Copenhagen, Denmark
Onsite/Online

ESTRO 2022

Session Item

Monday
May 09
09:00 - 10:00
Mini-Oral Theatre 1
22: Mixed sites, palliation
Jon Cacicedo, Spain;
Nadia Bouzid, Tunisia
Mini-Oral
Clinical
Clinical outcomes of a large cohort of oligometastatic patients treated with SRT
Davide Franceschini, Italy
MO-0712

Abstract

Clinical outcomes of a large cohort of oligometastatic patients treated with SRT
Authors:

Davide Franceschini1, Luca Cozzi1, Lorenzo Lo Faro1,2, Antonio Marzo1,2, Luciana Di Cristina1,2, Beatrice Marini1,2, Ciro Franzese1,2, Carmela Galdieri1, Marta Scorsetti1,2

1IRCCS Humanitas Research Hospital, Radiotherapy and Radiosurgery, Rozzano – Milan, Italy; 2Humanitas University, Biomedical Sciences, Pieve Emanuele – Milan, Italy

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Purpose or Objective

The aim of this study was to evaluate clinical outcomes in a large cohort of consecutively treated oligometastatic patients treated in our institution with stereotactic radiotherapy (SRT). 

Material and Methods

The study included patients affected by 1 to 5 metastases in 1 to 3 different organs treated with SRT from 2014 to 2020. Demographic features, primary tumor characteristic, patients’ features and treatments received were collected from the hospital chart. The Kaplan Meier analysis was applied to assess local control (LC), progression-free survival (PFS), distant metastases free survival (DMFS) and overall survival (OS). 

Results

Between 2014 and 2020, 1172 patients were treated with SRT on oligometastatic sites. Patients and treatment characteristic are shown in table 1.

Best local response during follow up according to RECIST criteria v 1.1 was as follow: complete response 425 patients (36.3%); partial response 533 (45.5%); stable disease 194 (16.6%); progressive disease 20 (1.7%)

After a median follow up of 20.3 months, 208 patients (17.7 months) had a relapse in irradiated site(s). LC at 1, 2 and 3 years was 88%, 80.4% and 75.2%, respectively.

Most patients (834, 71.2%) had a further distant progression. DMFS at 1, 2 and 3 years was 59.5%, 44.7% and 40.1%, respectively. Among progressing patients, the majority (598, 71.6%) experienced a further oligometastatic progression. In 347 patients (41.6%) the new metastases appeared in the same organ of the irradiated lesion(s), in 341 (40.8%) in a different organ, while in 147 (17.6%) progression occurred both in the same and in at least one different organ.

Considering both local and distant progression, PFS at 1, 2 and 3 years was 57.2%, 43.4% and 39.4%.

During follow up, 512 (43.7%) patients died for disease progression, 55 (4.7%) died for other causes not related to cancer. Among living patients, 159 (13.6%) remained free from disease progression, 78 (6.7%) were still affected by active residual disease in irradiated sites and 367 (31.3%) experienced were alive with further metastatic disease. OS at 1,2 and 3 years was 86.6%, 65.4% and 50.3%, respectively. KM curves are shown in figure 1.

At univariate analysis, age, primary tumor site, disease free interval, PS, previous systemic therapies, number of irradiated metastases, site of irradiated metastases and BED resulted statistically significant for OS with a p value < 0,05. Primary tumor site, disease free interval, PS, previous systemic therapies, number of irradiated metastases, site of irradiated metastases and BED had a statistically significant correlation with PFS.

Conclusion

SRT for oligometastatic patients is a valid treatment, with potential for long term remission. In a large database analysis, half of patients is still alive after 3 years. A better integration with effective systemic therapies could reduce the occurrence of distant progression, which remains the main pattern of failure.