Continued versus Interrupted Targeted Therapy during Metastasis-Directed Stereotactic Radiotherapy: A Retrospective Multi-Center Safety and Efficacy Analysis
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Patient Characteristics
3.2. Targeted Therapy
3.3. Stereotactic Radiotherapy
3.4. Efficacy
3.5. Toxicity
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Characteristics | Total # of Patients (n = 158) (%) Median (Range) | Tt Continued n = 88 (56%) | Tt Paused n = 70 (44%) | p Value |
---|---|---|---|---|
Age (y) | 60 (26–86) | 57 (26–80) | 64 (22–86) | 0.16 |
Sex | 0.798 | |||
Female | 58 (37) | 28 (35) | 27 (37) | |
Male | 100 (63) | 52 (65) | 46 (63) | |
Primary tumor: | 0.594 | |||
Melanoma | 46 (29) | 27 (33) | 19 (26) | |
Non-small cell lung cancer | 69 (44) | 32 (38) | 37 (49) | |
Renal cell carcinoma | 37 (23) | 20 (25) | 17 (22) | |
Colorectal cancer | 6 (4) | 3 (4) | 3 (4) | |
ECOG-PS previous to SRT treatment | 0.094 | |||
0–1 | 139 (98) | 72 (88) | 67 (97) | |
2–3 | 13 (2) | 11 (12) | 2 (3) | |
Present metastases | 0.831 | |||
Oligometastatic (≤5 lesions) | 64 (45) | 33 (44) | 30 (40.5) | |
Polymetastatic (>5 lesions) | 84 (55) | 42 (56) | 41 (55) | |
Involved organs | 0.423 | |||
1 | 38 (25) | 24 (30) | 14 (18) | |
>1 (2–6) | 116 (75) | 57 (70) | 73 (82) | |
Targeted therapy | 0.225 | |||
EGFRi | 59 (37) | 27 (33) | 32 (43) | |
mTKI | 29 (18) | 13 (16) | 15 (20) | |
VEGF(R)i | 7 (4.4) | 6 (7.4) | 1 (1.4) | |
mTORi | 4 (2.5) | 2 (2.5) | 2 (2.7) | |
ALKi | 16 (10) | 6 (7.4) | 8 (11) | |
BRAF(±MEK)i | 43 (27) | 27 (33) | 16 (21.6) | |
Start of targeted therapy | 0.681 | |||
Before SRT | 118 (77) | 73 (90) | 45 (61) | |
time (days) | 195 (5–1490) | 200 (1–1000) | 198 (7–1490) | |
During/after SRT | 37 (23) | 8 (10) | 29 (39) | |
time (days) | 7 (0–49) | - | 7 (0–49) | |
Treatment site, total | 454 | 190 | 264 | 0.241 |
Cranial | 374 | 160 | 214 | |
Extracranial: | 80 | 30 | 50 | |
Lymph nodes | 2 | 1 | 1 | |
Lung | 27 | 12 | 15 | |
Abdomen | 13 | 3 | 10 | |
Bone | 34 | 12 | 22 | |
Soft tissue/muscle | 4 | 2 | 2 | |
Prescribed dose (BED10, Gy) | ||||
Brain SRT | 63 (44–114) | 63 (46.9–102) | 62.1 (44–114) | 0.216 |
SBRT | 93 (53–180) | 101.2 (54–180) | 91.5 (53–159) | 0.275 |
Tumor volume (mL) | ||||
Cranial metastases | 1 (0.03–23.9) | 1.3 (0.04–15.3) | 0.91 (0.03–23.9) | 0.26 |
Extracranial metastases | 7.5 (0.54–154.5) | 11.6 (0.64–154.5) | 6.4 (0.54–140.7) | 0.437 |
Correlation of Variables to Toxicity * | Acute Severe (≥G3) Toxicity | Late Severe (≥G3) Toxicity | ||||
---|---|---|---|---|---|---|
