Stereotactic Body Radiation Therapy for Metastatic and Recurrent Solid Tumors in Children and Young Adults

Christopher L. Tinkle, Charu Singh, Shane Lloyd, Yian Guo, Yimei Li, Alberto S. Pappo, Steven G. DuBois, John T. Lucas, Daphne A. Haas-Kogan, Stephanie A. Terezakis, Steve E. Braunstein, Matthew J. Krasin

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Purpose: The use of stereotactic body radiation therapy (SBRT) in pediatric patients has been underreported. We reviewed practice patterns, outcomes, and toxicity of SBRT in this population. Methods and Materials: In this multi-institutional study, 55 patients with 107 non-central nervous system lesions treated with SBRT between 2010 and 2016 were reviewed. Treatment response was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 and modified RECIST v1.1 criteria for soft-tissue and bone lesions, respectively. Patterns of local failure (LF) were assessed dosimetrically. The cumulative incidence of LF and toxicity were estimated accounting for the competing risk event of death. Predictors of LF were identified through joint frailty models for clustered competing risks. Results: The median (range) dose/fraction was 7 (4.5-25) Gy, the total (range) dose/site was 35 (12-45), and the median (range) number of fractions was 5 (1-9). The radiographic response rates of bone and soft-tissue lesions were 90.6% and 76.7%, respectively. Symptom improvement was observed for 62% of symptomatic sites. A total of 27 LFs were documented, with 14 in-field, 9 marginal, and 4 out-of-field LFs. The 1-year estimated cumulative LF rate, progression-free survival, and overall survival were 25.2% (95% confidence interval [CI], 17.2%-36.1%), 17.5% (95% CI, 9.0%-34.1%), and 61% (95% CI, 48.9%-76.1%), respectively. Lesion type (soft tissue vs bone) was the only significant predictor of LF on multivariable analysis (P = .04), with increased hazard for soft-tissue lesions. No acute or late toxicity of grade 4 or higher was observed; the estimated 1-year cumulative incidence of late toxicity of any grade was 7.5% (95% CI, 3.6%-12.1%). Conclusions: The SBRT was well tolerated and resulted in radiographic response and symptom palliation in most pediatric patients with advanced disease. The 1-year cumulative LF rate of 25% will serve as a benchmark for further modifications to radiation therapy indications, parameters, and combination therapy.

Original languageEnglish (US)
Pages (from-to)1396-1405
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume109
Issue number5
DOIs
StatePublished - Apr 1 2021
Externally publishedYes

Bibliographical note

Funding Information:
This research has been supported in part by the American Lebanese Syrian Associated Charities (ALSAC), by National Cancer Institute grant P30 CA021765 (St. Jude Cancer Center Support Grant), and by the William M. Wood Foundation (D.H.K). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding institutions.

Publisher Copyright:
© 2020 Elsevier Inc.

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