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
  • View Affiliations

  • Published online on: December 27, 2016     https://doi.org/10.3892/ol.2016.5540
  • Pages: 1087-1094
  • Copyright: © Wray et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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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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March-2017
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Spandidos Publications style
Wray J, Hawamdeh RF, Hasija N, Dagan R, Yeung AR, Lightsey JL, Okunieff P, Daily KC, George TJ, Zlotecki RA, Zlotecki RA, et al: Stereotactic body radiation therapy for oligoprogression of metastatic disease from gastrointestinal cancers: A novel approach to extend chemotherapy efficacy. Oncol Lett 13: 1087-1094, 2017.
APA
Wray, J., Hawamdeh, R.F., Hasija, N., Dagan, R., Yeung, A.R., Lightsey, J.L. ... Dang, L.H. (2017). Stereotactic body radiation therapy for oligoprogression of metastatic disease from gastrointestinal cancers: A novel approach to extend chemotherapy efficacy. Oncology Letters, 13, 1087-1094. https://doi.org/10.3892/ol.2016.5540
MLA
Wray, J., Hawamdeh, R. F., Hasija, N., Dagan, R., Yeung, A. R., Lightsey, J. L., Okunieff, P., Daily, K. C., George, T. J., Zlotecki, R. A., Trevino, J., Dang, L. H."Stereotactic body radiation therapy for oligoprogression of metastatic disease from gastrointestinal cancers: A novel approach to extend chemotherapy efficacy". Oncology Letters 13.3 (2017): 1087-1094.
Chicago
Wray, J., Hawamdeh, R. F., Hasija, N., Dagan, R., Yeung, A. R., Lightsey, J. L., Okunieff, P., Daily, K. C., George, T. J., Zlotecki, R. A., Trevino, J., Dang, L. H."Stereotactic body radiation therapy for oligoprogression of metastatic disease from gastrointestinal cancers: A novel approach to extend chemotherapy efficacy". Oncology Letters 13, no. 3 (2017): 1087-1094. https://doi.org/10.3892/ol.2016.5540