Cancer-specific dose and fractionation schedules in stereotactic body radiotherapy for oligometastatic disease: An interim analysis of the EORTC-ESTRO E2-RADIatE OligoCare study

Sebastian M Christ; Filippo Alongi; Umberto Ricardi; Marta Scorsetti; Lorenzo Livi; Panagiotis Balermpas; Yolande Lievens; Pètra Braam; Barbara Alicja Jereczek-Fossa; Karin Stellamans; Ivica Ratosa; Joachim Widder; Heike Peulen; Piet Dirix; Samuel Bral; Sara Ramella; Hossein Hemmatazad; Kaouthar Khanfir; Xavier Geets; Paul Jeene; Thomas Zilli; Beatrice Fournier; Giovanni Battista Ivaldi; Enrico Clementel; Catherine Fortpied; Felix Boakye Oppong; Piet Ost; Matthias Guckenberger

doi:10.1016/j.radonc.2024.110235

Cancer-specific dose and fractionation schedules in stereotactic body radiotherapy for oligometastatic disease: An interim analysis of the EORTC-ESTRO E²-RADIatE OligoCare study

Radiother Oncol. 2024 Mar 19:195:110235. doi: 10.1016/j.radonc.2024.110235. Online ahead of print.

Authors

Sebastian M Christ¹, Filippo Alongi², Umberto Ricardi³, Marta Scorsetti⁴, Lorenzo Livi⁵, Panagiotis Balermpas⁶, Yolande Lievens⁷, Pètra Braam⁸, Barbara Alicja Jereczek-Fossa⁹, Karin Stellamans¹⁰, Ivica Ratosa¹¹, Joachim Widder¹², Heike Peulen¹³, Piet Dirix¹⁴, Samuel Bral¹⁵, Sara Ramella¹⁶, Hossein Hemmatazad¹⁷, Kaouthar Khanfir¹⁸, Xavier Geets¹⁹, Paul Jeene²⁰, Thomas Zilli²¹, Beatrice Fournier²², Giovanni Battista Ivaldi²³, Enrico Clementel²², Catherine Fortpied²², Felix Boakye Oppong²², Piet Ost²⁴, Matthias Guckenberger⁶

Affiliations

¹ Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland. Electronic address: sebastian.christ@usz.ch.
² IRCCS Sacro Cuore Don Calabria Hospital, Advanced Radiation Oncology Department, Negrar-Verona, Italy & University of Brescia, Brescia, Italy.
³ University of Turin, Department of Oncology, Turin, Italy.
⁴ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano 20089, Milan, Italy.
⁵ Azienda Ospedaliero-Universitaria Careggi, Radiation Oncology, Florence, Italy.
⁶ Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
⁷ Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium.
⁸ Radboud University Medical Center Nijmegen, Radiation Oncology, Nijmegen, the Netherlands.
⁹ Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
¹⁰ Campus Kennedylaan, AZ Groeninge Kortrijk, Kortrijk, Belgium.
¹¹ Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia & Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
¹² Department of Radiation Oncology, Comprehensive Cancer Center, University Hospital Vienna, Medical University of Vienna, Austria.
¹³ Catharina Hospital, Radiation Oncology, Eindhoven, the Netherlands.
¹⁴ Iridium Network, Radiation Oncology, Wilrijk, Belgium.
¹⁵ Onze-Lieve-Vrouw Ziekenhuis, Radiation Oncology, Aalst, Belgium.
¹⁶ Policlinico Universitario Campus Bio-Medico-Oncology Center, Radiation Oncology, Roma, Italy.
¹⁷ Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland.
¹⁸ Hopital de Sion, Hopital du Valais, Radiation Oncology, Sion, and University of Lausanne, Lausanne, Switzerland.
¹⁹ Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, MIRO-IREC Lab UCLouvain, Brussels, Belgium.
²⁰ Radiotherapiegroep, Deventer, the Netherlands.
²¹ Hôpitaux Universitaires de Genève (HUG), Radiation Oncology, Geneva, Switzerland; Oncology Institute of Southern Switzerland, EOC, Radiation Oncology, Bellinzona, Switzerland.
²² European Organisation for Research and Treatment of Cancer (EORTC), Headquarters, Brussels, Belgium.
²³ Department of Radiation Oncology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy.
²⁴ Iridium Network, Radiation Oncology, Wilrijk, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium.

PMID: 38508239
DOI: 10.1016/j.radonc.2024.110235

Abstract

Background and introduction: Optimal dose and fractionation in stereotactic body radiotherapy (SBRT) for oligometastatic cancer patients remain unknown. In this interim analysis of OligoCare, we analyzed factors associated with SBRT dose and fractionation.

Materials and methods: Analysis was based on the first 1,099 registered patients. SBRT doses were converted to biological effective doses (BED) using α/β of 10 Gy for all primaries, and cancer-specific α/β of 10 Gy for non-small cell lung and colorectal cancer (NSCLC, CRC), 2.5 Gy for breast cancer (BC), or 1.5 Gy for prostate cancer (PC).

Results: Of the interim analysis population of 1,099 patients, 999 (99.5 %) fulfilled inclusion criteria and received metastasis-directed SBRT for NSCLC (n = 195; 19.5 %), BC (n = 163; 16.3 %), CRC (n = 184; 18.4 %), or PC (n = 457; 47.5 %). Two thirds of patients were treated for single metastasis. Median number of fractions was 5 (IQR, 3-5) and median dose per fraction was 9.7 (IQR, 7.7-12.4) Gy. The most frequently treated sites were non-vertebral bone (22.8 %), lung (21.0 %), and distant lymph node metastases (19.0 %). On multivariate analysis, the dose varied significantly for primary cancer type (BC: 237.3 Gy BED, PC 300.6 Gy BED, and CRC 84.3 Gy BED), and metastatic sites, with higher doses for lung and liver lesions.

Conclusion: This real-world analysis suggests that SBRT doses are adjusted to the primary cancers and oligometastasis location. Future analysis will address safety and efficacy of this site- and disease-adapted SBRT fractionation approach (NCT03818503).

Keywords: Fractionation; Oligometastasis; Radiation dose; SBRT.

Associated data

ClinicalTrials.gov/NCT03818503