Stereotactic body radiation therapy for oligoprogression of metastatic disease from gastrointestinal cancers: A novel approach to extend chemotherapy efficacy

Wray,Justin; Hawamdeh,Rana  Fawzi; Hasija,Nalini; Dagan,Roi; Yeung,Anamaria  R.; Lightsey,Judith  L.; Okunieff,Paul; Daily,Karen  C.; George,Thomas  J.; Zlotecki,Robert  A.; Trevino,Jose; Dang,Long  H.

doi:10.3892/ol.2016.5540

March-2017 Volume 13 Issue 3

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March-2017 Volume 13 Issue 3

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Article Open Access

Stereotactic body radiation therapy for oligoprogression of metastatic disease from gastrointestinal cancers: A novel approach to extend chemotherapy efficacy

Authors:
- Justin Wray
- Rana Fawzi Hawamdeh
- Nalini Hasija
- Roi Dagan
- Anamaria R. Yeung
- Judith L. Lightsey
- Paul Okunieff
- Karen C. Daily
- Thomas J. George
- Robert A. Zlotecki
- Jose Trevino
- Long H. Dang
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Affiliations: Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA, Division of Hematology and Oncology, Department of Internal Medicine, University of Florida, Gainesville, FL 32610, USA, University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA, Department of General Surgery, University of Florida, Gainesville, FL 32610, USA

Copyright: © Wray et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Pages: 1087-1094
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Published online on: December 27, 2016

https://doi.org/10.3892/ol.2016.5540
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Abstract

Chemotherapy and targeted therapies are effective palliative options for numerous unresectable or metastatic cancers. However, treatment resistance inevitably develops leading to mortality. In a subset of patients, systemic therapy appears to control the majority of tumors leaving 5 or less to progress, a phenomenon described as oligoprogression. Reasoning that the majority of lesions remain responsive to ongoing systemic chemotherapy, we hypothesized that local treatment of the progressing lesions would confer a benefit. The present study describes the cases of 5 patients whose metastatic disease was largely controlled by chemotherapy. The oligoprogressive lesions (≤5) were treated with stereotactic body radiotherapy (SBRT), justifying continued use of an effective systemic regimen. A total of 5 patients with metastatic disease on chemotherapy, with ≤5 progressing lesions amenable to SBRT, were treated with ablative intent. Primary tumor site and histology were as follows: 2 with metastatic colon adenocarcinoma, 2 with metastatic rectal adenocarcinoma and 1 with metastatic pancreatic adenocarcinoma. Imaging was performed prior to SBRT and every 3 months after SBRT. In total, 4 out of the 5 patients achieved disease control for >7 months with SBRT, without changing chemotherapy regimen. The median time to chemotherapy change was 9 months, with a median follow‑up time of 9 months. The patient who failed to respond developed progressive disease outside of the SBRT field at 3 months. In conclusion, the addition of SBRT to chemotherapy is an option for the overall systemic control of oligoprogressive disease.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Stereotactic body radiation therapy for oligoprogression of metastatic disease from gastrointestinal cancers: A novel approach to extend chemotherapy efficacy

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