Addition of radiotherapy to the primary tumour in oligometastatic NSCLC: A systematic review and meta-analysis

Petrelli, Fausto; Ghidini, Antonio; Cabiddu, Mary; Tomasello, Gianluca; Stefani, Agostina De; Bruschieri, Lorenza; Vitali, Ettore; Ghilardi, Mara; Borgonovo, Karen; Barni, Sandro; Trevisan, Francesca

doi:10.1016/j.lungcan.2018.11.017

Cited by 49 publications

(45 citation statements)

References 37 publications

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“…Recently, two interesting studies have been published to evaluate the role of irradiating the primary tumor in oligometastatic NSCLC. In the first one, Petrelli et al[94] conducted a systematic review and meta-analysis of all published prospective trials and retrospective studies (up to July 2018) that compared radiotherapy versus no radiotherapy to the primary lung tumor in patients with synchronous oligometastatic NSCLC. A total of 924 patients from 21 studies were included.…”

Section: Managment Of the Primary Tumor In Oligometastasic Nsclcmentioning

confidence: 99%

Management of oligometastatic non-small cell lung cancer patients: Current controversies and future directions

Couñago

Luna

Guerrero

et al. 2019

WJCO

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Oligometastatic non-small cell lung cancer (NSCLC) describes an intermediate stage of NSCLC between localized and widely-disseminated disease. This stage of NSCLC is characterized by a limited number of metastases and a more indolent tumor biology. Currently, the management of oligometastatic NSCLC involves radical treatment (radiotherapy or surgery) that targets the metastatic lesions and the primary tumor to achieve disease control. This approach offers the potential to achieve prolonged survival in patients who, in the past, would have only received palliative measures. The optimal therapeutic strategies for the different scenarios of oligometastatic disease (intracranial vs extracranial disease, synchronous vs metachronous) remain undefined. Given the lack of head-to-head studies comparing radiotherapy to surgery in these patients, the decision to apply surgery or radiotherapy (with or without systemic treatment) must be based on prognostic factors that allow us to classify patients. This classification will allow us to select the most appropriate therapeutic strategy on an individualized basis. In the future, the molecular or microRNA profiles will likely improve the treatment selection process. The objective of the present article is to review the most relevant scientific evidence on the management of patients with oligometastatic NSCLC, focusing on the role of radiotherapy and surgery. We also discuss areas of controversy and future directions.

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Section: Managment Of the Primary Tumor In Oligometastasic Nsclcmentioning

confidence: 99%

Management of oligometastatic non-small cell lung cancer patients: Current controversies and future directions

Couñago

Luna

Guerrero

et al. 2019

WJCO

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“…Although the results suggest that applying consolidative local therapy to all metastatic sites would result in the best outcome, local ablative therapy for primary tumor seemed to offer survival benefits, also. Together with a recent meta-analysis [7], most studies focused on the oligometastatic population. Even less, more than half of the patients in the post-resection group (56.6%) were not oligometastatic disease but they also experienced a long survival time.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, many studies have investigated whether local thoracic therapy can improve the outcome of advanced lung cancer [7-9]. The analysis of the Surveillance, Epidemiology, and End Results (SEER)-registered database suggested that multimodality therapy, particularly the addition of thoracic surgery to chemotherapy, is associated with a significantly better prognosis [10].…”

Section: Introductionmentioning

confidence: 99%

Primary Tumor Resection Is Associated with a Better Outcome among Advanced EGFR-Mutant Lung Adenocarcinoma Patients Receiving EGFR-TKI Treatment

