Abstract Introduction Metastasis-directed radiotherapy is of increasing importance in the multidisciplinary management of oligometastatic non-small cell lung cancer (NSCLC), but outcome patterns for stereotactic body radiotherapy (SBRT) of bone oligometastases (BoM) remain insufficiently defined. We aimed to determine oncological outcomes and prognostic factors of SBRT for BoM of NSCLC. Materials and methods Patients with NSCLC treated with SBRT for < 5 BoM between 2010 and 2024 at 15 European cancer centers were retrospectively analyzed. Outcomes included freedom from local recurrence (FFLR), progression-free survival (PFS), overall survival (OS), and adverse events. Results With a median follow-up of 14 months (IQR: 7–24 months), 85 patients with 111 treated BoM were analyzed. The 2-year FFLR was 87.2% (95%-CI: 73.3%-94.1%). The 1-/2-year PFS for singular BoM was 60.1% (CI: 44.6%-72.5%)/ 39.9% (CI: 24.6%-54.8%), while for 2–3 BoM they amounted to 10.2% (95%-CI: 0.6%-35.8%) and 0%. In multivariable analysis, less favorable outcome for OS and PFS was associated with larger BoM (HR 1.003; p < 0.01 and HR 1.005, p < 0.001) and increased number of treated BoM (HR 1.72; p = 0.03 and HR 1.93; p < 0.01). Treatment was well tolerated, with fracture rates of 5.4% and no grade 4 and 5 adverse events. Conclusion This multicenter cohort analysis revealed that SBRT of BoM from NSCLC appears to be an effective and well-tolerated treatment. Presence of singular BoM was a favorable prognostic factor. Prospective studies are needed to confirm these findings and to determine the role of SBRT in the multidisciplinary management of oligometastases.

Background and purpose:The interdisciplinary treatment concept for bone metastases (BoM) of oligometastatic breast cancer includes metastasis-directed radiotherapy. We evaluated oncological outcomes of BoM treated with stereotactic body radiotherapy (SBRT) in a large European cohort. Material and methods:Data of breast cancer patients treated with SBRT for BoM between 2010 and 2024 at 17 European cancer centers were retrospectively collected. Treatment and dose concepts were analyzed regarding their impact on freedom from local recurrence (FFLR), overall survival (OS), progression-free survival (PFS), and safety profile. Results:With a median follow-up of 29.6 months (interquartile range: 15.0-48.0), 109 patients with 147 BoM were analyzed. SBRT was performed with a prescribed dose of median 35 Gy in median 5 fractions. 1-/3-year FFLR for mean biologically effective dose (BED10) ≥ 50 Gy in the gross tumor volume (GTVmean) was 98.1% (95%-CI: 92.7%-99.5%) and 93.9% (95%-CI: 85.5%-97.5%), respectively. For GTVmean BED10 ≥ 50 Gy, 1-/3-year PFS was 62.1% (95%-CI: 43.6%-76.0%)/26.7% (95%-CI: 11.0%-45.4%) for non-spine BoM and 66.2% (95%-CI: 50.8%-77.8%)/35.8% (95%-CI: 21.3%-50.4%) for spine BoM. In multivariable analysis, systemic therapy (HR [hazard ratio] 0.22; p < 0.001) was associated with improved OS, while higher GTVmean BED10 (HR 0.96; p < 0.001) was associated with improved PFS and spine localization with worse PFS (HR 1.81; p = 0.02). Adverse events were rare, with fracture rates of 2.7%. Conclusion:In this multicenter retrospective cohort analysis, SBRT of BoM from breast cancer was a well-tolerated, effective treatment. Prospective studies are needed to investigate these findings further and determine the role of standardized SBRT concepts in the multidisciplinary management of oligometastatic breast cancer.

To compare treatment patterns and oncologic outcomes of patients with pharyngeal and laryngeal squamous cell carcinoma treated at a tertiary hospital versus three secondary regional hospitals in Franconia, Germany. We retrospectively analyzed 308 consecutive patients (tertiary hospital n = 164; secondary regional hospitals n = 144) diagnosed between 01/2017 and 12/2019 and treated with primary or adjuvant radiotherapy (RT), with or without concomitant chemotherapy. Primary endpoints were overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRRFS). Kaplan-Meier estimates, multivariable Cox regression models, and a 1:1 matched-pair analysis were applied. Residual confounding was quantified using E‑values. The cohorts were well balanced, except for a higher prevalence of HPV-negative tumors (52

