ABSTRACT
In this report, we have reviewed the research progress in the involvement, efficacy and prediction of biomarkers of radiotherapy in oligo-metastatic prostate cancer. According to the timing of metastasis, oligo-metastases can be divided into four categories: de-novo oligo-metastasis, oligo-recurrence, oligo-progression and oligo-persistence. The use of radiotherapy in oligo-metastases of prostate cancer is becoming more and more important, which can be used not only for primary radiotherapy in newly diagnosed oligo-metastasis patients, but also for metastatic radiotherapy in oligo-recurrence patients. In addition, studies are trying to conduct full coverage of primary and metastatic radiotherapy for 4 types of oligometastases.
ABSTRACT
The rapid progress on immunotherapy and targeted therapy has brought long-term survival benefits for locally advanced non-small cell lung cancer (NSCLC). The oncology community has also paid more attention to the local treatment for advanced NSCLC, especially for patients with limited metastatic lesions, also known as oligo-metastasis. Many studies have reported that oligo-metastatic NSCLC patients could benefit from the combination of local and systematic treatment, and even to be cured. In recent years, with the advances in radiation technology, stereotactic body radiation therapy (SBRT) has achieved precise high-dose radiotherapy for small target tumors. Currently, SBRT has been widely applied in the treatment of inoperable early lung cancer, and its application value and safety in patients with advanced lung cancer are also being actively explored. In this article, the research status, progress and future development direction of SBRT in the treatment of oligo-metastatic NSCLC were discussed.
ABSTRACT
In recent years, the application of immune checkpoint inhibitors (PD-1/PD-L1/CTLA-4, etc.) in the treatment of non-small cell lung cancer (NSCLC) has developed rapidly. However, the response rate of immune checkpoint inhibitors alone is as low as 15%-30%. There are still many problems in clinical practice, such as limited benefit population, lack of effective biomarkers and treatment resistance, etc. Compared with conventional fractionated radiotherapy, stereotactic body radiation therapy (SBRT) has the characteristics of higher single dose, less irradiation times and stronger immune activation ability. It has shown good anti-tumor effect in patients with advanced NSCLC oligometastasis. The combination of immune checkpoint inhibitors and SBRT is the development trend of tumor therapy. Preclinical and clinical studies show that SBRT can enhance the efficacy of immunotherapy in patients with NSCLC. In the initial study, single-lesion SBRT was first recommended to reduce potential toxicity. However, more and more studies have confirmed the feasibility and necessity of multi-lesion SBRT. In this review, we not only elucidated the mechanism and the latest progress upon combined use of SBRT and immune checkpoint inhibitors in advanced NSCLC oligometastasis, but also explored the basic and clinical research of multi-lesion SBRT combined with immunotherapy, aiming to guide clinical practice.
ABSTRACT
Objective:To investigate the efficacy and safety of radiotherapy for all metastases in patients with metachronous oligo-metastatic prostate cancer after radical treatment.Methods:From October 2011 to February 2021, 41 patients with prostate cancer with less than 5 metastases after radical treatment were retrospectively analyzed in a single center. The median age at radiotherapy was 68 (57-81) years. Forty patients (98%) received androgen deprivation therapy (ADT). There were 28 patients in the hormone sensitive (HSPC) group and 13 patients in the hormone resistant (CRPC) group. The median initial PSA was 24.4 (7.4-399.0) ng/ml. Tumor stage: T 2 stage 11 patients, T 3 stage 27 patients, T 4 stage 3 patients.30 patients were in N 0 stage and 11 patients in N 1 stage. Gleason score was 7 in 12 patients, 8 in 9 patients, 9 in 18 patients, and 10 in 2 patients.33 patients were treated with surgery, and 8 patients were treated with radiotherapy. The time span from diagnosis to metastasis was 3.1 (0.2-1.8) years. Conventional imaging examination (CT/ MRI/bone scan) before radiotherapy was used in 7 patients, and PSMA PET/CT examination was used in 34 patients.The median PSA before radiotherapy was 1.3(0.1-33.8) ng/ml. There were 62 metastases in 41 patients, including 1 lesion in 28 patients, 2 lesions in 9 patients, 3 lesions in 2 patients, and 5 lesions in 2 patients. Fifty-four patients had bone metastases and eight had retroperitoneal lymph node metastases. Twenty-two bone metastases were located in the pelvis, 18 in the vertebral body, 12 in the ribs, one in the femur and one in the sternum.The median metastatic volume was 5.8(0.2-81.7) cm 3.Daily image-guided rotational intensity modulated radiotherapy was used to cover all metastases.Dose segmentation modes include 37.5Gy/7.5Gy/5F, 60Gy/3Gy/20F, 65-70Gy/2.6-2.8Gy/25F.The median biological effective dose (BED 3) was 120 (67-147) Gy. The primary endpoint was biochemical progression-free survival (BPFS), the secondary endpoints were acute and late toxic side effects, local relapse-free survival (LPFS), and overall survival (OS). Results:The median follow-up time was 21 months (range 5-72 months). All patients completed radiotherapy, and 16 patients had grade 1 to 2 acute toxicity and side effects, and no grade 3 or above acute and late stage side effects. 1-year LPFS was 97.1%.The 1-year and 2-year BPFS were 77.5% and 59.2%, respectively. The median BPFS time was 29 months (range 13.9-44.2 months). Univariate analysis showed that the HSPC group ( P<0.001) and the group with total metastatic volume ≤ 5.8cm 3 ( P=0.010) had higher BPFS. The median BPFS time was 37 months in the retroperitoneal lymph node metastases subgroup and 17 months in the bone metastases subgroup ( P=0.141). In the HSPC group, the median BPFS was 30(22-38) months. After radiotherapy, PSA decreased in all 28 patients, and increased in 6 patients. The median BPFS was 12(4-18) months. In the CRPC group, the median BPFS was 4(0-8) months. PSA decreased in 10 patients (76.9%) after radiotherapy, and PSA decreased in 6 patients. The median BPFS was 5(3-28) months. Three patients’PSA did not decrease after radiotherapy, and they were treated with new endocrine therapy drugs, chemotherapy, immunotherapy and other systemic therapy. Conclusions:For patients with metachronous metastases after radical treatment, full coverage radiotherapy has good safety and high local control rate. HSPC patients and patients with low tumor load could be recommended to receive radiotherapy for all metastatic lesions preferentially, and patients with only retroperitoneal lymph node metastases may have better prognosis after radiotherapy than patients with bone metastases.
ABSTRACT
The treatment strategies and prognosis of previously untreated oligometastatic nasopharyngeal carcinoma (NPC) are extremely different due to the heterogeneity of this disease. More and more studies have found the survival advantages of oligometastatic NPC over NPC with multiple metastases. In addition to systemic chemotherapy,the primary tumor and metastatic lesions should be considered in the treatment of previously untreated oligometastatic NPC.Adding radical radiotherapy for primary tumor and aggressive managements for metastatic lesions to the systemic chemotherapy can substantially improve the survival of patients,even achieving a radical cure. Several molecular markers and prognostic models can screen out some patients who will benefit from aggressive treatment,but more studies are needed in the future.