JRSBRT 9.3, p. 215-226

Stereotactic ablative radiation therapy for pulmonary metastases from sarcoma primaries: A systematic review and meta-analysis of safety and efficacy
Raj Singh, Robert Sierra, Casey Leimbach, Sidharth Iyer, Eric J. Lehrer, Haley Perlow, Rituraj Upadhyay, Sung Jun Ma, Austin Sim, Emile Gogineni, Sujith Baliga, Daniel M. Trifiletti, Joshua D. Palmer, David J. Konieczkowski, Jeremy Brownstein and Nicholas G. Zaorzky

Background: Though promising retrospective and prospective studies have reported on stereotactic ablative radiation therapy(SABR) for management of lung metastases from sarcoma primaries, they are limited by small patient numbers.

Methods: The primary outcomes of interest were 1-year and 2-year local control (LC) and Grade 3-5 toxicities. Secondary outcomes were 1-year overall survival (OS) and 2-year OS. Weighted random effects meta-analyses using the DerSimonian and Laird methods were performed to calculate effect sizes.

Results: Thirteen studies were identified with 533 patients and 940 lung metastases. The median prescription dose was 50 Gy (range: 48-60 Gy) in 5 fractions (range: 4-10). Following SABR, 1- and 2-year pooled LC rates were 97% (95% CI: 95-98%) and 91% (95% CI: 88-95%), respectively. Pooled 1- and 2-year OS rates were 85% (95% CI: 80-90%) and 68% (95% CI: 57-80%), respectively. The estimated incidence of Grade 3-5 toxicities following SABR was 0.1% (95% CI: 0-0.5%).

Conclusion: SABR for sarcoma pulmonary metastases resulted in excellent LC with minimal toxicities.

Keywords: stereotactic ablative radiation therapy, sarcoma metastases, lung metastases, local control, overall survival, toxicity

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