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Cancers
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Radiotherapy of Oligometastatic Cancers
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Radiotherapy of Oligometastatic Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Metastasis".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 8444

Special Issue Editor

Prof. Dr. Filippo Alongi

E-Mail Website
Guest Editor
Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria, 37024 Verona, Italy
Interests: radiotherapy; radiomics; prostate cancer; MR-Linac applications

Special Issue Information

Dear Colleagues,

The improvement of cancer survival, due to better oncology treatments and the concomitant widespread use of new-generation imaging, has been associated with an increasing number of patients diagnosed (after primary treatment or de novo) with oligometastatic disease. Systemic therapies, including chemotherapy, targeted therapy, immuno-therapy, and hormone-therapy, remain the standard approach for these cases. Due to the limited metastatic burden and frequently favorable outcomes, metastasis-directed therapies (MDTs) have been tested in retrospective studies and prospective trials as a therapeutic alternative to increase progression-free survival or to delay the utilization of systemic therapies in several settings.

In the specific scenario of oligometastatic disease, as postulated by Hellman and Weichselbaum, radiotherapy represents an attractive treatment option for the management of oligometastases. Radiotherapy has been increasingly implemented in clinical practice as an MDT strategy for the intensification of care in oligometastatic cancer patients. The MDRT (metastasis-directed radiotherapy) approach is mainly represented by stereotactic body radiotherapy (SBRT), also called stereotactic ablative radiotherapy (SABR), with or without systemic therapy. Furthermore, the evidence of advanced and focused radiotherapy in this context is increasing: the recently updated results of the SABRCOMET trial confirm a survival advantage with the addition of SBRT to the standard-of-care. These results are in line with those of several other studies with consistent data confirming the promising application of SBRT in the field of oligometastases. However, several criticisms and issues to resolve are still objects of debate. Even if MDRT has been largely adopted in oligometastasis clinical practice, a large variability remains in terms of the definition of the ideal candidate, the radiation treatment doses and schedules to adopt, the volumes to irradiate, and treatment planning optimization to use.

The goal of this Special Issue is to highlight the role of radiotherapy in oligometastatic cancer, especially covering clinical aspects that advance our understanding of targeting this complex metastatic disease with radiotherapy.

Prof. Dr. Filippo Alongi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • SBRT
  • SABR
  • oligometastases
  • oligorecurrence
  • oligoprogression

Published Papers (6 papers)

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Editorial

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3 pages, 144 KiB  
Editorial
Radiotherapy of Oligometastatic Cancers
by Filippo Alongi and Simona Gaito
Cancers 2024, 16(3), 511; https://doi.org/10.3390/cancers16030511 - 24 Jan 2024
Viewed by 933
Abstract
The enhanced multidisciplinary treatment approach and the widespread use of advanced imaging techniques have led to an improvement in survival rates, inevitably associated with an increase in the number of oligometastatic diagnoses in cancer patients [...] Full article
(This article belongs to the Special Issue Radiotherapy of Oligometastatic Cancers)