INTRODUCTION:Outcome patterns for stereotactic body radiotherapy (SBRT) of bone oligometastases (BoM) especially for older patients are inadequately defined. We aimed to evaluate oncological outcomes and tolerability of SBRT for BoM in older patients. MATERIAL AND METHODS:Patients ≥70 years treated with SBRT for BoM between 2010 and 2024 at 20 European centers were analyzed and compared to patients <70 years. Outcomes included local recurrence (LR)/ freedom from LR (FFLR), progression-free survival (PFS), overall survival (OS), and adverse events. RESULTS:789 patients with 1079 BoM were analyzed. Median age was 68 years (range: 19-91), and 355 patients (45.0%) were ≥70 years. Most common primary tumors were prostate (57.4%), breast (13.8%), and lung cancers (10.5%). LR at 3 years was 9.3% (CI: 6.0-12.8%) in patients <70 years and 11.7% (CI: 7.1-16.8%) in patients ≥70 years (p = 0.39). Grade-3 adverse events occurred in 1.8% of patients <70 years and 1.4% ≥70 years. No grade-4/5 adverse events were observed. Fracture rates were 2.9% for patients <70 years, and 1.8% ≥70 years. A higher metastatic volume was associated with reduced FFLR (Hazard ratio [HR] 1.006; p = 0.02), PFS (HR 1.003; p = 0.05), and OS (HR 1.003; p = 0.04). A better performance status was related to improved PFS (HR 0.98; p < 0.01) and OS (HR 0.96; p < 0.001), while age was not a significant factor. CONCLUSION:This multicenter cohort analysis showed that SBRT of BoM is effective and well tolerated even in older patients. There were no significant differences in outcomes or side effects including fracture rates across patient age groups.

BACKGROUND AND PURPOSE:The importance of metastasis-directed radiotherapy is increasing in the management of oligometastatic prostate cancer. We evaluated different target volume and dose concepts for stereotactic body radiotherapy (SBRT) of spine bone metastases (BoM) from prostate cancer in a large European cohort. MATERIAL AND METHODS:Data of prostate cancer patients receiving SBRT for spine BoM between 2010 and 2024 at 19 European cancer centers were retrospectively collected. Treatment volumes and dose concepts were analyzed regarding their impact on overall survival (OS), freedom from local recurrence (FFLR), biochemical recurrence-free survival (BRFS), and progression-free survival (PFS). RESULTS:With a median follow-up of 25.1 months (range: 1.4-77.2), 213 patients with 283 spine BoM were evaluated. 1-/3-year PFS with simultaneously integrated boost (SIB) were 85.7 %/73.9 % (BED4 [Biologically effective dose with α/β-ratio = 4 Gy] ≥ 100 Gy) and for non-SIB concepts 81.2 %/45.5 % (BED4 ≥ 100 Gy), respectively. 1-/3-year BRFS for SIB-treated BoM amounted to 81.7 %/68.4 % (BED4 ≥ 100 Gy) and for non-SIB 78.3 %/43.6 % (BED4 ≥ 100 Gy). OS was not significantly different for the evaluated dose and target volume concepts. For FFLR a significant difference was observed favoring BED4 ≥ 100 Gy. In multivariable analysis, following factors were positively associated with both PFS and BRFS: BED4 for GTVmean dose and SIB concept. Adverse events were very low, with fracture rates of 2.2 %. CONCLUSION:This multicenter cohort analysis showed that SBRT of spine BoM from prostate cancer is an effective and well-tolerated treatment. Both BED and usage of a SIB concept were associated with improved PFS and BRFS. Prospective studies are needed to confirm these findings and further standardize SBRT concepts.

PURPOSE:To compare local control, disease-free survival and overall survival after postoperative radiochemotherapy with or without total mesorectal excision (TME) in a retrospective analysis.PATIENTS AND METHODS:Between 1993 and 2002, 103 patients with UICC stage II and III rectal cancer were treated by surgery and postoperative chemoradiation. Group B (n = 50; 1993-1998) were operated before TME era without using TME and group A (n = 53; 1998-2002) with TME; both groups received identical radiochemotherapy to a total dose of 50.4 Gy (median) and two courses of continuous 5-fluorouracil infusion.RESULTS:Patients in group A (TME) showed a significant improvement in 5-year disease-free survival (71.1%; 46.8%) and freedom from distant metastases (76.3%; 46.9%) and a marked improvement of local control (85.2%; 62.5%). Acute and late toxicity were significantly less frequent in group A.CONCLUSION:Radiochemotherapy cannot compensate an insufficient surgical procedure. These data confirm that TME is the standard. High outcome quality can be achieved in daily practice compared to results of randomized studies without patient selection.

A patterns-of-care study of radiotherapy (RT) in prostate cancer was performed in Northern Bavaria, Germany, to characterize patient selection, treatment strategies and outcome for the time period 1998–2000.

