All patients received stereotactic radiation to all metastatic sites. Radiation dosing and fractionation were dependent on the size and location of each metastasis. All patients had good performance status (ECOG 0-1) and a life expectancy of more than 6 months. Median follow-up time for this report was 41 months (range=14.6-59.0).
Following treatment with stereotactic radiation, more than eight in ten patients (84 percent) survived at least one year, and four in ten (43 percent) survived 5 years or longer. The median overall survival (OS) time was 42.3 months.
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Local recurrences were uncommon; half of the patients experienced complete (26%) or partial (26%) remission following treatment. An additional third (32 percent) had stable disease, meaning their cancer did not progress or recede. The remaining patients either had local progression following treatment (14 percent) or their response could not be determined (12 percent). Distant recurrences were more common, with a median time of 8.7 months until distant progression. The one-year and five-year rates of distant progression free survival (DPFS) were 44 percent and 17 percent, respectively.
The type of primary tumor was associated with both OS (p=0.002) and DPFS (p=0.008). Patients with primary breast (9 percent of patients), prostate (7.5 percent) and colorectal (21 percent) tumors had longer survival than those with primary lung (22 percent) or head and neck (11 percent) tumors.
Severe side effects were limited. Just under 10 percent of patients experienced short-term toxicity of grade-2 or higher, including one grade-3 case each of labored breathing, skin inflammation and anemia. Even fewer patients had severe long-term toxicity, with one grade-3 ureter obstruction and one grade-4 obstruction of the small bowel.
A unique aspect of the trial design was the decision to use patient-reported rather than physician-assessed quality of life (QoL). Patients reported no significant changes in their quality of life immediately after completing stereotactic radiation, nor at 6 weeks, 3 months and 9 months follow-up. At the 6- and 12-month marks, QoL was significantly better than before treatment.
“Many of the cancer treatments we deliver, even though they have a therapeutic benefit, also are associated with some toxicity, and that may impact patients’ quality of life. In this study, for patients with stage-IV disease, we have a treatment paradigm that can result in long-term survival while maintaining overall quality of life. We had a sense this was the case from retrospective data, but the addition of prospective data is very convincing,” said Dr. Heron.