Research

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15 pages, 482 KiB  
Article
Survival, Treatment Outcome, and Safety of Multiple and Repeated Courses of Stereotactic Body Radiotherapy for Pulmonary Oligometastases of Head and Neck Squamous Cell Carcinoma
by Samuel Moritz Vorbach, Julian Mangesius, Daniel Dejaco, Thomas Seppi, Matthias Santer, Stephanie Zur Nedden, Manuel Paolo Sarcletti, Martin Josef Pointner, Tilmann Jakob Hart, Herbert Riechelmann, Ute Ganswindt and Meinhard Nevinny-Stickel
Cancers 2023, 15(21), 5253; https://doi.org/10.3390/cancers15215253 - 1 Nov 2023
Cited by 2 | Viewed by 898
Abstract
Current literature regarding survival and treatment outcome of SBRT in patients with pulmonary oligometastatic head and neck squamous cell carcinoma (HNSCC) is limited. Additionally, most of the published studies include metastatic lesions deriving also from primaries with histologies other than SCC when investigating [...] Read more.
Current literature regarding survival and treatment outcome of SBRT in patients with pulmonary oligometastatic head and neck squamous cell carcinoma (HNSCC) is limited. Additionally, most of the published studies include metastatic lesions deriving also from primaries with histologies other than SCC when investigating the outcome of SBRT. The aim of the present retrospective study is to explore local control (LC) of treated metastases, progression-free survival (PFS), and overall survival (OS) of exclusively pulmonary oligometastatic HNSCC-patients treated with SBRT. Between 2006 and 2021, a total of 46 patients were treated with SBRT for a maximum of four pulmonary oligometastases (PM) concurrently (mean PM per patient = 2.0; range 1 to 6 PM, total of 92). Of these, 17 patients (37.0%) developed new pulmonary metastases after their first SBRT. Repeated courses of SBRT were required once in 15 patients (88.2%) and twice in 2 patients (11.8%). Median follow-up was 17 months (range, 0–109 months). One year after completion of SBRT, LC rate, PFS, and OS were 98.7%, 37.9%, and 79.5%, respectively. After two years, LC rate, PFS, and OS were 98.7%, 28.7%, and 54.9%; as well as 98.7%, 16.7%, and 31.0% after five years. Radiochemotherapy (HR 2.72, p < 0.001) or radiotherapy as primary treatment (HR 8.60; p = 0.003), as well as reduced patient performance status (HR 48.30, p = 0.002), were associated with lower PFS. Inferior OS correlated with poor performance status (HR 198.51, p < 0.001) and surgery followed by radiochemotherapy (HR 4.18, p = 0.032) as primary treatment, as well as radiotherapy alone (HR 7.11, p = 0.020). Treatment of more than one PM is an independent predictor of impaired OS (HR 3.30, p = 0.016). SBRT of HNSCC-derived PMs results in excellent LC rates and encouraging OS rates of 54.9% at two years along with good tolerability (no more than grade 2 toxicities). Favourable outcome and low toxicity also apply to repeated courses of SBRT of newly emerging PMs. Full article
(This article belongs to the Special Issue Radiotherapy of Oligometastatic Cancers)
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15 pages, 5166 KiB  
Article
A Bibliometric Analysis of the Oligometastatic State over the Last Two Decades: A Shifting Paradigm for Oncology? An AIRO Oligometastatic Study Group
by Giulia Marvaso, Federico Mastroleo, Giulia Corrao, Mattia Zaffaroni, Maria Giulia Vincini, Paolo Borghetti, Francesco Cuccia, Manuela Federico, Giampaolo Montesi, Antonio Pontoriero, Davide Franceschini, Ciro Franzese, Marta Scorsetti and Barbara Alicja Jereczek-Fossa
Cancers 2023, 15(15), 3902; https://doi.org/10.3390/cancers15153902 - 31 Jul 2023
Cited by 2 | Viewed by 1445
Abstract
The term “oligometastasis” represents a relatively novel idea, which denotes a condition characterized by cancer dissemination with a limited number of lesions (usually fewer than five). The aim of the present study is to report a bibliometric analysis of the oligometastatic disease/state, incorporating [...] Read more.
