Sarcoma and Cutaneous Tumors

SS 20 - Sarcoma and Cutaneous Tumors

155 - Multi-institutional Analysis of Stereotactic Body Radiation Therapy for Sarcoma Pulmonary Metastases: High Rates of Local Control With Favorable Toxicity

Tuesday, October 23
8:15 AM - 8:25 AM
Location: Room 007 A/B

Multi-institutional Analysis of Stereotactic Body Radiation Therapy for Sarcoma Pulmonary Metastases: High Rates of Local Control With Favorable Toxicity
B. C. Baumann1, K. D. Bernstein2, W. P. Levin3, T. F. DeLaney2, J. D. Kolker3, E. Choy4, K. Weber5, A. Muniappan6, A. T. Berman3, A. Staddon7, L. Hartner7, B. A. Van Tine8, S. M. Hahn9, E. J. Glatstein3, C. B. Simone II10, S. Nagda3, and Y. L. E. Chen2; 1Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 2Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, 3University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, 4Massachusetts General Hospital, Department of Medical Oncology, Boston, MA, 5University of Pennsylvania, Department of Orthopedic Oncology, Philadelphia, PA, 6Massachusetts General Hospital, Department of Thoracic Surgery, Boston, MA, 7University of Pennsylvania, Department of Medical Oncology, Philadelphia, PA, 8Washington University School of Medicine, Department of Medical Oncology, Saint Louis, MO, 9The University of Texas MD Anderson Cancer Center, Houston, TX, 10University of Maryland, Department of Radiation Oncology, Baltimore, MD

Purpose/Objective(s): Oligometastatic pulmonary metastases from sarcoma have traditionally been treated with resection and/or systemic therapy. We hypothesize that stereotactic body radiotherapy (SBRT) can be an alternative treatment to surgery that can achieve high rates of local control with limited toxicity.

Materials/Methods: All consecutive patients treated with SBRT for pulmonary sarcoma metastasis from 2011-2016 at two high-volume academic sarcoma centers were analyzed. Patients underwent CT or PET/CT scans q3 months after SBRT. Local failure (LF) was defined as >20% increase in longest tumor diameter. Toxicities were scored using CTCAE v4.0.

Results: 44 patients with 56 separate lung metastases were treated with SBRT. Median age was 59 (range 19 – 82) and median pre-SBRT ECOG status was 1 (range 0-2). The most common histologies were leiomyosarcoma (30%), pleomorphic sarcoma (18%), synovial sarcoma (9%), and fibrosarcoma (9%). Most patients (82%) had received prior chemotherapy, 66% had prior pulmonary resections (range 1-5 resections), and 32% had received prior thoracic radiotherapy. Median lesion size was 2.0 cm (range 0.5-8.1 cm). SBRT was most commonly delivered to 50 Gy in 4 or 5 fractions (80%). Median follow-up was 16 months for all patients and 21 months for patients alive at last follow-up. Overall survival at 12 and 24 months was 74% (95%CI 67-81%) and 46% (95%CI 39-55%). Local control at 12 and 24 months was 96% (95%CI 93-98%) and 90% (95%CI 84-96%), respectively There were 3 LFs. Two lesions (1.6 and 2.0 cm) failed at 5 months, and one lesion (3.9 cm) recurred 21 months after SBRT. Two of the 3 patients with LF received SBRT as salvage after failing metastatectomy at the same site. In the entire cohort, local control and OS did not differ based on age, gender, histology, fractionation regimen, lesion location, or size (all p>0.05). Three patients developed grade 2 chest wall toxicities; one patient had grade 2 pneumonitis. No other acute or late grade ≥2 toxicities were observed.

Conclusion: To our knowledge, this is the first multi-institutional series reporting on SBRT for pulmonary sarcoma metastases and demonstrates that SBRT is well-tolerated with excellent local control. SBRT should be considered in these patients as an alternative to surgical resection. Prospective trials of SBRT vs. surgery are warranted.

Author Disclosure: B.C. Baumann: None. K.D. Bernstein: None. W.P. Levin: None. J.D. Kolker: None. E. Choy: None. K. Weber: None. B.A. Van Tine: None. S.M. Hahn: Honoraria; AACR, Academic Institutions, UCSF Radiation Oncology External Advisory Board, UCSF Cancer Center External Advisory Board. Travel Expenses; AACR, Academic Institutions, UCSF Radiation Oncology External Advisory Board, UCSF Cancer Center External Advisory Board. Partnership; Liquid Biotech. Royalty; NIH/Mitos Inc. Patent/License Fees/Copyright; Liquid Biotech. VC Educational Council; ASTRO Board of Directors. C.B. Simone: Employee; Nemours/Alfred I. duPont Hospital for Children. Chair, Executive Council; Chair, Lung Committee; Proton Collaborative Group (PCG). Editor-in-Chief; Annals of Palliative Medicine. Chair, Lung Resource Panel; American Society for Radiation Oncology. Y.E. Chen: Employee; Beth Israel Deaconess Medical Center.

Brian Baumann, MD

Washington University in Saint Louis

Disclosure:
Employment
University of Pennsylvania Health System: resident physician: Employee

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