Influence of institutional experience and technological advances on outcome of stereotactic body radiotherapy for oligo-metastatic lung disease

Publication date: Available online 26 September 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Juliane Rieber, Nasrin Abbassi-Senger, Sonja Adebahr, Nicolaus Andratschke, Oliver Blanck, Marciana Duma, Michael J. Eble, Iris Ernst, Michael Flentje, Sabine Gerum, Peter Hass, Christoph Henkenberens, Guido Hildebrandt, Detlef Imhoff, Henning Kahl, Nathalie Desirée Klass, Robert Krempien, Fabian Lohaus, Frank Lohr, Cordula Petersen, Elsge Schrade, Jan Streblow, Lorenz Uhlmann, Andrea Wittig, Florian Sterzing, Matthias Guckenberger
PurposeMany technological and methodical advances have made stereotactic body radiotherapy (SBRT) more accurate and more efficient during the last years. This study aims to investigate whether experience in SBRT and technological innovations also translated into improved local control (LC) and overall survival (OS).Methods and MaterialsA database of 700 patients treated with SBRT for lung metastases in 20 XXX centers between 1997 and 2014 was used for analysis. It was the aim of this study to investigate the impact of FDG-PET staging (fluoro-deoxy-glucose positron emission tomography), biopsy confirmation, image guidance, immobilization and dose calculation algorithm as well as the influence of SBRT experience on LC and OS.ResultsMedian follow-up time was 14.3 months (range 0-131.9 months) with 2-year LC and OS of 81.2% (CI 75.8-85.7%) and 54.4% (CI 50.2-59.0%), respectively. In multivariate analysis, all treatment technologies except FDG-PET staging did not significantly influence outcome. Patients who received pre-SBRT FDG-PET staging showed superior 1- and 2-year OS of 82.7% (CI 77.4-88.6%) and 64.8% (CI 57.5-73.3%) compared to patients without FDG-PET staging resulting in 1- and 2-year OS rates of 72.8% (CI 67.4-78.8%) and 52.6% (CI 46.0-60.4%), respectively (p=0.012). SBRT experience was identified as the main prognostic factor for LC: institutions with higher SBRT experience (patients treated with SBRT within the last two years of the inclusion period) showed superior LC compared to less experienced centers (p≤0.001). SBRT experience within the last two years was independent from known prognostic factors for LC.ConclusionInvestigated technological and methodical advancements except FDG-PET staging prior to SBRT did not significantly improve outcome in SBRT for pulmonary metastases. In contrast, LC was superior with increasing SBRT experience of the individual center.

Teaser

Based on a multi-institutional database of 700 patients treated with SBRT for lung metastases, this study investigated whether institutional experience and the introduction of technological advances into stereotactic body radiotherapy (SBRT) improved outcome over time. Overall, technological innovations did not significantly affect outcome. Only, the use of pre-SBRT FDG-PET staging was identified as an independent prognostic factor for superior survival. However, local control following pulmonary SBRT was significantly influenced by the individual center's experience.


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