The term “oligometastasis” represents a relatively novel idea, which denotes a condition characterized by cancer dissemination with a limited number of lesions (usually fewer than five). The aim of the present study is to report a bibliometric analysis of the oligometastatic disease/state, incorporating all relevant studies on the topic for more than 20 years. The research strategy included at least one the terms “Oligmetastases”, “Oligometastasis”, “Oligometastatic”, “Oligoprogression, “Oligoprogressive”, “Oligorecurrent”, or “Oligorecurrency” in the title, abstract, and/or keywords. All English-language documents from 1 January 1995 (the year of the earliest available document in Scopus) to 31 December 2022 were considered for the analysis. R code (R version 4.2.0) with R Studio (version 2022.12.0-353) and the Bibliometrix package (version 4.0.1) were used for the analysis. A total of 3304 documents, mainly articles (n = 2083, 63.0%) and reviews (n = 813, 24.6%), were collected from 1995 to 2022. The average annual growth rate of literature on the topic was 26.7%. Overall 15,176 authors published on the topic, with an average of eight authors/publication. From 1995, 69 countries contributed to the literature, with the USA and Italy being the top contributors. Among all keywords used by authors, the top three were oligometastases (19%), SBRT (18%), and radiation therapy (8%). Themes regarding “locoregional treatment”, “organ motion”, and “immunotherapy” were the most recent trend topics, mainly developed from 2019 to 2022, while “high-dose chemotherapy”, “whole-brain radiotherapy”, and “metastatic breast cancer” saw their main development during 2009–2018. Our study shows the exceptionally flourishing scientific production on the oligometastatic state, summarizing the most influential studies and highlighting the future developments and interests. This analysis will serve as a benchmark to identify this area for the attention of researchers worldwide and contribute to the increasing scientific work. Full article
(This article belongs to the Special Issue Radiotherapy of Oligometastatic Cancers)
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9 pages, 263 KiB  
Article
PSMA-PET/CT-Based Stereotactic Body Radiotherapy (SBRT) in the Treatment of Uncomplicated Non-Spinal Bone Oligometastases from Prostate Cancer
by Edoardo Pastorello, Luca Nicosia, Francesco Cuccia, Laura Olivari, Matilde Fiorini, Niccolò Giaj Levra, Rosario Mazzola, Francesco Ricchetti, Michele Rigo, Paolo Ravelli, Salvatore D’Alessandro, Matteo Salgarello, Ruggero Ruggieri and Filippo Alongi
Cancers 2023, 15(10), 2800; https://doi.org/10.3390/cancers15102800 - 17 May 2023
Cited by 2 | Viewed by 1661
Abstract
Background and purpose: Stereotactic body radiotherapy (SBRT) has a consolidated role in the treatment of bone oligometastases from prostate cancer (PCa). While the evidence for spinal oligometastases SBRT was robust, its role in non-spinal-bone metastases (NSBM) is not standardized. In fact, there was [...] Read more.
Background and purpose: Stereotactic body radiotherapy (SBRT) has a consolidated role in the treatment of bone oligometastases from prostate cancer (PCa). While the evidence for spinal oligometastases SBRT was robust, its role in non-spinal-bone metastases (NSBM) is not standardized. In fact, there was no clear consensus about dose and target definition in this setting. The aim of our study was to evaluate efficacy, toxicity, and the pattern of relapse in SBRT delivered to NSBM from PCa. Materials and methods: From 2016 to 2021, we treated a series of oligo-NSBM from PCa with 68Ga-PSMA PET/CT-guided SBRT. The primary endpoint was local progression-free survival (LPFS). The secondary endpoints were toxicity, the pattern of intraosseous relapse, distant progression-free survival (DPFS), polimetastases-free survival (PMFS), and overall survival (OS). Results: a total of 150 NSBM in 95 patients were treated with 30–35 Gy in five fractions. With a median follow-up of 26 months, 1- and 3 years LPFS was 96.3% and 89%, respectively. A biologically effective dose (BED) ≥ 198 Gy was correlated with improved LPFS (p = 0.007). Intraosseous relapse occurred in eight (5.3%) cases. Oligorecurrent disease was associated with a better PMFS compared to de novo oligometastatic disease (p = 0.001) and oligoprogressive patients (p = 0.007). No grade ≥ 3 toxicity occurred. Conclusion: SBRT is a safe and effective tool for NSBM from PCa in the oligometastatic setting. Intraosseous relapse was a relatively rare event. Predictive factors of the improved outcomes were defined. Full article
(This article belongs to the Special Issue Radiotherapy of Oligometastatic Cancers)

