SABR Update Breast SSG June 2017
SABR in Bristol First patient treated in February 2014 In past 3 years: 330 referrals 250 patients treated Includes patients treated with oligometastatic disease through CtE Areas treated include: lung, liver, adrenal, lymph node and bone
Referral Centers PLYMOUTH EXETER TORBAY BARNSTABLE TAUNTON YEOVIL BATH UHB NBT GLOUCESTER CHELTENHAM WESTON
OVERALL SURVIVAL OVERALL SURVIVAL AT 1 YEAR WAS 87% (95% CI 80 – 94%) AND 2 YEARS 78.8% (95% CI 66.8 – 90.8%). THIS IS COMPARABLE WITH PUBLISHED DATA PFS AND LRR WILL BE GENERATED ONCE WE HAVE FURTHER DATA FROM LOCAL CENTRES AND CENTRAL RADIOLOGY REVIEW
Case History: CT before and 12 months after treatment
But in reality……
Things are not quite so simple……
Indications for SABR Medically-inoperable lung cancer Good evidence base; standard of care Oligo-metastatic disease Synchronous Metachronous Oligo-progressive disease Progression in a small number of sites while patient on maintenance treatment Stage IV disease Combining SABR with systemic treatment - immunotherapy
Oligometastatic Disease: Randomised trials SARON trial synchronous metastatic disease in NSCLC Sequential chemoRT followed SABR to up to 3 metastatic sites vs palliative chemo CORE trial metachronous disease in lung, breast and prostate SABR to up to 3 metastatic sites vs standard of care Must have minimum of 6 months disease free interval HALT trial oligoprogressive disease in patients with driver mutation SABR and continued TKI vs change in systemic treatment
CORE trial schema Randomise (1:1) SBRT + Standard of Care NSCLC, breast or prostate cancer patients Completed radical treatment ≤3 extra cranial metachronous oligometastases Suitable for SBRT Randomise (1:1) Standard of Care SBRT + Standard of Care Standard of Care defined prior to randomisation May include further chemotherapy, hormone therapy, palliative radiotherapy or observation at PI discretion
Aims/Objectives Primary Secondary To evaluate if the addition of SBRT to SoC improves PFS Secondary
Secondary Aims/Objectives To demonstrate feasibility of recruitment To demonstrate deliverability of SBRT within dosimetric constraints To evaluate if the addition of SBRT to SoC improves OS To evaluate the acute and late toxicity associated with the addition of SBRT to SoC To evaluate the lesion local control rates in those receiving SBRT To compare the quality of life (QoL) in patients receiving SBRT compared to those receiving SoC alone To investigate and evaluate resource use and costs of SBRT and SoC therapy within the trial setting.