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Review
. 2019 Aug 2:9:706.
doi: 10.3389/fonc.2019.00706. eCollection 2019.

The Yin and Yang of Cytoreductive SBRT in Oligometastases and Beyond

Benjamin E Onderdonk  1 , Steven J Chmura  1
Affiliations
Review

The Yin and Yang of Cytoreductive SBRT in Oligometastases and Beyond

Benjamin E Onderdonk et al. Front Oncol. .

Abstract

Background: Oligometastatic disease has emerged as a possibly distinct metastatic phenotype in numerous cancer histologies. With the advancement in treatment modalities including stereotactic body radiation therapy (SBRT), certain patients may derive benefits from local ablative therapy. SBRT alone has already shown to have potential benefits in certain oligometastatic disease types. However, more understanding of the immunologic modulation and microenvironment is needed to guide which patients may benefit from SBRT alone or with combination therapy, if at all. Purpose: The purpose of this review is to offer an update on the emerging data testing SBRT combined with immunotherapy, review the pro-inflammatory and immunosuppressive effects of the tumor microenvironment, discuss novel molecular targets used to augment the immune response, and review potential methods used to decrease toxicity in order to improve the therapeutic ratio.

Keywords: 4-1BB; CSF-1R; SBRT; TGF-beta; cytoreduction; immunotherapy; oligometastases; radiation.

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Figures

Figure 1
Figure 1
Depicts the balance between increasing anti-tumor immunity with toxicity within the tumor microenvironment.
Figure 2
Figure 2
Depicts partial tumor coverage of a large liver lesion. The 45 Gy in three fractions was prescribed to the central 65 cc of the tumor (SUCITV) with a 5 mm PTV expansion. ITV, internal target volume; SUCITV, seriously undercovered immuno-target volume; PTV, planning target volume.
See this image and copyright information in PMC

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