Vol 27, No 1 (2022)
Research paper
Published online: 2022-02-02

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Helical tomotherapy for asymptomatic chemotherapy-refractory or -unfit multiple (3 or more) metastases

Yuki Yamada12, Yuta Shibamoto13, Kazushi Kishi4, Nozomi Kita14, Takuhito Kondo15, Taro Murai1, Chikao Sugie6
Rep Pract Oncol Radiother 2022;27(1):125-133.

Abstract

Background: Despite chemotherapy innovations, prognosis of patients with chemotherapy-refractory or -unfit multiple metastases (CRMM/CUMM) remains poor. In this prospective study, the efficacy and toxicity of helical tomotherapy for CRMM/CUMM were evaluated.

Materials and methods: Between 2014 and 2020, asymptomatic patients with CRMM/CUMM with ≥ 3 lesions and no prior radiotherapy of the targets were enrolled. Patients who had intolerable toxicities to chemotherapy and those who refused chemotherapy were included in the CRMM and CUMM groups, respectively. Prostate cancer patients and patients with metastases mainly localized in the liver, lung, or brain were excluded. By helical tomotherapy, up to 10 lesions per patient were irradiated in order of volume. The standard dose was 50–60 Gy in 25–30 fractions.

Results: Forty-five patients (median age, 63 years; 35 CRMM/10 CUMM) were enrolled. Primary tumors included lung, gynecological, and gastrointestinal cancers. The most frequently treated targets were lymph node metastases, followed by peritoneal/pleural disseminations and bone tumors. The 1-year survival rate was 51% (median, 12.5 months). In the 35 patients with CRMM, the median survival time was 12.5 months, and the median pre-radiation chemotherapy period was 8.8 months (p > 0.05). The 6-month target control rate was 78%. Acute adverse events (grade ≥ 2) occurred in 33 patients: hematologic toxicities in 23, dermatitis in 6, and others in 8. Late grade ≥ 2 toxicities occurred in 6 patients: pneumonitis in 4 and gastric hemorrhage in 2.

Conclusion: Tomotherapy for CRMM/CUMM resulted in median survival times > 1 year. This treatment should be investigated further in larger prospective studies

 

