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The Role of Stereotactic Ablative Radiotherapy in the Management of...
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The Role of Stereotactic Ablative Radiotherapy in the Management of Localized and Metastatic Genitourinary Tumours

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (29 June 2024) | Viewed by 6843

Special Issue Editors

Dr. Stefano Arcangeli

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Guest Editor
1. School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
2. Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
Interests: imaging; radiotherapy
Special Issues, Collections and Topics in MDPI journals
Dr. Giulia Marvaso

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Guest Editor
Department of Radiotherapy, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
Interests: urological malignancies; radiation oncology; new fractionation protocols; treatment accuracy; patient’s quality of life; prognostic and predictive factors; SBRT hypofractionation; oligometastatic disease
Special Issues, Collections and Topics in MDPI journals
Dr. Denis Panizza

E-Mail Website
Guest Editor
1. Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
2. School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
Interests: stereotactic ablative radiation therapy; LINAC-based radiosurgery; prostate tumors
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

The development of stereotactic body radiotherapy (SBRT), building on its intrinsic physical properties, restriction of tumour movement during treatment (tumour motion management) and meticulous verification of tumour position before and during treatment (image-guided radiation therapy (IGRT)), now allows for the delivery of ablative doses of radiation to both primary and metastatic tumours with high control rates and minimal toxicity.

Accumulating evidence shows that SBRT is an attractive approach to reduce the burden of care without losing clinical effectiveness, and is entitled to become the procedure of choice for the management of many patients with primary and/or oligometastatic GU malignancies, especially in light of the increasing number of elderly patients in need of treatment. Furthermore, the success of SBRT, relying on its ability to deliver high radiation doses to the target and yet sparing the surrounding normal tissues, seems to be confirmed in radioresistant histologies (i.e., renal tumours, sarcomas), thus defying the principles of the established radiobiological paradigm. An in-depth analysis of several aspects underlying the role of SBRT in this setting, as well as its potential interaction with the newest systemic therapies, will aid in the development of new therapeutic strategies in these  common and often undertreated diseases.

Dr. Stefano Arcangeli
Dr. Giulia Marvaso
Dr. Denis Panizza
Guest Editors

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Keywords

  • stereotactic body radiation therapy (SBRT)
  • image-guided radiation therapy (IGRT)
  • imaging
  • prostate cancer
  • kidney cancer
  • motion management
  • oligometastases
  • androgen deprivation therapy (ADT)
  • targeted therapy
  • immunotherapy
  • toxicity

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Published Papers (4 papers)

