Managing Patients With Oligometastatic Non–Small-Cell Lung Cancer

Stephens, Sarah Jo; Moravan, Michael J.; Salama, Joseph K.

doi:10.1200/jop.2017.026500

Cited by 46 publications

(28 citation statements)

References 61 publications

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“…With the widespread use of regularly performed staging with CT or positron-emission-tomography (PET)-CT, and the growing recognition of the oligometastatic or oligoprogressive state in different tumor entities, the number of patients presenting with asymptomatic adrenal metastases has increased [32][33][34]. For these patients, surgical resection remains the gold standard, however, many patients are medically unfit for surgery, or their tumors are not technically resectable, and alternative local treatment approaches are required [4,16,35].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

et al. 2020

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Introduction: Local ablative treatment strategies are frequently offered to patients diagnosed with oligometastatic disease. Stereotactic body radiotherapy (SBRT), as ablative treatment option, is well established for lung and liver metastases, whereas for isolated adrenal gland metastases the level of evidence is scarce. Material and methods: This single-institution analysis of oligometastatic or oligoprogressive disease was limited to patients who received SBRT to adrenal metastasis between 2012 and 2019. Patient, tumor, treatment characteristics, and dosimetric parameters were analyzed for evaluation of their effect on survival outcomes. Results: During the period of review 28 patients received ablative SBRT to their adrenal gland metastases. Most common primary tumors were non-small cell lung cancers (46%) with most patients diagnosed with a single adrenal gland metastasis (61%), which occurred after a median time of 14 months. SBRT was delivered to a median biological effective dose at α/β of 10 (BED 10) of 75 Gy (range: 58-151 Gy). Median gross tumor volume (GTV) and median planning target volume (PTV) were 42 and 111 mL, respectively. The homogeneity and conformity indices were 1.17 (range: 1.04-1.64) and 0.5 (range: 0.4.0.99), respectively, with the conformity index being affected by dose restrictions to organs at risk (OARs) in 50% of the patients. Overall response rate based on RECIST criteria was 86% (CR = 29%, PR = 57%) with 2-year local control (LC) of 84.8%, 2-year progression-free survival (PFS) of 26.3%, and 1and 2-year overall survival (OS) of 46.6 and 32.0%, respectively. During follow up, only two local recurrences occurred. A trend for superior LC was seen if BED 10 was ≥75Gy (p = 0.101) or if the PTV was < 100 ml (p = 0.072). SBRT was tolerated well with only mild toxicity. Conclusion: SBRT for adrenal metastases resulted in promising LC with low toxicity. Treatment response appeared to be superior, if SBRT was applied with higher BED. As the close proximity of OARs often limits the application of sufficiently high doses, further dose escalations strategies and techniques should be investigated in future.

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Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

et al. 2020

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“…A limited number of metastases, called oligometastases, are thought to be intermediate state of malignancy between localized disease and widespread systemic metastasis . For oligometastatic non‐small cell lung cancer, eradication of primary lesion and metastatic sites is thought to lead better prognosis and even cure in a proportion of patients . These kinds of aggressive treatment have spread much wider than previously thought in mPCa .…”

Section: Introductionmentioning

confidence: 99%

“…2 For oligometastatic non-small cell lung cancer, eradication of primary lesion and metastatic sites is thought to lead better prognosis and even cure in a proportion of patients. 3 These kinds of aggressive treatment have spread much wider than previously thought in mPCa. 4 However, a strategy for cytoreductive therapy is not currently standard for newly diagnosed oligometastatic prostate cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes of combining prostate brachytherapy and metastasis‐directed radiotherapy in newly diagnosed oligometastatic prostate cancer: A retrospective cohort study

