Proton Beam Therapy in the Oligometastatic/Oligorecurrent Setting: Is There a Role? A Literature Review

Simona Gaito; Giulia Marvaso; Ramon Ortiz; Adrian Crellin; Marianne C Aznar; Daniel J Indelicato; Shermaine Pan; Gillian Whitfield; Filippo Alongi; Barbara Alicja Jereczek-Fossa; Neil Burnet; Michelle P Li; Bethany Rothwell; Ed Smith; Rovel J Colaco

doi:10.3390/cancers15092489

Proton Beam Therapy in the Oligometastatic/Oligorecurrent Setting: Is There a Role? A Literature Review

Cancers (Basel). 2023 Apr 26;15(9):2489. doi: 10.3390/cancers15092489.

Authors

Simona Gaito^{1

2}, Giulia Marvaso^{3

4}, Ramon Ortiz⁵, Adrian Crellin⁶, Marianne C Aznar², Daniel J Indelicato⁷, Shermaine Pan⁸, Gillian Whitfield^{2

8}, Filippo Alongi^{9

10}, Barbara Alicja Jereczek-Fossa^{3

4}, Neil Burnet⁸, Michelle P Li^{8

11

12}, Bethany Rothwell¹³, Ed Smith^{1

2

8}, Rovel J Colaco⁸

Affiliations

¹ Proton Clinical Outcomes Unit, The Christie NHS Proton Beam Therapy Centre, Manchester M20 4BX, UK.
² Division of Clinical Cancer Science, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK.
³ Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
⁴ Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20126 Milan, Italy.
⁵ Department of Radiation Oncology, University of California, San Francisco, CA 94720, USA.
⁶ National Lead Proton Beam Therapy NHSe, Manchester M20 4BX, UK.
⁷ Department of Radiation Oncology, University of Florida, Jacksonville, FL 32206, USA.
⁸ Department of Proton Beam Therapy, The Christie Proton Beam Therapy Centre, Manchester M20 3DA, UK.
⁹ Advanced Radiation Oncology Department, IRCCS Ospedale Sacro Cuore don Calabria, 37024 Verona, Italy.
¹⁰ Division of Radiology and Radiotherapy, University of Brescia, 25121 Brescia, Italy.
¹¹ Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.
¹² Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3010, Australia.
¹³ Division of Physics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.

Abstract

Background: Stereotactic ablative radiotherapy (SABR) and stereotactic radiosurgery (SRS) with conventional photon radiotherapy (XRT) are well-established treatment options for selected patients with oligometastatic/oligorecurrent disease. The use of PBT for SABR-SRS is attractive given the property of a lack of exit dose. The aim of this review is to evaluate the role and current utilisation of PBT in the oligometastatic/oligorecurrent setting.

Methods: Using Medline and Embase, a comprehensive literature review was conducted following the PICO (Patients, Intervention, Comparison, and Outcomes) criteria, which returned 83 records. After screening, 16 records were deemed to be relevant and included in the review.

Results: Six of the sixteen records analysed originated in Japan, six in the USA, and four in Europe. The focus was oligometastatic disease in 12, oligorecurrence in 3, and both in 1. Most of the studies analysed (12/16) were retrospective cohorts or case reports, two were phase II clinical trials, one was a literature review, and one study discussed the pros and cons of PBT in these settings. The studies presented in this review included a total of 925 patients. The metastatic sites analysed in these articles were the liver (4/16), lungs (3/16), thoracic lymph nodes (2/16), bone (2/16), brain (1/16), pelvis (1/16), and various sites in 2/16.

Conclusions: PBT could represent an option for the treatment of oligometastatic/oligorecurrent disease in patients with a low metastatic burden. Nevertheless, due to its limited availability, PBT has traditionally been funded for selected tumour indications that are defined as curable. The availability of new systemic therapies has widened this definition. This, together with the exponential growth of PBT capacity worldwide, will potentially redefine its commissioning to include selected patients with oligometastatic/oligorecurrent disease. To date, PBT has been used with encouraging results for the treatment of liver metastases. However, PBT could be an option in those cases in which the reduced radiation exposure to normal tissues leads to a clinically significant reduction in treatment-related toxicities.

Keywords: oligometastases; oligorecurrences; proton beam therapy.

Publication types

Review

Grants and funding

This research received no external funding.