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References

  1. Reshko LB, Gaskins JT, Silverman CL, et al. Stereotactic body radiation therapy (SBRT) of adrenal gland metastases in oligometastatic and oligoprogressive disease. Rep Pract Oncol Radiother. 2021; 26(3): 325–340.
  2. Hong JC, Salama JK. The expanding role of stereotactic body radiation therapy in oligometastatic solid tumors: What do we know and where are we going? Cancer Treat Rev. 2017; 52: 22–32.
  3. Palma D, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet. 2019; 393(10185): 2051–2058.
  4. Al-Shafa F, Arifin AJ, Rodrigues GB, et al. A Review of Ongoing Trials of Stereotactic Ablative Radiotherapy for Oligometastatic Cancers: Where Will the Evidence Lead? Front Oncol. 2019; 9: 543.
  5. Shibamoto Y, Okamoto M, Kobayashi M, et al. Immune-maximizing (IMAX) therapy for cancer: Combination of dendritic cell vaccine and intensity-modulated radiation. Mol Clin Oncol. 2013; 1(4): 649–654.
  6. Merad M, Sathe P, Helft J, et al. The dendritic cell lineage: ontogeny and function of dendritic cells and their subsets in the steady state and the inflamed setting. Annu Rev Immunol. 2013; 31: 563–604.
  7. Takaoka T, Shibamoto Y, Murai T, et al. Helical tomotherapy for chemo-refractory multiple liver metastases. Cancer Med. 2019; 8(18): 7594–7602.
  8. Piotrowski T, Skórska M, Jodda A, et al. Tomotherapy - a different way of dose delivery in radiotherapy. Contemp Oncol (Pozn). 2012; 16(1): 16–25.
  9. Gwilliam B, Keeley V, Todd, C. Development of prognosis in palliative care study (PiPS) predictor models to improve prognostication in advanced cancer: prospective cohort study. BMJ. 2011; 343(d4920.).
  10. Pelzer U, Schwaner I, Stieler J, et al. Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: a phase III-study from the German CONKO-study group. Eur J Cancer. 2011; 47(11): 1676–1681.
  11. Freedman LS. Tables of the number of patients required in clinical trials using the logrank test. Stat Med. 1982; 1(2): 121–129.
  12. Manabe Y, Shibamoto Y, Sugie C, et al. Helical and Static-port Tomotherapy Using the Newly-developed Dynamic Jaws Technology for Lung Cancer. Technol Cancer Res Treat. 2015; 14(5): 583–591.
  13. Shibamoto Y, Murai T, Suzuki K, et al. Definitive Radiotherapy With SBRT or IMRT Boost for Breast Cancer: Excellent Local Control and Cosmetic Outcome. Technol Cancer Res Treat. 2018; 17: 1533033818799355.
  14. Shibamoto Y, Naruse A, Fukuma H, et al. Influence of contrast materials on dose calculation in radiotherapy planning using computed tomography for tumors at various anatomical regions: a prospective study. Radiother Oncol. 2007; 84(1): 52–55.
  15. Sugie C, Manabe Y, Hayashi A, et al. Efficacy of the Dynamic Jaw Mode in Helical Tomotherapy With Static Ports for Breast Cancer. Technol Cancer Res Treat. 2015; 14(4): 459–465.
  16. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991; 21(1): 109–122.
  17. Kobayashi M, Sakabe T, Abe H, et al. DC-vaccine study group at the Japan Society of Innovative Cell Therapy (J-SICT). Dendritic cell-based immunotherapy targeting synthesized peptides for advanced biliary tract cancer. J Gastrointest Surg. 2013; 17(9): 1609–1617.
  18. Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy for the comprehensive treatment of 4-10 oligometastatic tumors (SABR-COMET-10): study protocol for a randomized phase III trial. BMC Cancer. 2019; 19(1): 816.
  19. Chanez B, Bertucci F, Gilabert M, et al. A scoring system to guide the decision for a new systemic treatment after at least two lines of palliative chemotherapy for metastatic cancers: a prospective study. Support Care Cancer. 2017; 25(9): 2715–2722.
  20. Jang RW, Caraiscos VB, Swami N, et al. Simple prognostic model for patients with advanced cancer based on performance status. J Oncol Pract. 2014; 10(5): e335–e341.
  21. Ozols RF, Masuda H, Hamilton TV. Mechanisms of cross-resistance between radiation and antineoplastic drugs. NCI Monogr. 1988; 6: 159–165.
  22. Lehnert S, Greene D, Batist G. Radiation Response of Drug-Resistant Variants of a Human Breast Cancer Cell Line. Radiat Res. 1989; 118(3): 568.
  23. Oshita F, Fujiwara Y, Saijo N. Radiation sensitivities in various anticancer-drug-resistant human lung cancer cell lines and mechanism of radiation cross-resistance in a cisplatin-resistant cell line. J Cancer Res Clin Oncol. 1992; 119(1): 28–34.
  24. Murai T, Shibamoto Y, Manabe Y, et al. Intensity-modulated radiation therapy using static ports of tomotherapy (TomoDirect): comparison with the TomoHelical mode. Radiat Oncol. 2013; 8: 68.
  25. Nagai A, Shibamoto Y, Yoshida M, et al. Intensity-modulated radiotherapy using two static ports of tomotherapy for breast cancer after conservative surgery: dosimetric comparison with other treatment methods and 3-year clinical results. J Radiat Res. 2017; 58(4): 529–536.
  26. Manabe Y, Shibamoto Y, Murai T, et al. Intensity-modulated radiation therapy for multiple targets with tomotherapy using multiple sets of static ports from different angles. J Appl Clin Med Phys. 2020; 21(6): 132–138.