SBRT for lung metastases: Case report - Your Future. Our ... · PDF file12th European...

12th European International Kidney

Cancer Symposium 21-22 April 2017

SBRT for lung metastases: Case report

Guillermo de Velasco MD, PhD

University Hospital 12 de Octubre

@H12O_GUCancer@g_develasco

Case report

• 71 years old man

• Smoker

• DM

• 2005 • Right radical nephrectomy

• Histology: clear cell, Fuhrman grade 3

Case report

• March 2014• Chest pain

• CT scan • Pulmonary nodules

Renal cell carcinoma and lung metastases

• Lungs are the most common sites of metastases in RCC patients

• ~ 15% Only lung metastases

Management only-lung metastases from RCC

• Active Surveillance

• Local treatment• Surgery

• RFA/SBRT

• Systemic therapy

Rini et al. Lancet Oncol 2016

The length of active surveillance was associated with

1) Site of metastases (1 vs 2 vs more than two; p=0·0239),

2) Location of the metastases (lung only vs other organs only vs

both; p=0·0280),

• RFA/SBRT

Choueiri & Motzer, NEJM 2017

Overall

Alt et al. Cancer 2011

• RFA/SBRT

Only lung metastases

Alt et al. Cancer 2011

• RFA/SBRT

Zhao et al. International Journal of Surgery, 2017

• RFA/SBRT

• Systemic therapyThe resection of oligometastases is

supported by Level C evidence

• RFA/SBRT

• Renal-cell carcinoma is considered to be aradioresistant tumor

• However…high fraction dose, stereotactic body radiotherapy seems to be relevant

Management lung metastases from RCC

• RFA/SBRT

Renal cell carcinoma and lung metastases

• Lungs are the most common sites of metastases

in RCC patients

• 15% Only lung metastases

• 45% lung metastases +

Management lung metastases from RCC

Only lung metastases

• RFA/SBRT

Lung metastases and other mets

• RFA/SBRT

• Systemic therapy++

Case Report

• March 2014. Pazopanib

Case Report

March 2014 January 2015

Case Report

Case report

• May 2015

Stop treatment due to toxicity

Case report

• June 2015

Case report

• Re-start treatment

• Second line therapy

• Local treatment

Case report

• Re-start treatment

• Second line therapy

• Local treatment

Concept

• Oligometastatic disease

• SBRT is generally safe and feasible

• Many single-center retrospective case series of highly selected patients

Studies of oligometastasis from renal-cell carcinoma with high-dose and high-dose-per-fraction radiotherapy

Gert De Meerleer et al. Lancet Oncology 2014

Concept

• Oligometastatic disease

• Oligoprogression disease?

Case report

• June 2015

• Oct 2015

TKI was restarted

Patient continues on his 1st line

• Feb 2017

Evidence

• Clinical trials

Stereotactic Body Radiation Therapy in Treating Patients With Metastatic or Recurrent Kidney Cancer

• PRIMARY OBJECTIVES:

• To establish that patients can be treated with 5-fraction stereotactic body radiation therapy (SBRT) to all sites of metastatic disease with a low (< 16%) rate of severe (grade 4) toxicity.

NCT02542202

Evidence

•Clinical trials

•Guidelines

•No general guidelines can be given

Guidelines Recommendations

Metastasectomy and other local treatment strategies including

✓Whole brain radiotherapy (WBRT)

✓Conventional radiotherapy

✓ Stereotactic radiosurgery (SRS)

✓ Stereotactic body radiotherapy (SBRT)

✓Cyberknife radiotherapy

✓ Hypofractionated radiotherapy

can be considered and carried out for selected patients after multidisciplinary review.

Conclusions

• Patient has been on 1L nearly 3 years

• SBRT is a feasible and may help to control oligometastatic progression withing the lungs

• Prostective randomized trials are needed (or not)

AcknowledgementsHopsital 12 de Octubre

JM. Sepúlveda

D. Castellano

MD Anderson Cancer Center Madrid

P. López Criado

Dana-Farber Cancer Insitute

Toni K. Choueiri

Thank you

SBRT for lung metastases: Case report - Your Future. Our ... · PDF file12th European...

Documents

Accuracy of Breath-Hold CT for lung SBRT treatment planning · 2014-10-11 · Introduction Methods Results Discussion Accuracy of Breath-Hold CT for lung SBRT treatment planning Dominique

Non-‐small Cell Lung Cancer: SBRT, Protons & Improvements in

Implementation of Acuros XB in Treatment Planning of SBRT ... · Implementation of Acuros XB in Treatment Planning of . SBRT of Lung Cancer. OPEN ACCESS *Correspondence: Roumiana

Liver & Lung Metastases - Living Beyond Breast Cancer · LOCAL THERAPY FOR LUNG METS: SURGERY •Resection of lung mets may be diagnostic •Ideal in patients with multiple good risk

SBRT LUNG CANCER CLINICAL PATHWAY

03 suh lung sbrt hyderabad feb 2013 (cancer ci 2013) john h. suh

Lung SBRT in a patient with poor pulmonary function7189552a-46a0-4ac5-a576... · 2020. 2. 20. · 3 Figure 2. Lung SBRT treatment Plan Treatment planning The planning CT scan and

Lung SBRT 4D simulation, Planning, and QA - AMOS Onlineamos3.aapm.org/abstracts/pdf/90-25321-333462-103346.pdf · Lung SBRT 4D simulation, Planning, and QA Krishni Wijesooriya, PhD

On the pitfalls of PTV in lung SBRT using type-B dose

Bone Metastases in Lung Cancer

Lung Optimized Treatment - atfisica.comatfisica.com/site/upload/ficheros/501094_a_lungoptimizedtreatment(… · Offering Non-Invasive Treatment Options for Every Lung SBRT Patient,

Lung Neoplasm Lungs frequently are the site of metastases from cancers arising in extrathoracic…

Immunohistochemical characteristics of brain metastases and corresponding primary … · 1628 Characteristics of brain metastases and primary lung cancer JBUON 2019; 24(4): 1628 tocol

Prognosis of lung metastases in patients with metastatic colorectal ... · Prognosis of lung metastases in patients with metastatic colorectal cancer (mCRC): an ARCAD metabase analysis

sbrt for inoperable lung cancer

Resection For Lung Metastases M62 Coloproctology Course

SBRT of Lung & Liver lesions using Novalis® IGRT System

Cancer Imaging | Home page - Lung metastases...Cancer Imaging (2003) 3, 126–128 DOI: 10.1102/1470-7330.2003.0010 CI REVIEW Lung metastases G Schueller and C J Herold Department of

SBRT In Lung and Oligometastatic Cancer...•SBRT and immunotherapy combination appears very promising. SBRT for early stage Lung cancer - Curative. J Clin Oncol 2019. NRG/RTOG 0813

DosimetriccomparisonofSBRTforDosimetric …chapter.aapm.org/swaapm/Past/Fall2009/2009_Fall_Papers/Z...DosimetriccomparisonofSBRTforDosimetric comparison of SBRT for lung cancer: Cyberknife