Cancer Research

Nagata Y et al. Stereotactic Radiotherapy of Primary Lung Cancer and Other Targets: Results of Consultant Meeting of the International Atomic Energy Agency. IJROBP 79(3) 660-9, 2011.

• Cancer burden increasing worldwide, to 20M new cases/year by 2020. 50% are in developing countries.
• The benefit of SBRT in these countries is clear given the fact that an entire course of therapy can be given in 4-5 fractions.
• Primary lung cancers are now being treated in as few as 3 fractions with over 90% control rate, similar to surgical data; the critical component to therapy is a BED of at least 100.
• Toxicity from this treatment is minimal
• We are seeing comparable results in lung oligometastases as well as primary and metastatic liver tumors.
• Data is mixed/limited in retroperitoneal tumors such as pancreas and kidney.
• Economically, SBRT is cheaper than surgical intervention and is becoming a standard treatment option worldwide.

Christie D et al. LIMITED CHEMOTHEARPY AND SHRINKING FIELD RADIOTHERAPY FOR OSTEOLYMPHOMA (PRIMARY BONE LYMPHOMA): RESULTS FROM THE TRANS-TASMAN RADIATION ONCOLOGY GROUP 99.04 AND AUSTRALASIAN LEUKAEMIA AND LYMPHOMA GROUP LY02 PROSPECTIVE TRIAL. IJROBP (in press as of Nov 2010).

• Goal was to est benchmark for CMT used in future studies for primary bone lymphoma. Large multi-group study looking at 3 cycles of CHOP followed by XRT to a dose of 45 Gy in 25 fx using a shrinking field technique
• Study closed after 33 patients (slow accrual given the more widespread use of rituxan). Median f/u 4.3 years. 5 year OS 90%, LC 72%. Only 3 patients had fractures that persisted after treatment, one with recurrence.
• Study concluded that the radiation dose needs to remain higher than other lymphomas given the persistently high LR rate.
• Disability after treatment—related specifically to pathological fracture—was not seen using this regimen.
• Dubey P et al. LOCALIZED PRIMARY MALIGNANT LYMPHOMA OF BONE. IJROBP 37(5) 1087-1093, 1997.
• Single institution (MD Anderson)
• Retrospective analysis of 45 patients stage IE and IIE. All patients received at least 40 Gy. Systemic therapy doxorubin based.
• 41 patients with DLBCL. 36 of the 45 patients tx with CMT. NO difference in outcomes XRT alone versus CMT.
• 5 and 10-year OS were 68% and 60%, respectively. Slight trend in favor of CMT over XRT alone. No difference in stage I vs. II or doses less than or greater than 50 Gy.

Fidia P et al. LONG-TERM RESULTS OF COMBINED MODALITY THERAPY IN PRIMARY BONE LYMPHOMAS. IJROBP 45 (5) 1213-1218, 1999.

• Single-institutional study (Mass General) looking at combined tx for primary bone lymphoma
• Total of 37 patients reviewed; 2 with surgery and 35 XRT to median docs of 54 Gy; all patients got multiple chemotx regimen
• DFS a 5 and 10-years was 73 and 78% respectively with OS of 91 and 87%
• No local failures seen
• Negative prognostic factors included path fx at presentation, pelvic primary, and age greater than 60.
• Combined approach was statistically superior to local treatment only based on comparison to controls
• 27% of patient required orthopedic stabilization after completion of therapy; most of the complications were seen in weight-bearing bones.
• Conclusion: CMT was superior to XRT or surgery alone for PBL.

Barbieri E et al. PRIMARY NON-HODGKIN’S LYMPHOMA OF THE BONE: TREATMENT AND ANALYSIS OF PROGNOSTIC FACTORS FOR STAGE I AND STAGE II. IJROBP 59(3) 760-764.

• Retrospective experience at Bologna University; 77 patients over 30 years
• 44 had stage I, 33 stage II, all treated with XRT to median dose 40 Gy and 67/77 received anthrocycline-based chemotx.
• 94.8% CR rate with 18.2% relapse at 23 months; 4 of 14 failures XRT alone.
• 15-year DFS and OS were 76.6% and 88.3% respectively
• Age over 40 was a negative prognostic factor; gender, bulk, and stage were not.
• Acute and late toxicity was “moderate”
• Conclusion: CMT is superior to XRT alone. XRT alone is reserved for lesions in the mandible, which are typically diagnosed at a very small/early stage.