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9 pages, 980 KiB  
Article
Predictive Factors for Long-Term Disease Control in Systemic Treatment-Naïve Oligorecurrent Renal Cell Carcinoma Treated with Up-Front Stereotactic Ablative Radiotherapy (SABR)
by Ciro Franzese, Veronica Vernier, Marco Badalamenti, Raffaella Lucchini, Sara Stefanini, Anna Bertolini, Maryia Ilieva, Luciana Di Cristina, Beatrice Marini, Davide Franceschini, Tiziana Comito, Ruggero Spoto, Luca Dominici, Carmela Galdieri, Pietro Mancosu, Stefano Tomatis and Marta Scorsetti
Cancers 2024, 16(17), 2963; https://doi.org/10.3390/cancers16172963 - 25 Aug 2024
Viewed by 812
Abstract
Background: Stereotactic ablative radiotherapy (SABR) is emerging as a potential local treatment option for oligometastatic RCC. This study aims to evaluate the efficacy of SABR in patients with oligorecurrent RCC. Methods: A total of 50 patients with histologically confirmed RCC underwent SABR for [...] Read more.
Background: Stereotactic ablative radiotherapy (SABR) is emerging as a potential local treatment option for oligometastatic RCC. This study aims to evaluate the efficacy of SABR in patients with oligorecurrent RCC. Methods: A total of 50 patients with histologically confirmed RCC underwent SABR for oligorecurrence between 2006 and 2022. Eligible patients had up to five extracranial metastases and were systemic treatment-naïve at the time of irradiation. The primary endpoints of the analysis were overall survival (OS), local control (LC), distant metastasis–free survival (DMFS), and time to systemic therapy initiation. Results: The median OS was not reached, with 1- and 3-year OS rates of 93.8% and 77.5%, respectively. LC rates at one and three years were 95.8% and 86.5%, respectively. The median time to systemic therapy initiation was 63.8 months, and the median DMFS was 17.9 months, with one- and three-year rates of 63.4% and 36.6%, respectively. Multiple metastases were a negative predictive factor for DMFS (HR 2.39, p = 0.023), whereas lung metastases were associated with a more favorable outcome (HR 0.38, p = 0.011). Conclusions: SABR offers a valuable treatment option for oligometastatic RCC, demonstrating significant potential for achieving long-term disease control and delaying the need for systemic therapy. Full article
(This article belongs to the Special Issue The Role of Stereotactic Ablative Radiotherapy in the Management of Localized and Metastatic Genitourinary Tumours)
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11 pages, 4427 KiB  
Article
Treatment Optimization in Linac-Based SBRT for Localized Prostate Cancer: A Single-Arc versus Dual-Arc Plan Comparison
by Denis Panizza, Valeria Faccenda, Stefano Arcangeli and Elena De Ponti
Cancers 2024, 16(1), 13; https://doi.org/10.3390/cancers16010013 - 19 Dec 2023
Cited by 2 | Viewed by 3062
Abstract
This study aimed to comprehensively present data on treatment optimization in linac-based SBRT for localized prostate cancer at a single institution. Moreover, the dosimetric quality and treatment efficiency of single-arc (SA) versus dual-arc (DA) VMAT planning and delivery approaches were compared. Re-optimization was [...] Read more.
This study aimed to comprehensively present data on treatment optimization in linac-based SBRT for localized prostate cancer at a single institution. Moreover, the dosimetric quality and treatment efficiency of single-arc (SA) versus dual-arc (DA) VMAT planning and delivery approaches were compared. Re-optimization was performed on twenty low-to-intermediate-risk- (36.25 Gy in 5 fractions) and twenty high-risk (42.7 Gy in 7 fractions) prostate plans initially administered with the DA FFF-VMAT technique in 2021. An SA approach was adopted, incorporating new optimization parameters based on increased planning and clinical experience. Analysis included target coverage, organ-at-risk (OAR) sparing, treatment delivery time, and the pre-treatment verification’s gamma analysis-passing ratio. The SA optimization technique has consistently produced superior plans. Rectum and bladder mean doses were significantly reduced, and comparable target coverage and homogeneity were achieved in order to maintain a urethra protection strategy. The mean SA treatment delivery time was reduced by 22%; the mean monitor units increased due to higher plan complexity; and dose measurements demonstrated optimal agreement with calculations. The substantial reduction in treatment delivery time decreased the probability of prostate motion beyond the applied margins, suggesting potential decrease in treatment-related toxicity and improved target coverage in prostate SBRT. Further investigations are warranted to assess the long-term clinical outcomes. Full article
(This article belongs to the Special Issue The Role of Stereotactic Ablative Radiotherapy in the Management of Localized and Metastatic Genitourinary Tumours)
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10 pages, 647 KiB  
Article
Five Fractions versus Seven Fractions SBRT for Intermediate- and High-Risk Prostate Cancer: A Propensity Score Matched Pair Analysis
by Christina Schröder, Lucas Mose, Etienne Mathier, Daniel Rudolf Zwahlen, Daniel Matthias Aebersold, Robert Förster and Mohamed Shelan
Cancers 2023, 15(24), 5815; https://doi.org/10.3390/cancers15245815 - 12 Dec 2023
Viewed by 1415
Abstract
