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Lee
L
Hartner
Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
Stephen M
SM
Hahn
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Eli
E
Glatstein
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Charles B
CB
Simone
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents
SBRT; metastatectomy; pulmonary metastasis; sarcoma; stereotactic body radiation therapy