et al. 2020

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Objectives: The characteristics and efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) in advanced EGFR-mutant lung adenocarcinoma patients with primary tumor resection (PTR) is not yet clear. Methods: We enrolled advanced EGFR-mutant lung adenocarcinoma patients with EGFR-TKI as first-line therapy to access the impact of PTR on the outcomes. Results: A total of 466 patients were enrolled with 76 patients (16.3%) undergoing PTR; 59 patients recurred after curative surgery, while 17 patients underwent surgery as diagnostic purposes. PTR patients displayed a better performance status, a lower metastatic burden, and much less measurable diseases (30.3 vs. 97.4%, p < 0.001). PTR patients experienced a significantly longer progression-free survival (25.1 [95% CI 16.6–33.7] vs. 9.4 [95% CI 8.4–10.4] months; aHR 0.40 [95% CI 0.30–0.54], p < 0.001) and overall survival (56.8 [95% CI 36.3–77.2] vs. 31.8 [95% CI 28.2–35.4] months; aHR 0.57 [95% CI 0.39–0.84], p = 0.004). Survival advantage was still observed while comparing PTR patients with the better performance and lower metastatic burden subgroup found within the non-resection group. Moreover, the progression-free survival and overall survival of 11 patients who were found having pleural metastases during surgery and underwent PTR plus pleural biopsy, were also longer than those with pure N0--1/M1a-malignant pleural effusion disease in the non-resection group (n = 19) (p < 0.001 and p = 0.002, respectively). Conclusion: PTR was associated with significantly better outcomes in advanced lung adenocarcinoma patients treated with EGFR-TKI. Further studies are needed to evaluate the biological role of PTR among these patients.

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“…Given the development of conformal technologies based on computed tomography planning, such as stereotactic body radiotherapy (SBRT), non-invasive and ablative irradiation methods for metastatic lesions have become feasible. (6) Extensive literature has recently emerged regarding the application of local consolidative treatment (LCT) for oligometastases (7,8); however, the vast majority publications describe single-arm observational studies. This is partly because it can be difficult to design randomized controlled trials (RCTs) involving patients with metastases given the ethical considerations and patients' widely varying clinical characteristics.…”

Section: Introductionmentioning

confidence: 99%

Benefits of local consolidative treatment in oligometastases of solid cancers: a stepwise-hierarchical pooled analysis and systematic review

Rim

Shin

Park

et al. 2020

Preprint

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Purpose: Any available evidence regarding the application of local consolidative therapy (LCT) for oligometastases is from phase 2 and observational studies. This study aimed to evaluate the oncologic benefits of LCT in oligometastatic setting. Methods: The MEDLINE, EMBASE, and Cochrane library were searched. We applied stepwise analyses that enabled the evaluation of data from randomized controlled trials (RCTs), balanced studies (e.g. without significant differences regarding major prognosticators between arms), and all studies separately and in a hierarchical manner Results: Thirty one studies including seven randomized trials were reviewed. Pooled analyses of the effect of LCT on overall survival (OS) revealed odds ratios (ORs) of 3.04 (95% confidence interval [CI]: 2.28~4.06, p<0.001), 2.56 (95% CI: 1.79~3.66, p<0.001), and 1.41 (95% CI: 1.02~1.95, p=0.041) for all studies, balanced studies, and RCTs, respectively. The corresponding ORs for progression free survival were 2.82 (95% CI: 1.96~4.06, p<0.001), 2.32 (95% CI: 1.60~3.38, p<0.001), and 1.39 (95% CI: 1.09~1.80, p=0.009), respectively. The benefit of LCT was higher in non small cell lung cancer (OR: 3.14, p<0.001; pooled 2 year OS: 65.2% vs. 37.0%) and colorectal cancer (OR: 4.11, p=0.066; pooled two year OS: 66.2% vs. 33.2%) than in prostate (OR: 1.87, p=0.006; pooled three year OS: 95.6% vs. 92.6%) and small cell lung cancer (OR: 1.04, p=0.942; pooled one year OS: 60.7% vs. 42.8%). Complications were generally mild. Conclusion: LCT provides oncologic benefits in the oligometastatic setting, although such benefits were less evident in RCTs than in data from observational studies. The appropriate LCTs should be carefully selected, considering their feasibility and disease types.

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Addition of radiotherapy to the primary tumour in oligometastatic NSCLC: A systematic review and meta-analysis

Cited by 49 publications

References 37 publications

Management of oligometastatic non-small cell lung cancer patients: Current controversies and future directions

Management of oligometastatic non-small cell lung cancer patients: Current controversies and future directions

Primary Tumor Resection Is Associated with a Better Outcome among Advanced EGFR-Mutant Lung Adenocarcinoma Patients Receiving EGFR-TKI Treatment

Benefits of local consolidative treatment in oligometastases of solid cancers: a stepwise-hierarchical pooled analysis and systematic review

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