Oligometastatic disease represent a subgroup of cancer patients characterized by a low burden of metastatic disease potentially amenable for local treatments, aimed at achieving long-term remission. At the same time, in a percentage of the patient the localization of oligometastases can be challenging. In particular, ultracentral localization are characterized by the overlapping of the target volumes with critical structures such as proximal bronchial tree, trachea, esophagus, pulmonary vein or pulmonary artery. For this subset of localizations, the optimal dose and fractionation, as well as the safety of a radiotherapy approach, is still unknown. We report a case of an oligometastatic lung cancer patient undergoing therapy with Nivolumab that was successfully treated with thoracic stereotactic ablative radiation therapy (SABR) for a subcarinal lymph node metastasis. The patient began the radiation treatment concurrent with immunotherapy and reported no acute toxicity. The computed tomography (CT) scan 60 days after radiotherapy showed partial response and no acute toxicity. The subsequent positron emission tomography (PET)/CT scan performed 6 months after radiotherapy showed, conversely, a complete response of the irradiated lesion. The patient is still undergoing immunotherapy and show no signs of recurrence of disease. The association between immunotherapy and SABR seems to be useful in terms of outcomes, although at the present time we need more data on the safety of this combined approach in the subset of ultra-central localizations.
Feasibility of ultra-central stereotactic ablative irradiation in lung cancer undergoing nivolumab: A case report
Nardone V.;Reginelli A.;Cappabianca S.;
2020
Abstract
Oligometastatic disease represent a subgroup of cancer patients characterized by a low burden of metastatic disease potentially amenable for local treatments, aimed at achieving long-term remission. At the same time, in a percentage of the patient the localization of oligometastases can be challenging. In particular, ultracentral localization are characterized by the overlapping of the target volumes with critical structures such as proximal bronchial tree, trachea, esophagus, pulmonary vein or pulmonary artery. For this subset of localizations, the optimal dose and fractionation, as well as the safety of a radiotherapy approach, is still unknown. We report a case of an oligometastatic lung cancer patient undergoing therapy with Nivolumab that was successfully treated with thoracic stereotactic ablative radiation therapy (SABR) for a subcarinal lymph node metastasis. The patient began the radiation treatment concurrent with immunotherapy and reported no acute toxicity. The computed tomography (CT) scan 60 days after radiotherapy showed partial response and no acute toxicity. The subsequent positron emission tomography (PET)/CT scan performed 6 months after radiotherapy showed, conversely, a complete response of the irradiated lesion. The patient is still undergoing immunotherapy and show no signs of recurrence of disease. The association between immunotherapy and SABR seems to be useful in terms of outcomes, although at the present time we need more data on the safety of this combined approach in the subset of ultra-central localizations.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
