Stereotactic body radiotherapy for oligometastases.
TL;DR: In this paper, the authors review published work showing that SBRT offers durable local control and the potential for progression-free survival in non-liver, nonlung oligometastatic disease at a range of sites.
Abstract: The management of metastatic solid tumours has historically focused on systemic treatment given with palliative intent. However, radical surgical treatment of oligometastases is now common practice in some settings. The development of stereotactic body radiotherapy (SBRT), building on improvements in delivery achieved by intensity-modulated and image-guided radiotherapy, now allows delivery of ablative doses of radiation to extracranial sites. Many non-randomised studies have shown that SBRT for oligometastases is safe and effective, with local control rates of about 80%. Importantly, these studies also suggest that the natural history of the disease is changing, with 2-5 year progression-free survival of about 20%. Although complete cure might be possible in a few patients with oligometastases, the aim of SBRT in this setting is to achieve local control and delay progression, and thereby also postpone the need for further treatment. We review published work showing that SBRT offers durable local control and the potential for progression-free survival in non-liver, non-lung oligometastatic disease at a range of sites. However, to test whether SBRT really does improve progression-free survival, randomised trials will be essential.
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Teikyo University1, Hiroshima University2, Niigata University3, University of Tsukuba4, Saitama Medical University5, Tokyo Medical and Dental University6, University of Tokyo7, Japanese Foundation for Cancer Research8, Kyorin University9, Kyoto University10, National Defense Medical College11, Dokkyo Medical University12, Tohoku University13, Tokyo Metropolitan Komagome Hospital14, Osaka Medical College15, Kurume University16, International University of Health and Welfare17, Toho University18
TL;DR: The English version of the JSCCR Guidelines 2016 is presented, which can be used as a tool for treating colorectal cancer in actual clinical practice settings and as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient.
Abstract: Colorectal cancer is a major cause of death in Japan, where it accounts for the largest number of deaths from malignant neoplasms in women and the third largest number in men. Many new treatment methods have been developed over the last few decades. The Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer (JSCCR Guidelines 2010) have been prepared to show standard treatment strategies for colorectal cancer, to eliminate disparities among institutions in terms of treatment, to eliminate unnecessary treatment and insufficient treatment, and to deepen mutual understanding between health-care professionals and patients by making these Guidelines available to the general public. These Guidelines have been prepared by consensuses reached by the JSCCR Guideline Committee, based on a careful review of the evidence retrieved by literature searches and in view of the medical health insurance system and actual clinical practice settings in Japan. Therefore, these Guidelines can be used as a tool for treating colorectal cancer in actual clinical practice settings. More specifically, they can be used as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient. As a result of the discussions held by the Guideline Committee, controversial issues were selected as Clinical Questions, and recommendations were made. Each recommendation is accompanied by a classification of the evidence and a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here we present the English version of the JSCCR Guidelines 2010.
1,709 citations
University of Tokyo1, Hiroshima University2, Niigata University3, University of Tsukuba4, Japanese Foundation for Cancer Research5, Saitama Medical University6, Tokyo Medical and Dental University7, Kyorin University8, Kyoto University9, National Defense Medical College10, Dokkyo Medical University11, Tohoku Pharmaceutical University12, Kurume University13, International University of Health and Welfare14, Toho University15
TL;DR: The English version of the JSCCR Guidelines 2014 can be used as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient, and can, therefore, be used for treating colorectal cancer in clinical practice.
Abstract: Colorectal cancer is a major cause of death in Japan, where it accounts for the largest number of deaths from malignant neoplasms among women and the third largest number among men. Many new methods of treatment have been developed during recent decades. The Japanese Society for Cancer of the Colon and Rectum Guidelines 2014 for treatment of colorectal cancer (JSCCR Guidelines 2014) have been prepared as standard treatment strategies for colorectal cancer, to eliminate treatment disparities among institutions, to eliminate unnecessary treatment and insufficient treatment, and to deepen mutual understanding among health-care professionals and patients by making these guidelines available to the general public. These guidelines have been prepared as a result of consensuses reached by the JSCCR Guideline Committee on the basis of careful review of evidence retrieved by literature searches and taking into consideration the medical health insurance system and actual clinical practice in Japan. They can, therefore, be used as a guide for treating colorectal cancer in clinical practice. More specifically, they can be used as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient. As a result of the discussions of the Guideline Committee, controversial issues were selected as clinical questions, and recommendations were made. Each recommendation is accompanied by a classification of the evidence and a classification of recommendation categories, on the basis of consensus reached by Guideline Committee members. Here we present the English version of the JSCCR Guidelines 2014.
675 citations
Cites background from "Stereotactic body radiotherapy for ..."