Review

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17 pages, 913 KiB  
Review
Node Oligorecurrence in Prostate Cancer: A Challenge
by Almudena Zapatero, Antonio José Conde Moreno, Marta Barrado Los Arcos and Diego Aldave
Cancers 2023, 15(16), 4159; https://doi.org/10.3390/cancers15164159 - 17 Aug 2023
Cited by 2 | Viewed by 1248
Abstract
Within the oligometastatic state, oligorecurrent lymph node disease in prostate cancer represents an interesting clinical entity characterized by a relatively indolent biology that makes it unique: it can be treated radically, and its treatment is usually associated with a long period of control [...] Read more.
Within the oligometastatic state, oligorecurrent lymph node disease in prostate cancer represents an interesting clinical entity characterized by a relatively indolent biology that makes it unique: it can be treated radically, and its treatment is usually associated with a long period of control and excellent survival. Additionally, it is an emergent situation that we are facing more frequently mainly due to (a) the incorporation into clinical practice of the PSMA-PET that provides strikingly increased superior images in comparison to conventional imaging, with higher sensitivity and specificity; (b) the higher detection rates of bone and node disease with extremely low levels of PSA; and (c) the availability of high-precision technology in radiotherapy treatments with the incorporation of stereotaxic body radiotherapy (SBRT) or stereotaxic ablative radiotherapy (SABR) technology that allows the safe administration of high doses of radiation in a very limited number of fractions with low toxicity and excellent tolerance. This approach of new image-guided patient management is compelling for doctors and patients since it can potentially contribute to improving the clinical outcome. In this work, we discuss the available evidence, areas of debate, and potential future directions concerning the utilization of new imaging-guided SBRT for the treatment of nodal recurrence in prostate cancer. Full article
(This article belongs to the Special Issue Radiotherapy of Oligometastatic Cancers)
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14 pages, 1571 KiB  
Review
Proton Beam Therapy in the Oligometastatic/Oligorecurrent Setting: Is There a Role? A Literature Review
by Simona Gaito, Giulia Marvaso, Ramon Ortiz, Adrian Crellin, Marianne C. Aznar, Daniel J. Indelicato, Shermaine Pan, Gillian Whitfield, Filippo Alongi, Barbara Alicja Jereczek-Fossa, Neil Burnet, Michelle P. Li, Bethany Rothwell, Ed Smith and Rovel J. Colaco
Cancers 2023, 15(9), 2489; https://doi.org/10.3390/cancers15092489 - 26 Apr 2023
Cited by 5 | Viewed by 1787
Abstract
Background: Stereotactic ablative radiotherapy (SABR) and stereotactic radiosurgery (SRS) with conventional photon radiotherapy (XRT) are well-established treatment options for selected patients with oligometastatic/oligorecurrent disease. The use of PBT for SABR-SRS is attractive given the property of a lack of exit dose. The aim [...] Read more.
Background: Stereotactic ablative radiotherapy (SABR) and stereotactic radiosurgery (SRS) with conventional photon radiotherapy (XRT) are well-established treatment options for selected patients with oligometastatic/oligorecurrent disease. The use of PBT for SABR-SRS is attractive given the property of a lack of exit dose. The aim of this review is to evaluate the role and current utilisation of PBT in the oligometastatic/oligorecurrent setting. Methods: Using Medline and Embase, a comprehensive literature review was conducted following the PICO (Patients, Intervention, Comparison, and Outcomes) criteria, which returned 83 records. After screening, 16 records were deemed to be relevant and included in the review. Results: Six of the sixteen records analysed originated in Japan, six in the USA, and four in Europe. The focus was oligometastatic disease in 12, oligorecurrence in 3, and both in 1. Most of the studies analysed (12/16) were retrospective cohorts or case reports, two were phase II clinical trials, one was a literature review, and one study discussed the pros and cons of PBT in these settings. The studies presented in this review included a total of 925 patients. The metastatic sites analysed in these articles were the liver (4/16), lungs (3/16), thoracic lymph nodes (2/16), bone (2/16), brain (1/16), pelvis (1/16), and various sites in 2/16. Conclusions: PBT could represent an option for the treatment of oligometastatic/oligorecurrent disease in patients with a low metastatic burden. Nevertheless, due to its limited availability, PBT has traditionally been funded for selected tumour indications that are defined as curable. The availability of new systemic therapies has widened this definition. This, together with the exponential growth of PBT capacity worldwide, will potentially redefine its commissioning to include selected patients with oligometastatic/oligorecurrent disease. To date, PBT has been used with encouraging results for the treatment of liver metastases. However, PBT could be an option in those cases in which the reduced radiation exposure to normal tissues leads to a clinically significant reduction in treatment-related toxicities. Full article
(This article belongs to the Special Issue Radiotherapy of Oligometastatic Cancers)
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