Efficacy and safety of stereotactic body radiation therapy (SBRT) for pediatric malignancies

Committee/Faculty

Presenting Author(s)

RS

Raj Singh, M.D.

Resident Physician
Virginia Commonwealth University Health System
Richmond, Virginia, United States

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

AV

Anisha Valluri, B.S.

Medical Student
Marshall University Joan C. Edwards School of Medicine
Huntington, West Virginia, United States

Disclosure: Disclosure information not submitted.
PD

Prabhanjan Didwania, B.S.

Graduate Student
University of California San Diego Rady School of Management
La Jolla, California, United States

Disclosure: Disclosure information not submitted.
EL

Eric J. Lehrer, M.D.

Resident Physician
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Disclosure: Disclosure information not submitted.
SL

Stanislav Lazarev, M.D.

Assistant Professor of Radiation Oncology
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Disclosure: Disclosure information not submitted.
CT

Christopher Tinkle, M.D., Ph.D.

Assistant Member
St. Jude Children's Research Hospital
Memphis, Tennessee, United States

Disclosure: Disclosure information not submitted.
JP

Joshua D. Palmer, M.D.

Associate Professor of Radiation Oncology
The James Cancer Hospital at the Ohio State University Wexner Medical Center
Columbus, Ohio, United States

Disclosure: Disclosure information not submitted.

Purpose: Limited data is currently available on clinical outcomes following stereotactic body radiation therapy (SBRT) for pediatric and AYA patients with cancer. As such, we aimed to perform a systematic review and meta-analysis to characterize associated local control (LC), progression-free survival (PFS), overall survival (OS), and toxicity following SBRT.

Methodology: Relevant studies were queried for inclusion utilizing a PICOS/PRISMA/MOOSE selection criterion. The primary outcomes were 1-year and 2-year LC as well as incidence of acute and/or late Grade 3-5 toxicities, with secondary outcomes of 1-year OS and 1-year PFS. Outcome effect sizes were estimated with weighted random effects meta-analyses. Mixed effects weighted regression models were performed to examine potential correlations between biologically effective dose (BED10), LC, and toxicity incidence.

Results: Across 9 published studies, we identified 142 pediatric and AYA patients with 217 lesions that were treated with SBRT. The estimated 1-year OS and PFS rates were 75.4% (95% CI: 54.5-96.3%) and 27.1% (95% CI: 17.3-37.0%), respectively. Estimated 1-year and 2-year LC rates were 83.5% (95% CI: 70.9-96.2%) and 74.0% (95% CI: 64.6-83.4%), respectively, with an estimated acute and/or late Grade 3-5 toxicity rate of 2.9% (95% CI: 0.4-5.4%). Initial analysis including all studies did not reveal a significant correlation between either 1-year or 2-year LC and BED10 (p=0.27). On meta-regression of studies with sarcoma-predominant cohorts, higher BED10 was correlated with improved 2-year LC with every 10 Gy increase in BED10 associated with a 5% improvement in 2-year LC (p=0.02). No correlation was noted between BED10 and acute and/or late Grade 3-5 toxicity incidence following meta-regression (p = 0.32).

Conclusions: SBRT provides durable LC for pediatric and AYA patients with cancer with minimal severe toxicity. Dose escalation resulted in improved LC for sarcoma-predominant cohorts without a subsequent increase in toxicity. Further prospective trials are warranted to determine the optimal role of SBRT for pediatric and AYA patients, particularly those with recurrent or metastatic disease.

References: