Disease Control and Toxicity Outcomes after Stereotactic Ablative Radiation Therapy for Recurrent and/or Metastatic Cancers in Young-Adult and Pediatric Patients.

Simple Summary: Pediatric patients with recurrent and metastatic cancers often present with substantial tumor and symptom burden. Local control is an important factor to consider in this setting. Stereotactic ablative radiation therapy (SABR) offers a therapeutic advantage with higher, ablative doses potentially providing durable local control and a shorter fractionation schedule allowing minimum interruptions in systemic therapy and disruption in quality of life. In this study, we evaluate the outcomes of pediatric patients treated with SABR. We observed that SABR is well tolerated with local failure rates of <10% at 1 year and a median survival of 16.9 months. Patients with oligometastatic disease had a better survival rate than patients with widely metastatic disease, suggesting that the total consolidation of all metastatic sites in patients with a limited metastatic burden may be associated with better survival outcomes. Higher local control was associated with a higher radiation dose and sarcoma histology. Future studies evaluating SABR in combination with systemic therapy are warranted. Background: Pediatric patients with metastatic and/or recurrent solid tumors have poor survival outcomes despite standard-of-care systemic therapy. Stereotactic ablative radiation therapy (SABR) may improve tumor control. We report the outcomes with the use of SABR in our pediatric solid tumor population. Methods: This was a single-institutional study in patients < 30 years treated with SABR. The primary endpoint was local control (LC), while the secondary endpoints were progression-free survival (PFS), overall survival (OS), and toxicity. The survival analysis was performed using Kaplan–Meier estimates in R v4.2.3. Results: In total, 48 patients receiving 135 SABR courses were included. The median age was 15.6 years (interquartile range, IQR 14–23 y) and the median follow-up was 18.1 months (IQR: 7.7–29.1). The median SABR dose was 30 Gy (IQR 25–35 Gy). The most common primary histologies were Ewing sarcoma (25%), rhabdomyosarcoma (17%), osteosarcoma (13%), and central nervous system (CNS) gliomas (13%). Furthermore, 57% of patients had oligometastatic disease (≤5 lesions) at the time of SABR. The one-year LC, PFS, and OS rates were 94%, 22%, and 70%, respectively. No grade 4 or higher toxicities were observed, while the rates of any grade 1, 2, and 3 toxicities were 11.8%, 3.7%, and 4.4%, respectively. Patients with oligometastatic disease, lung, or brain metastases and those who underwent surgery for a metastatic site had a significantly longer PFS. LC at 1-year was significantly higher for patients with a sarcoma histology (95.7% vs. 86.5%, p = 0.01) and for those who received a biological equivalent dose (BED10) > 48 Gy (100% vs. 91.2%, p = 0.001). Conclusions: SABR is well tolerated in pediatric patients with 1-year local failure and OS rates of <10% and 70%, respectively. Future studies evaluating SABR in combination with systemic therapy are needed to address progression outside of the irradiated field. [ABSTRACT FROM AUTHOR]

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