Study
n of patients
Median dose/n of fraction
Median (range) follow-up, months
Local control rate
Overall survival
Toxicity
Onimaru et al. [51]
45
48 Gy/8; 60 Gy/8
18 (2–44)
3-years, 69.6 % for 48 Gy, 100 % for 60 Gy
2-years, 47.1 %
Grade 5, 1 (2.2 %)
Wulf et al. [52]
27
30 Gy/3; 36 Gy/3
13–17
2-years, 71 %
1-year, 48 %
Grade 3, 1 (3.7 %)
2-years, 21 %
Grade 5, 1 (3.7 %)
Yoon et al. [53]
53
30 Gy/3; 40 Gy/4; 48 Gy/4
14 (4–56)
70 % for 30 Gy, 77 % for 40 Gy, 100 % for 48 Gy
1-year, 89 %;
Grade >2, 0 %
2-years, 51 %
Okunieff et al. [31]
50
50 Gy/10; 48 Gy/6; 57 Gy/3
18.7 (3.7–60.9)
3-years, 91 %
2-years, 50 %
Grade 2, 6.1 %
Grade 3, 2 %
Norihisa et al. [34]
34
48 Gy/4; 60 Gy/5
27 (10–80)
2-years, 90 %
2-years, 84 %
Grade 2, 4 (12 %)
Grade 3, 1 (3 %)
Brown et al. [54]
35
5 Gy/1–60 Gy/4
18 (2–41)
Crude, 77 %
2-years, 72.5 %
Grade 3–4, 1 (2.8 %)
Rusthoven et al. [32]
38
60 Gy/3
15.4 (6–48)
2-years, 96 %
2-years, 39 %
No grade 4
Grade 3, 3 (8 %)
Ricardi et al. [55]
61
45 Gy/3; 26 Gy/1
20.4 (3–77)
2-years, 89 %
2-years, 66.5 %
Grade 3, 1 (1.6 %)
Table 13.2
Summary of recent prospective trials with stereotactic body radiation therapy for liver metastases
Study | n of patients | Dose/n of fraction | Median (range) follow-up, months | Local control rate | Overall survival | Toxicity |
|---|---|---|---|---|---|---|
Blomgren et al. [37] | 14 | Mean dose to PTV 8–63 Gy/1–4 | 1.5–13 | Crude, 70 % | – | Grade >3 toxic effects, 0 % |
Blomgren et al. [56] | 17 | 20–45 Gy/2–4 | 9.6 (mean) (1.5–24) | Crude, 95 % | – | Grade >3 toxic effects, 0 % |
Herfarth et al. [38] | 33 | 14–26 Gy/1, prescribed to 80 % | 18 | Crude, 78 % | 1-year, 72 % | Radiation-induced liver disease: 0 % |
6-months, 75 % | ||||||
12-months, 71 % | ||||||
18-months,67 % | ||||||
Hoyer et al. [57] | 44 | 45 Gy/3, prescribed to 95 % | 4.3 years | 86 % | 24-months, 38 % | – |
Kavanagh et al. [58] | 36 | 60 Gy/3 | 19 | 18-months, 93 % | – | – |
Lee et al. [41] | 70 | 27.7–60.0 Gy/6, prescribed to isodose line covering PTV (median, 41.4 Gy) | 10.8 for 68 assessable patients | 1-year, 71 % | 18-months, 47 % | Late grade 4 and 5 toxic effects, 2.9 % and 1.5 %, respectively |
Méndez Romero et al. [59] | 14 | 37.5 Gy/3, prescribed to 65 % | 12.9 | Crude, 94 % | 1-year, 85 %; | Grade >4 toxic effects, 0 % |
1-year, 100 % | 2-years, 62 % | |||||
2-years, 86 % | ||||||
Rusthoven et al. [40] | 47 | 12–20 Gy/3, prescribed to isodose line covering PTV | 16 | 1-year, 95 % | 2-years, 30 % | Grade 4 toxic effects, 0 % |
2-years, 92 % | ||||||
Goodman et al. [60] | 26 | 18–30 Gy/1, prescribed to 80 % | 17.3 | 1-year, 61.8 %; | 1-year, 61.8 %; 2-years, 49.4 % | Late grade 2 gastrointestinal toxic effects, 2 of 26 patients |
2-years, 49.4 % | ||||||
Rule et al. [61] | 27 | 30–60 Gy/5 | 20 | 2-years, 56, 89, and 100 % for the 30-, 50-, and 60-Gy cohorts, respectively | – | Grade >3 toxic effects, 0 % |
Schefter et al. [39] | 18 | 36–60 Gy/3 | 7.1 | – | – | Grade >3 toxic effects, 0 % |
Katz et al. [42] | 69 | 30–55 Gy/7–20 (mean 11), prescribed to 80 % | 14.5 | 10 month, 76 % | Median, 14.5 months | Grade >3, 0 % |
20 month, 57 % |
Table 13.3
Summary of published trials of stereotactic body radiation therapy for lymph node metastases
Study | Primary | Treated site(s) | n of patients | Median dose/n of fraction | Median (range) follow-up, months | Local control rate | Overall survival | Toxicity |
|---|---|---|---|---|---|---|---|---|
Choi et al. [62] | Cervix | Paraaortic nodes | 30 | 33–45 Gy/3 (n = 24); | 15 (2–65) | 4-years, 67.4 % | 4-years, 50.1 month | Late grade 3 or 4 toxicity, 3 % |
4 patients also received 27–45 Gy external beam radiotherapy | ||||||||
Jereczek-Fossa et al. [63] | urological, gastrointestinal, gynecologic, malignancies | Abdominal lymph nodes | 69 | 24 Gy/3 | 20 | 3-years, 64.3 % | 3-years, 49.9 % | Acute grade 3 toxicity in 2; |
Grade 4 toxicity in 1 | ||||||||
Kim et al. [64] | Stomach | Paraaortic nodes | 7 | 45–51 Gy (median, 48 Gy)/3 | 26 (19–33) | – | 3-years, 43 % | Late grade 3 or 4 toxicity, 0 % |
