Stereotactic radiation therapy for oligometastases or oligorecurrence within mediastinal lymph nodes
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Huan-Huan Wang1, Nicholas G. Zaorsky2, Mao-Bin Meng1, Xian-Liang Zeng1, Lei Deng3, Yong-Chun Song1, Hong-Qing Zhuang1, Feng-Tong Li1, Lu-Jun Zhao1, Zhi-Yong Yuan1, Ping Wang1, Xi-Shan Hao4
1 Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
2 Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
3 Department of Thoracic Cancer and Huaxi Student Society of Oncology Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
4 Department of Gastrointestinal Surgery, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
Mao-Bin Meng, email:
Keywords: stereotactic radiation therapy, mediastinal lymph node, neoplasm metastasis, oligometastasis, oligorecurrence
Received: October 26, 2015 Accepted: February 11, 2016 Published: February 23, 2016
Aims: This study evaluated the safety and efficacy of stereotactic radiation therapy (SRT) for the treatment of patients with oligometastases or oligorecurrence within mediastinal lymph nodes (MLNs) originating from different tumors.
Methods: Between October 2006 and May 2015, patients with MLN oligometastases or oligorecurrence were enrolled and treated with SRT at our hospital. The primary endpoint was MLN local control (LC). Secondary endpoints were time to symptom alleviation, overall survival (OS) after SRT, and toxicity using the Common Terminology Criteria for Adverse Events (CTCAE v4.0).
Results: Eighty-five patients with 98 MLN oligometastases or oligorecurrences were treated with SRT. For the entire cohort, the 1-year and 5-year actuarial LC rates were 97% and 77%, respectively. Of 53 symptomatic patients, symptom alleviation was observed in 47 (89%) after a median of 5 days (range, 3-30 days). The median OS was 27.2 months for all patients. For patients with non-small cell lung cancer, univariate and multivariate analyses revealed that a shorter interval between diagnosis of primary tumors and SRT and larger MLN SRT volume were associated with worse OS. CTCAE v4.0 ≥ Grade 3 toxicities occurred in six patients (7%), with Grade 5 in three patients (all with RT history to MLN station 7).
Conclusions: SRT is a safe and efficacious treatment modality for patients with oligometastases or oligorecurrence to MLNs originating from different tumors, except for patients who received radiotherapy to MLN station 7. Further investigation is warranted to identify the patients who benefit most from this treatment modality.
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