Consolidative Radiotherapy for Limited Metastatic Non–Small-Cell Lung Cancer

Iyengar, Puneeth; Wardak, Zabi; Gerber, David E.; Tumati, Vasu; Ahn, Chul; Hughes, Randall; Dowell, Jonathan E.; Cheedella, Naga; Nedzi, Lucien A.; Westover, Kenneth D.; Pulipparacharuvil, Suprabha; Choy, Hak; Timmerman, Robert

doi:10.1001/jamaoncol.2017.3501

Cited by 864 publications

(475 citation statements)

References 51 publications

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“…In addition to surgical resection, SBRT has been shown to be effective, demonstrating high rates of local control and improved PFS in prospective studies. 34,35 In a randomized phase II study of patients with oligometastases from mixed histologies (SABR-COMET), Palma et al reported improved outcomes in PFS (12 vs. 6 months, p < 0.001) and OS (41 vs. 27 months, p = 0.09) with the addition of SBRT to standard of care systemic therapy compared to systemic therapy alone. 36 Although phase III studies are needed, the data supporting an increased role for local therapies in oligometastatic disease are encouraging, particularly if advances in systemic therapies for patients with HCC, such as immunotherapies, continue to evolve.…”

Section: Stereotactic Body Radiation Therapy For Extrahepatic Lesionsmentioning

confidence: 99%

Radiotherapy for HCC: Ready for prime time?

Bang

Dawson

2019

JHEP Reports

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Stereotactic body radiation therapy (SBRT) has an evolving role in the management of hepatocellular carcinoma (HCC), largely due to recent advances in imaging technology. Often utilized in situations where other locoregional therapies are not feasible, SBRT has been demonstrated to be an effective treatment that confers high rates of durable local control. However, there is limited evidence to firmly establish its place in the treatment paradigm for HCC. In this article, we review the current evidence and highlight specific considerations in the multiple settings where SBRT may be used, including for primary HCC treatment and bridging/downstaging, as well as exploring the potential for SBRT in the treatment of extrahepatic oligo-metastatic HCC.

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Section: Stereotactic Body Radiation Therapy For Extrahepatic Lesionsmentioning

confidence: 99%

Radiotherapy for HCC: Ready for prime time?

Bang

Dawson

2019

JHEP Reports

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“…An increasing body of literature is now supporting the use of local ablative approaches with curative intent in oligometastatic patients, the most convincing data arising from the group of NSCLC patients [11,25,26]. Nevertheless, in clinical situations such as the occurrence of ultra-central lung oligometastases, the delivery of SBRT to radical doses can be technically challenging.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiotherapy for Ultra-Central Lung Oligometastases in Non-Small-Cell Lung Cancer

Loi

Franceschini

Dominici

et al. 2020

Cancers

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Background: Stereotactic body radiotherapy (SBRT) in ultra-central (UC) lung tumors, defined in the presence of planning target volume (PTV) overlap or direct tumor abutment to the central bronchial tree or esophagus, may be correlated to a higher incidence of severe adverse events. Outcome and toxicity in oligometastatic (≤3 metastases) non-small-cell lung cancer (NSCLC) patients receiving SBRT for UC tumors were evaluated. Methods: Oligometastatic NSCLC patients treated with SBRT for UC were retrospectively reviewed. Local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS) and overall survival (OS) were calculated. Incidence and grade of toxicity were evaluated. Statistical analysis was performed to assess the impact of clinical and treatment-related variables on outcome and toxicity occurrence. Results: Seventy-two patients were treated to a median biologically effective dose (BED) of 105 (75–132) Gy10. Two-year LC, DMFS, PFS, and OS were 83%, 46%, 43%, and 49%. BED>75 Gy10 was correlated to superior LC (p = 0.02), PFS (p = 0.036), and OS (p < 0.001). Grade ≥3 toxicity rate was 7%, including one fatal esophagitis. No variables were correlated to DMFS or to occurrence of overall and grade ≥3 toxicity. Conclusions: SBRT using dose-intensive schedules improves outcome in NSCLC patients. Overall toxicity is acceptable, although rare but potentially fatal toxicities may occur.

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“…The results indicated that RT provided significantly better PFS and OS, relative to historical values for patients who had received only systemic treatment. A later prospective study (Iyengar et al 2018) involved 29 patients with oligometastatic stage IV NSCLC, including 14 patients who were treated using stereotactic ablative radiotherapy (SAbR) plus maintenance chemotherapy and 15 patients who were treated using maintenance chemotherapy. That trial was closed early after an interim analysis revealed that SAbR plus maintenance chemotherapy yielded significantly improved PFS (9.7 months vs. 3.5 months, p = 0.01).…”

Section: Discussionmentioning

confidence: 99%

“…There is increasing awareness regarding the concept of oligometastasis, which, relative to extensive metastasis, is thought to involve a milder stage of tumor invasion, with fewer metastases (≤ 3-5 metastases) and localization (Ashworth et al 2013;De Rose et al 2016;Mitchell et al 2019). Multiple studies have shown that patients with stage IV non-small cell lung cancer (NSCLC) generally experience progression of advanced disease at the original sites of gross disease and that patients with oligometastasis may potentially be cured via local treatment (Iyengar et al 2018). Thus, local consolidation therapy (LCT) involving surgery and radiotherapy (RT) is expected to prolong the survival of patients with oligometastatic NSCLC.…”

Section: Introductionmentioning

confidence: 99%

Treatment patterns and survival after 18F-fluorodeoxyglucose positron emission tomography/computed tomography-guided local consolidation therapy for oligometastatic non-small cell lung cancer: a two-center propensity score-matched analysis

Song

Qiao

et al. 2020

J Cancer Res Clin Oncol

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Purpose In this retrospective study, we evaluated the treatment patterns and survival after positron emission tomographycomputed tomography (PET/CT)-guided local consolidation therapy (LCT) for oligometastatic non-small cell lung cancer (NSCLC). Methods We reviewed the medical records of Chinese patients with oligometastatic stage IV non-small cell lung cancer (≤ 5 metastases) who had undergone PET/CT and were eligible for systemic therapy at two centers between May 2005 and August 2019. Propensity score matching (1:1) was used to reduce selection bias and imbalanced distribution of confounding factors. Results We identified 84 eligible patients and used propensity scores to create well-matched groups of 35 patients who did or did not undergo LCT. Among all patients, the 1-year overall survival (OS) rate was 47.6% and the 2-year OS rate was 22.6%. Relative to the group that did not receive LCT, the LCT group had a significantly higher OS rate (13 months vs. 7 months, p = 0.002). The two groups had similar incidences and classifications of LCT-related side effects. In multivariable analysis, LCT was found to be strongly associated with a favorable OS (hazard ratio: 0.508, 95% confidence interval: 0.311-0.828, p = 0.001). Conclusion We concluded that LCT was significantly associated with improved clinical outcomes among the Chinese patients with oligometastatic NSCLC who were eligible for systemic treatment and could undergo PET/CT evaluation.

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Consolidative Radiotherapy for Limited Metastatic Non–Small-Cell Lung Cancer

Abstract: clinicaltrials.gov Identifier: NCT02045446.

Cited by 864 publications

References 51 publications

Radiotherapy for HCC: Ready for prime time?

Radiotherapy for HCC: Ready for prime time?

Stereotactic Radiotherapy for Ultra-Central Lung Oligometastases in Non-Small-Cell Lung Cancer

Treatment patterns and survival after 18F-fluorodeoxyglucose positron emission tomography/computed tomography-guided local consolidation therapy for oligometastatic non-small cell lung cancer: a two-center propensity score-matched analysis

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