No | Yes | p-Value | No | Yes | p-Value | |
Histology | 0.133 | 0.829 | ||||
Melanoma | 62 | 1 | 60 | 3 | ||
Non-small cell lung cancer | 88 | 1 | 86 | 3 | ||
Renal cell carcinoma | 47 | 2 | 48 | 1 | ||
Colorectal cancer | 6 | 1 | 7 | 0 | ||
ECOG-PS | 0.408 | 0.387 | ||||
0–1 | 185 | 4 | 182 | 7 | ||
2–3 | 19 | 1 | 20 | 0 | ||
Number of organs with metastatic disease at time of SRT | ||||||
0–3 | 143 | 5 | 0.16 | 144 | 4 | 0.366 |
>3 | 57 | 0 | 54 | 3 | ||
Targeted therapy | 0.074 | 0.107 | ||||
EGFRi | 66 | 2 | 65 | 3 | ||
mTKI | 32 | 1 | 33 | 0 | ||
VEGF(R)i | 14 | 0 | 14 | 0 | ||
mTORi | 3 | 1 | 3 | 1 | ||
ALKi | 28 | 0 | 28 | 0 | ||
BRAF(±MEK)i | 60 | 1 | 58 | 3 | ||
Start of targeted therapy | 0.905 | 0.646 | ||||
Before SRT | 158 | 4 | 157 | 5 | ||
During/after SRT | 46 | 1 | 45 | 2 | ||
Targeted therapy paused during SRT | 0.841 | 0.188 | ||||
Yes | 89 | 1 (2) | 90 | 0 (0) | ||
No | 114 | 4 (3) | 111 | 7 (5) | ||
Prescribed dose (BED10, Gy) | ||||||
Brain SRT | 65.5 (12) | 61.9 (15) | 0.56 | 65.2 (12) | 70.3 (11) | 0.37 |
SBRT | 98.8 (33) | 91.5 (0) | 0.826 | 98.2 (33) | 110.7 (27) | 0.602 |
Tumor volume (cc) | ||||||
Cranial metastases | 3.0 (5) | 0.9 (0.4) | 0.377 | 3.0 (5) | 3.2 (4) | 0.93 |
Extracranial metastases | 19.5 (32) | 11.1 (0) | 0.794 | 19.0 (32) | 27.6 (24) | 0.706 |
Nr. of fractions | 0.486 | 0.732 | ||||
1 | 130 | 4 | 129 | 5 | ||
>1 | 70 | 1 | 69 | 2 |
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Kroeze, S.G.C.; Fritz, C.; Schaule, J.; Blanck, O.; Kahl, K.H.; Kaul, D.; Siva, S.; Gerum, S.; Claes, A.; Sundahl, N.; et al. Continued versus Interrupted Targeted Therapy during Metastasis-Directed Stereotactic Radiotherapy: A Retrospective Multi-Center Safety and Efficacy Analysis. Cancers 2021, 13, 4780. https://doi.org/10.3390/cancers13194780
Kroeze SGC, Fritz C, Schaule J, Blanck O, Kahl KH, Kaul D, Siva S, Gerum S, Claes A, Sundahl N, et al. Continued versus Interrupted Targeted Therapy during Metastasis-Directed Stereotactic Radiotherapy: A Retrospective Multi-Center Safety and Efficacy Analysis. Cancers. 2021; 13(19):4780. https://doi.org/10.3390/cancers13194780
Chicago/Turabian StyleKroeze, Stephanie G. C., Corinna Fritz, Jana Schaule, Oliver Blanck, Klaus Henning Kahl, David Kaul, Shankar Siva, Sabine Gerum, An Claes, Nora Sundahl, and et al. 2021. "Continued versus Interrupted Targeted Therapy during Metastasis-Directed Stereotactic Radiotherapy: A Retrospective Multi-Center Safety and Efficacy Analysis" Cancers 13, no. 19: 4780. https://doi.org/10.3390/cancers13194780