Radiosurgery for Patients with Oligometastasis to Retroperitoneal Lymph Nodes

Special Article - Stereotactic Body Radiotherapy

Austin J Radiat Oncol & Cancer. 2015;1(2): 1008.

Radiosurgery for Patients with Oligometastasis to Retroperitoneal Lymph Nodes

Barrios CJ¹, LaCouture T², Patel A², Goldsmith B², Asbell S², Xu Q², Warshal D³ and Kubicek GJ²*

¹Cooper Medical School of Rowan University, Camden, New Jersey

²Department of Radiation Oncology, Cooper University Hospital, New Jersey

³Department of Gynecology-Oncology, Cooper University Hospital, New Jersey

*Corresponding author: Kubicek GJ, Department of Radiation Oncology, Cooper University Hospital, Camden, NJ, United States of America

Received: April 04, 2015; Accepted: April 29, 2015; Published: April 29, 2015


Purpose: We report both the control and the toxicity of Stereotactic Body Radiotherapy (SBRT) therapy in a series of oligometastatic cancer patients with Retroperitoneal lymph Node (RPLN) involvement.

Methods: This is a retrospective review of a prospective database. Eligible patients for review received SBRT to metastatic RPLN. 26 patients with RPLN failure (median age: 61, 3 males) were treated with SBRT. Treatment was to an isodose line (median: 65%). Median dose was 27.5 Gy (range: 15-54 Gy) and median fractions were 5 (range: 3-5).

Results: 26 patients were analyzed with a median follow-up of 13 months and 22 months for surviving patients. 16 patients (61.5%) had distant cancer recurrence after SBRT, while 5 patients (19.2%) had a local recurrence at the site of SBRT. Six patients (23%) had grade 2 toxicities, including nausea/vomiting, constipation, and abdominal pain. There were no grade 3 or higher toxicities and no late toxicities. Overall survival was improved in patients with distant control (median survival for patients with distant failure was 430 days versus 845 days for patients without distant relapse, P < 0.047). Higher Biological Equivalent Dose (BED) predicted for improved local control (P < 0.027), we did not find any local failures with a BED-10 greater than 50 Gy.

Conclusion: SBRT in the treatment of RPLN recurrences is safe and effective. We recommend treatment to a dose greater than BED-10 50 Gy, our preferred dose regimen is 35 Gy in 5 fractions. Improved distant control was associated with an improved OS in this series.

Keywords: Radiosurgery; Cyberknife; Oligometastatic


BED: Biological Effective Dose; GTV: Gross Tumor Volume; Gy: Gray; KPS: Karnofsky Performance Status; OS: Overall Survival; PTV: Planned Tumor Volume; RPLN: Retroperitoneal Lymph Node; SBRT: Stereotactic Body Radiotherapy


Aggressive treatment for patients with limited metastatic disease (oligometastatic) is an ongoing area of research. Multiple studies have found that a subset of patients with oligometastatic disease will remain disease free on long-term follow-up. In a majority of these studies, evidence has shown that local therapy may even be curable for a subset of patients with local metastasis [1,2]. For example, D’Angelica et al. [1] found that some patients who underwent surgical resection for liver metastasis from colorectal cancer could remain disease free 5 years after local treatment.

One of the common methods for treating oligometastatic sites is Stereotactic Body Radiotherapy (SBRT), which entails high dose radiation with sub-centimeter precision. SBRT has been shown to be effective in the treatment of oligometastatic disease in several body sites including lung [3,4], liver [5,6], adrenal gland [7] and Retroperitoneal Lymph Nodes (RPLN) [8,9]. While not the most common site for oligometastatic disease, RPLN can be a site of distant failure, especially for cancers in the pelvis.

The effectiveness and use of SBRT in patients with metastasis to RPLN has not widely been reported in the literature. Bignardi et al. [8] reported on 19 patients with unresectable RPLN treated with SBRT (45 Gy in 6 fractions) and found local control in 17 patients, 11 patients with progression at distant sites, and limited toxicity. Jereczek-Fossa et al. [9] reported on 69 patients with a single RPLN treated with SBRT (median 24Gy/3 fractions) and found 75.3% infield control. 49.3% of patients had no toxicity at all and 2 patients had grade 3 acute toxicity (genitourinary) and one patient with late grade 4 toxicity (hemorrhagic duodenitis and duodenal substenosis).

The purpose of this study is to explore both the effectiveness and toxicity of SBRT in patients with oligometastasis to RPLN.

Methods and Materials

This is a retrospective review of a prospective database (IRB EX-1094). All patients signed consent to allow data collection on this database. Patient treatments and background information were prospectively collected while other information (patterns of failure, late toxicity, survival) was retrospectively gathered. Patients eligible for this review had SBRT treatment to a RPLN at our institution between 1/1/2009 and 9/1/2013. The database consisted of a total of 867 patients. Of these, 29 patients met eligibility criteria (treatment to RPLN), 3 patients were excluded for missing data leaving 26 patients eligible for this analysis. Median age was 61 years, 10 patients had gynecologic primaries, 3 patients were male, and the majority of patients had previous treatment including 15 with previous chemotherapy, 13 with previous radiation and 20 with previous abdominal surgery. Characteristics of analyzed patients are in (Table 1).