Kim et al. [65] | Colorectum | Pelvic/presacral lymph nodes | 7 | 36–51 Gy/3 | 26 (15–70) | 86 % | 3-years, 71.4 % | Late grade 4 toxicity, 14 % |
Bignardi et al. [66] | Miscellanous | Abdominal lymph nodes | 19 | 45 Gy/6 | 12 | 12-months, 77.8 % | – | Late grade 3 or 4 toxicity, 0 % |
Casamassima et al. [67] | Prostate | Pelvic, paraaortic or mediastinal lymph nodes | 25 | 30 Gy/3 | 29 (14.4–48) | 3-years, 90 % | 3-years, 92 % | Late grade >2 toxicity, 0 % |
Table 13.4
Summary of published trials of stereotactic body radiation therapy for adrenal metastases
Study | n of patients | Median dose/n of fraction | Median (range) follow-up, months | Local control rate | Overall survival | Toxicity |
|---|---|---|---|---|---|---|
Casamassima et al. [68] | 48 | 36 Gy/3 | 16.2 (3–63) | 1–2 years, 90 % | 1-year, 39.7 %; | 1 case of grade 2 adrenal insufficiency |
2-years, 14.5 % | ||||||
Chawla et al. [69] | 30 | 40 Gy/10 | 9.8 (3.2–28.3) | 1-year, 55 % | 1-year, 44 % | Mild grade 1 fatigue and nausea, “common” |
2-years, 25 % | ||||||
Oshiro et al. [70] | 19 | 45 Gy/10 | 11.5 (5.4–87.8) | Objective response rate, 68 % | 1-year, 56 %; | 1 grade 2 duodenal ulcer |
2-years, 33 %; | ||||||
3-years, 22 % | ||||||
Holy et al. [71] | 18 | 20 Gy/5; 40 Gy/8 | 21 | Objective response rate, 77 % | Median, 23 months | – |
Torok et al. [72] | 7 | 16 Gy/1; 27 Gy/3 | 14 (1–60) | 1-year, 63 % | Median, 8 months | – |
Scorsetti et al. [73] | 34 | 32 Gy/4 | 41 (12–75) | 1-year, 66 % | Median, 22 months | No grade 3 or 4 toxicity, 6 % grade 2 nausea |
2-years, 33 % |
Table 13.5
Summary of published trials of stereotactic body radiation therapy for mixed oligometastatic sites
Study | n of patients (n of treated targets) | Dose/n of fraction | Primary site | Treated site(s) | Treated metastasis control | Toxicity |
|---|---|---|---|---|---|---|
Milano et al. [47] | 121 (293) | Various; median 50 Gy/10 | All (mostly breast and colorectal) | Lung, liver, bone, lymph node, 7 CNS | 2-year LLC, 77 % | Grade 3 in 1 patient (1 %) |
4-year LLC, 74 % | ||||||
Salama et al. [74] | 61 (113) | Increasing from 24 Gy/3 to 48 Gy/3 | All (26 % NSCLC) | Lung, liver, lymph node, bone | 2-year LLC 66.7 %; 88 % if dose ≥30 Gy in 3 fractions | Acute grade 3 in 2 (3 %), 6 possible late grade 3 (10 %) |
Kang et al. [75] | 59 (78) | 42 Gy/3 | Colorectal | Lung, liver, lymph node, other | 3-year local control 66 % (note 69 % of patients had PD after chemotherapy) | No grade 3, 3 % grade 4 (gastrointestinal perforation/obstruction) |
Inoue et al. [46] | 44 (60) | 48 Gy/8 (adrenal), 35–60 Gy/4–8 | Mostly lung | Lung, adrenal, brain | 3-year local control, 80 % | 9 % grade 2; no grade 3 or higher |
Stinauer et al. [76] | 30 (53) | 40–50 Gy/5 or 42–60 Gy/3 | Renal-cell and melanoma | Lung, liver, bone | 18-months local control, 88 % | One grade 3 hypoxia (3 %) |
Bae et al. [77] | 41 (50) | Median 48 Gy/3 | Colorectal | Lymph node, lung, liver | 3-year local control, 64 % | No acute grade 3, 7 % late grade 3 |
Jereczek-Fossa et al. [63] | 34 (38) | 30 Gy/5 to 36 Gy/3 | Prostate | Lymph node, bone, prostate recurrence | 88 % local control | 6 % grade 3 urinary, 3 % grade 3 rectal (all prostate recurrence patients), 6 % grade 3 late urinary |
Hoyer et al. [57] | 64 (141) | 45 Gy/3 | Colorectal | Liver, lung, nodes, other | 2-year local control, 63 % (86 % LLC) | 30 % grade 3: pain, nausea, skin reaction; 9 % grade 4 |
Wersall et al. [78] | 58 (162) | Various: 30–40 Gy/3 was most common dose | Renal cell carcinoma | Lung (majority), renal bed, lymph node, adrenal | Local control 90 % or higher | 40 % had grade 1 or higher toxicity, with a high proportion of grade 3 events (some perhaps in the same patient); one death (gastric haemorrhage) |
Svedman et al. [79] | 30 (82) | Various: | Renal cell carcinoma | Lung (majority), renal bed, adrenal | Only 2 % documented progression at median follow-up 52 months | 4 % of side-effects were grade 3 |
40 Gy/4 was most common dose | ||||||
Nuyttens et al. [80] | 14 (15) | Median 7 Gy/1, median 6 fr | Mixed | Mixed
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