PURPOSE:The aim of this study was to examine whether, after preceding induction chemotherapy, simultaneous chemoradiotherapy is superior to radiotherapy alone.PATIENTS AND METHODS:Patients with non-small-cell lung cancer in inoperable stage IIIA or IIIB received induction chemotherapy with two cycles of paclitaxel 200 mg/m2 and carboplatin area under the curve 6 every 3 weeks. Patients without progression at restaging after induction chemotherapy were randomly assigned to radiotherapy (60 Gy) or chemoradiotherapy (paclitaxel 60 mg/m2 weekly). The primary end point was overall survival; secondary end points were time to progression, response, and toxicity.RESULTS:Three hundred three patients entered the study, and 276 completed induction chemotherapy. Two hundred fourteen patients were randomly assigned (radiotherapy alone: n = 113; simultaneous chemoradiotherapy: n = 101). Median follow-up time of all randomly assigned patients was 13.6 months (interquartile range [IQR], 6.4 to 29.0 months), and median follow-up time of the subgroup of censored patients (n = 52) was 37.4 months (IQR, 5.9 to 57.0 months; maximum, 76.1 months). Toxicities during the induction phase were mild. During radiotherapy, overall toxicity rates were not significantly different between the two arms. Median survival times in the radiotherapy group and chemoradiotherapy group were 14.1 months (95% CI, 11.8 to 16.3 months) and 18.7 months (95% CI, 14.1 to 23.3 months; difference not statistically significant, P = .091). Median time to progression significantly favored simultaneous chemoradiotherapy (11.5 months; 95% CI, 8.3 to 14.7 months) versus radiotherapy alone (6.3 months; 95% CI, 5.0 to 7.6 months; P < .001, log-rank test).CONCLUSION:Induction chemotherapy followed by chemoradiotherapy with weekly paclitaxel is feasible. Response, time to progression, and survival favor chemoradiotherapy compared with radiotherapy alone.

Introduction: Docetaxel consolidation therapy (DCT) after concurrent cisplatin/docetaxel chemoradiation therapy (CRT) produces high tumor control in non-small-cell lung cancer (NSCLC); toxicity is, however, considerable. We aimed to determine the maximally tolerated dose (MTD) for DCT Patients and Methods: Patients with inoperable stage IIIB NSCLC received docetaxel 20 mg/m(2) and cisplatin 25 mg/m(2) on days 1, 8,15, 22, 29, and 36, with concurrent radiation therapy 5 days per week for a total dose of 66 Gy. Patients achieving stable disease, partial response, or complete response were given DCT on days 71, 92, and 113. DCT was started with 75 mg/m(2) and titrated depending on tolerability. The MTD of docetaxel was defined as the dose preceding that at which 3 or more patients experienced dose-limiting toxicity (DLT). Results: Of 23 patients enrolled (median age, 58.8 years +/- 7.3 years), 19 received complete CRT (4 withdrew because of toxicity). Of the patients receiving complete CRT, 1 patient died and 1 became operable, leaving 17 patients eligible for DCT starting at 75 mg/m(2). After the third patient with DLT, dose was reduced to 60 mg/m(2). Median survival was 27.6 months +/- 23.1 months. Median TTP was 12.4 months +/- 10.7 months. Conclusion: The MTD of DCT after concurrent cisplatin/docetaxel CRT was determined to be 60 mg/m(2), but toxicity was considerable. The benefit-risk ratio of DCT has, however, been questioned by a placebo-controlled phase III trial. Further phase III trials need to consider further stratification factors (pretreatment forced expiratory volume [FEV](1), hemoglobin, performance, and stage) to define a role for DCT in patients with NSCLC.

Recommendations for radiation ports in adjuvant radiation therapy for rectal cancer are mainly based on analysis of recurrence patterns. To evaluate whether changes in surgical technique have influenced this pattern of recurrence, a multicenter retrospective analysis was carried out on a patient population treated recently.

BACKGROUND AND PURPOSE:Recommendations for radiation ports in adjuvant radiation therapy for rectal cancer are mainly based on analysis of recurrence patterns. To evaluate whether changes in surgical technique have influenced this pattern of recurrence, a multicenter retrospective analysis was carried out on a patient population treated recently.PATIENTS AND METHODS:123 patients were evaluated with the help of a CT-based self-developed 3-D data file system and an extensive questionnaire. Major inclusion criteria (one sufficient) for eligibility were: histological confirmation, clear bone destruction, and a positive PET scan, or at least three minor criteria: progressive soft tissue mass, invasion of adjacent organs on follow-up CT or MRI, rising tumor markers, and typical appearance in cross-sectional imaging. Clinical or serologic signs of inflammation were exclusion criteria.RESULTS:Initially, 54% of the evaluated patients were N0; in the remainder, N1 and N2 were distributed evenly. Initial T-category was T1 in 2%, T2 in 24%, T3 in 60%, and T4 in 13%, the male-to-female ratio was 2:1. Recurrent tumors were mainly situated in the posterior part of the bony pelvis as displayed in the figures. When abdominoperineal resection was compared to low anterior resection as primary operation, there was a significant difference in extension of recurrent tumors in the inferior parts of the pelvis (p<0.025 in all statistical tests applied), whereas no significant difference was found in the superior parts of the pelvis.CONCLUSION:Based on these results, a modest field size reduction in adjuvant radiotherapy for rectal cancer seems feasible, offering the perspective of a reduction in acute and late side effects.