Purpose: To compare two stereotactic body radiotherapy (SBRT) regimens in patients with intermediate- or high-risk prostate cancer with regards toxicity and efficacy. Methods/Material: We retrospectively collected data from 198 patients treated with SBRT for prostate cancer at two different institutions. Patients received either [...] Read more.
Purpose: To compare two stereotactic body radiotherapy (SBRT) regimens in patients with intermediate- or high-risk prostate cancer with regards toxicity and efficacy. Methods/Material: We retrospectively collected data from 198 patients treated with SBRT for prostate cancer at two different institutions. Patients received either 35–36.25 Gy in five fractions (group A) using Cyberknife robotic platform or 42.7 Gy in seven fractions (group B) using a C-arm LINAC (image-guided). Propensity score matching was done (2:1 nearest neighbor matching without replacement), resulting in 120 patients (80 patients for group A, 40 patients for group B). Toxicity, PSA nadir, biochemical failure and disease-free survival (DFS) were analyzed. Results: Median follow up of all patients was 13 months (range 1–91 months). Overall, 23.3% of patients had ≥G2 acute GU toxicity (21.1% group A versus 30% group B (p = 0.222)) and 6.6% of patients ≥G2 GI toxicity (2.5% versus 15% (p = 0.010)). There was one acute G3 GU toxicity in arm A and one acute G4 rectal bleeding in group B (anticoagulated patient). Regarding late toxicity, 14.1% of patients had ≥G2 late GU toxicity (17.4% versus 6.6% (p = 0.159)) and 5.0% of patients had ≥G2 late GI toxicity (1.4% versus 13.3% (p = 0.013)). There was one G3 late GU toxicity in arm B and two G3 late GI toxicities, one in each arm. Relative median PSA reduction was 92.4% (−53.9–99.9%) from baseline PSA (93.7% (−53.9–99.9%) in group A versus 87.7% (39.8–99.9%) in group B (p = 0.043). In total, 4.2% of patients had biochemical relapse, 5.0% in group A and 2.5% in group B (p = 0.518). One-year DFS in the overall cohort was 97.3%, 98.8% in group A and 94.3% in group B (p = 0.318). Conclusion: Both SBRT regimens have acceptable acute and late toxicity and good efficacy. There are significantly more GI toxicities in the seven-fraction regimen. Longer follow-up is warranted for better comparison of long-term efficacy. Full article
(This article belongs to the Special Issue The Role of Stereotactic Ablative Radiotherapy in the Management of Localized and Metastatic Genitourinary Tumours)
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9 pages, 460 KiB  
Systematic Review
Oligometastatic Urothelial Cancer and Stereotactic Body Radiotherapy: A Systematic Review and an Updated Insight of Current Evidence and Future Directions
by Antonio Angrisani, Davide Giovanni Bosetti, Ursula Maria Vogl, Francesco Mosè Castronovo and Thomas Zilli
Cancers 2024, 16(18), 3201; https://doi.org/10.3390/cancers16183201 - 20 Sep 2024
Viewed by 864
Abstract
Background: Stereotactic body radiation therapy (SBRT) is the most commonly used metastasis-directed therapy (MDT) for oligometastatic urothelial carcinoma (omUC). Despite efforts in defining this disease entity, open questions remain concerning the role of MDT and the use of biomarkers, imaging, and its combination [...] Read more.
Background: Stereotactic body radiation therapy (SBRT) is the most commonly used metastasis-directed therapy (MDT) for oligometastatic urothelial carcinoma (omUC). Despite efforts in defining this disease entity, open questions remain concerning the role of MDT and the use of biomarkers, imaging, and its combination with systemic therapies. The aim of the present systematic review is to provide an updated overview of the current clinical evidence on SBRT for omUC in terms of survival and local control benefits. We also aim to provide updates on controversial areas and future directions in this emerging field. Methods: With a systematic approach, following PRISMA recommendations, we searched two databases to identify and select articles published up until March 2024 reporting the use of SBRT for omUC with or without concomitant systemic therapies. Prospective randomized or non-randomized studies as well as retrospective studies were included. Results: Eight studies were selected for data extraction and 293 omUC patients treated with SBRT were collectively analyzed. In metachronous omUC patients, SBRT delivered with ablative doses (BED10 ≥ 78 Gy) was associated with a 2-year overall survival (OS) rate of 50.7% (95% CI 35.1–64.4%). The use of sub-ablative SBRT doses (BED10 = 43.2 Gy) in combination with immunotherapy did not demonstrate significant clinical outcome improvement in two prospective studies. The overall tolerance was good, with only one study reporting toxicity of grade 3 in up to 18% of the patients treated with SBRT in combination with immunotherapy. Conclusions: SBRT is an effective and widely available MDT option in omUC, although this is based on a limited number of studies. Despite the attempt to use SBRT as an immune response trigger in combination with immunotherapy, no significant improvement in survival outcomes has been observed. The integration of new systemic agents with MDT will likely define a new scenario for the treatment of omUC. The review protocol was registered in PROSPERO, ID: CRD42024522381. Full article
(This article belongs to the Special Issue The Role of Stereotactic Ablative Radiotherapy in the Management of Localized and Metastatic Genitourinary Tumours)
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