Stereotactic Body Radiotherapy Versus Metastasectomy in Patients With Pulmonary Metastases From Soft Tissue Sarcoma |
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| Institution: | 1. Rizzoli Orthopedic Institute, Bologna, Italy;2. Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands;1. The Ottawa Hospital Cancer Centre and University of Ottawa, Ottawa, Ontario, Canada;2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;4. University Health Network, Toronto, Ontario, Canada;5. Children''s Hospital of Eastern Ontario, Ottawa, Ontario, Canada;7. Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada;11. Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada;12. Department of Surgery, McMaster University, Hamilton, Ontario, Canada;8. Division of Urology, Department of Surgery, Western University, London, Ontario, Canada;9. Department of Surgery, Western University, London, Ontario, Canada;71. Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada;112. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada;123. Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada;84. Division of Urology, McGill University, Montreal, Quebec, Canada;95. Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada;77. Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada;1111. Laval University, Quebec City, Quebec, Canada;1212. Division of Medical Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, Ontario, Canada;1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada;2. Department of Urology, European Institute of Oncology IRCCS, Milan, Italy;3. Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Québec, Canada;4. Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy;5. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy;7. Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy;11. Department of Urology, IRCCS Fondazione Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy;12. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany;8. Department of Urology, Medical University of Vienna, Vienna, Austria;9. Dipartimento di Oncologia ed Emato-Oncologia, University of Milan, Milan, Italy;1. Faculty of Medicine, Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada;2. Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada;3. Department of Surgery, Vancouver General Hospital, University of British Columbia, British Columbia Cancer Agency – Vancouver Center, Vancouver, British Columbia, Canada;4. Department of Medical Oncology, University of British Columbia, British Columbia Cancer Agency – Vancouver Center, Vancouver, British Columbia, Canada;5. Department of Radiation Oncology, University of British Columbia, British Columbia Cancer Agency – Vancouver Center, Vancouver, British Columbia, Canada;1. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK;2. Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK;3. Department of Oncology, Guy''s and St. Thomas'' NHS Foundation Trust, London, UK;4. Department of General Surgery, Manchester University NHS Foundation Trust, Manchester, UK;5. Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK;1. Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy;2. Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy;3. Radiotherapy Unit, ASST Ospedale Niguarda, Milano, Italy;4. Radiation Oncology Center, Ospedale Manzoni, Lecco, Italy;5. Radiation Oncology Center, Ospedale Papa Giovanni XXIII, Bergamo, Italy;7. Radiation Oncology Center, Ospedale C. Poma, Mantova, Italy;11. Radiation Oncology Center, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy;12. Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan \"Bicocca\", Milano, Italy;8. Radiation Oncology Center, Istituto Clinico S. Anna, Brescia, Italy;9. Radiation Oncology Center, Centro Diagnostico Italiano (CDI), Milano, Italy;71. Radiation Oncology Center, Fondazione Poliambulanza, Brescia, Italy;112. Radiation Oncology Center, Ospedale, Busto Arsizio, Italy;123. Division of Radiation Oncology, Ospedale di Treviglio, Caravaggio di Treviglio, Italy;84. Radiation Oncology Center, S. Pio X-Humanitas, Milano, Italy;95. Radiation Oncology Center, IRCCS Ospedale Multimedica, Sesto San Giovanni/Castellanza, Italy;77. Division of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy;1111. Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy;1212. Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy;88. Radiation Oncology Center, Policlinico, Monza, Italy;99. Radiation Oncology Center, Istituti Ospedalieri Bergamaschi, Ponte S. Pietro-Zingonia, Italy;771. Radiation Oncology Center, Istituti Clinici di Pavia e Vigevano, Vigevano, Italy;11112. Radiation Oncology Center, National Center of Oncological Hadrontherapy, CNAO, Pavia, Italy;12123. Radiation Oncology Department, Esine and University of Brescia, Esine, Italy;884. Radiation Oncology Center, Istituto Clinico Sant''Ambrogio, Milano, Italy;995. Radiation Oncology Center, Ospedale Sant’Anna, ASST Lariana, Como, Italy;777. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy;111111. Radiation Oncology Center, Ospedale, Sondrio, Italy;121212. Radiation Oncology Center, Ospedale, Cremona, Italy;888. Ospedale di Casalpusterlengo, Azienda Ospedaliera della Provincia di Lodi, Casalpusterlengo, Italy;999. Unit of Radiotherapy, Cliniche Gavezzeni SPA, Bergamo, Italy |
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| Abstract: | The lung is the preferred site of metastasis from soft tissue sarcoma (STS). This systematic review aims to evaluate the outcomes of stereotactic body radiotherapy (SBRT) and metastasectomy (MTS) for the treatment of lung metastases from STS. A systematic review was carried out according to the PRISMA protocol. PubMed, Medline, EMBASE, Cochrane Library, Ovid and Web of Knowledge databases were searched for English-language articles to December 2018 using a predefined strategy. Retrieved studies were independently screened and rated for relevance. Data were extracted by two researchers. In total, there were 1306 patients with STS: 1104 underwent MTS and 202 had SBRT. The mean age ranged from 40 to 55.8 years in the MTS group and from 47.9 to 64 years in the SBRT group. The cumulative death rate was 72% (95% confidence interval 59–85%) in the MTS group and 56% (38–74%) in the SBRT group. The cumulative mean overall survival time was 46.7 months (36.4–57.0%) in the MTS group and 47.6 months (33.7–61.5%) in the SBRT group. The cumulative rate of patients alive with disease was 5% (2–9%) in the MTS group and 15% (6–36%) in the SBRT group. Finally, the cumulative rate of patients alive without disease in the two groups was 19% (9–29%) and 20% (10–50%), respectively. Our study showed that local treatment of pulmonary metastases from STS with SBRT, compared with surgery, was associated with a lower cumulative overall death rate and similar overall survival time and survival rates without disease. By contrast, SBRT was associated with a higher survival rate with disease than MTS. Large randomised trials are necessary to confirm these findings and to establish whether SBRT may be a reliable option for early stage disease. |
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| Keywords: | Lung metastasis metastasectomy sarcoma soft tissue sarcoma stereotactic body radiotherapy |
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