...• Even if the patient cannot tolerate surgery, stereotactic body radiotherapy is considered if the primary tumor and extrapulmonary metastases are controlled or can be controlled and the number of lung metastases within 5 cm in diameter is no more than three [48]....
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London Health Sciences Centre1, VU University Medical Center2, University of Paris3, Samsung Medical Center4, University of Turin5, The Catholic University of America6, University of Texas MD Anderson Cancer Center7, St. Vincent's Health System8, University of Rochester9, European Institute of Oncology10
TL;DR: Significant OS differences were observed in oligometastatic patients stratified according to type of metastatic presentation, and N status, and this risk classification scheme is proposed to be used in guiding selection of patients for clinical trials of ablative treatment.
356 citations
Cites background from "Stereotactic body radiotherapy for ..."
...There are, however, reports that the interval from diagnosis of the primary lung tumor to the diagnosis of metastases (disease-free interval) is prognostic for survival, where longer disease free intervals in the range of 6-12 months are associated with prolonged survival.(41)...
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Ghent University1, University of Zurich2, University of Texas MD Anderson Cancer Center3, Aarhus University Hospital4, University of Texas Southwestern Medical Center5, Erasmus University Rotterdam6, University of Antwerp7, London Health Sciences Centre8, University of California, San Francisco9, University of Turin10, Yale University11
TL;DR: Consensus was reached that OMD is largely independent of primary tumour, metastatic location and the presence or length of a disease-free interval, supporting both synchronous and metachronous OMD.
291 citations
TL;DR: MDT is a promising approach for oligometastatic PCa recurrence, but the low level of evidence generated by small case series does not allow extrapolation to a standard of care, and requires validation in randomised controlled trials.
288 citations
Cites background from "Stereotactic body radiotherapy for ..."
...In the case of SBRT, a dose of 6 Gy per fraction for a total dose of >36 Gy or 5 Gy per fraction for a total dose of >45 Gy was required [12]....
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References
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TL;DR: There is a need for clearly defined and widely applicable clinical criteria for the selection of patients who may benefit from hepatic resection for metastatic colorectal cancer and studies of preoperative staging techniques or of adjuvant therapies should consider using such a score for stratification of patients.
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TL;DR: It is shown that with flow-sorted nuclei, whole genome amplification and next generation sequencing the authors can accurately quantify genomic copy number within an individual nucleus and indicate that tumours grow by punctuated clonal expansions with few persistent intermediates.
Abstract: Genomic analysis provides insights into the role of copy number variation in disease, but most methods are not designed to resolve mixed populations of cells. In tumours, where genetic heterogeneity is common, very important information may be lost that would be useful for reconstructing evolutionary history. Here we show that with flow-sorted nuclei, whole genome amplification and next generation sequencing we can accurately quantify genomic copy number within an individual nucleus. We apply single-nucleus sequencing to investigate tumour population structure and evolution in two human breast cancer cases. Analysis of 100 single cells from a polygenomic tumour revealed three distinct clonal subpopulations that probably represent sequential clonal expansions. Additional analysis of 100 single cells from a monogenomic primary tumour and its liver metastasis indicated that a single clonal expansion formed the primary tumour and seeded the metastasis. In both primary tumours, we also identified an unexpectedly abundant subpopulation of genetically diverse 'pseudodiploid' cells that do not travel to the metastatic site. In contrast to gradual models of tumour progression, our data indicate that tumours grow by punctuated clonal expansions with few persistent intermediates.
2,426 citations
TL;DR: It is found that one, or indeed more than one, cancer-causing lesion can emerge out of the genomic crisis, which has important implications for the origins of genomic remodeling and temporal emergence of cancer.
2,099 citations
University of Virginia1, University of Chicago2, University of Texas MD Anderson Cancer Center3, Thomas Jefferson University4, Wake Forest University5, University of Colorado Denver6, Stanford University7, Memorial Sloan Kettering Cancer Center8, Orlando Regional Medical Center9, University of Texas Southwestern Medical Center10, University of Toronto11, University of Rochester12, University of Utah13, Johns Hopkins University14, University of Wisconsin-Madison15, Vrije Universiteit Brussel16, Fox Chase Cancer Center17, Duke University18
TL;DR: The task group report includes a review of the literature to identify reported clinical findings and expected outcomes for this treatment modality.
Abstract: Task Group 101 of the AAPM has prepared this report for medical physicists, clinicians, and therapists in order to outline the best practice guidelines for the external-beam radiation therapy technique referred to as stereotactic body radiation therapy (SBRT). The task group report includes a review of the literature to identify reported clinical findings and expected outcomes for this treatment modality. Information is provided for establishing a SBRT program, including protocols, equipment, resources, and QA procedures. Additionally, suggestions for developing consistent documentation for prescribing, reporting, and recording SBRT treatment delivery is provided.
1,586 citations