et al. 2018

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Background Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trial showed the survival benefit for prostate radiotherapy in newly diagnosed prostate cancer patients with a low metastatic burden. The result raises the next question whether additional radiotherapy to metastatic sites could improve the survival in those with a low metastatic burden. Methods We evaluated the efficacy and safety of prostate‐directed radiotherapy (PDRT) with or without metastasis‐directed radiotherapy (MDRT) in newly diagnosed oligometastatic patients who underwent combination of high‐dose‐rate prostate brachytherapy, external beam radiotherapy, and androgen deprivation therapy. Forty patients with bone metastasis and node positive prostate cancer were retrospectively analyzed. Of these, 22 (55%), 3 (7%), and 15 (38%) patients had N1M0, M1a, and M1b, respectively. Eighteen patients (45%) received MDRT to all metastatic sites. All patients initially underwent ≧6 months of androgen deprivation therapy. Oligometastatic disease was defined as presence of five or fewer metastatic lesions. Median follow‐up period was 62.5 months. Results Of the 40 patients, the 5‐year castration‐resistant prostate cancer (CRPC)‐free survival rate and cancer‐specific survival was 64.4% and 87.9%, respectively. Pre‐ or post‐treatment predictive value including prostate‐specific antigen (PSA) at diagnosis ≥20 ng/mL, Gleason grade group 5, positive biopsy core rate ≥51%, PSA nadir level of ≥0.02 ng/mL after the radiotherapy, and no MDRT were significantly associated with progression to CRPC. Patients with MDRT had significantly higher probability of achieving a PSA level of <0.02 ng/mL than those without the therapy (88.8% vs 54.5%, P = 0.0354) and consequently had a better CRPC‐free survival than those without the therapy (HR 0.319, 95%CI: 0.116‐0.877). Comparing PDRT alone, PDRT with MDRT did not significantly increase the incidences of genitourinary and gastrointestinal toxicities. Conclusions This single‐institutional study revealed the feasibility of combining prostate brachytherapy and MDRT for newly diagnosed oligometastatic prostate cancer. This combined approach has potential to prolong CRPC‐free survival.

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“…Recent clinical data suggest that curative therapeutic approaches, including local ablative therapies, such as surgery and/or radiotherapy, should be considered for patients with oligometastatic tumors at diagnosis, to improve disease control and thereby long-term survival outcomes (7). Progression in few metastatic sites under TKI therapy may be postulated to be a result of clonal evolution through the accumulation of molecular alterations in cancer cells, which can render some sub-clones resistant.…”

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confidence: 99%

“…In addition, local ablative therapies to metastatic sites can further improve long-term disease control. Stereotactic body radiotherapy (SBRT) or SBRT-like treatments have been used in patients with oligometastatic or oligo-progressive tumors, including aNSCLC, to treat metastasis at different anatomical sites, with encouraging results in terms of rates of local control rate and overall survival and limited toxicity (7,(16)(17)(18)(19)(20)(21)(22).…”

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confidence: 99%

High-dose Radiotherapy for Oligo-progressive NSCLC Receiving EGFR Tyrosine Kinase Inhibitors: Real World Data

Santarpía

Altavilla

Borsellino

et al. 2020

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Background/Aim. Local ablative treatments for oligo-progressive, EGFR mutated non-small cell lung cancer (mut-NCSLC) may improve long-term disease control and survival. We analyzed the efficacy of hypo-fractionated, highdose radiation therapy (HDRT), in association with prolonged EGFR tyrosine kinase inhibitors (TKI) in oligo-progressive, EGFR mutant-NSCLC. Patients and Methods. Progressionfree survival-1 (PFS-1, date from initiation of TKI therapy until oligo-progression or death), and progression-free survival-2 (PFS-2, date of focal progression until further progression or death) were evaluated. Results. Thirty-six patients were analyzed. The median PFS 1 was 12.5 months. HDHRT consisted of intensity-modulated RT and stereotactic RT in 23 (64%) and 13 (36%) patients respectively. The median PFS 2 was 6.3 months. Overall survival was 38.7 months. Conclusion. Hypo-fractionated HDRT plus TKI therapy, is associated with a significant prolongation of disease control (overall PFS: 18.8 months), with manageable side effects. These real-world data support the use of local ablative approaches in oligo-progressive EGFR mut-NSCLC. Non-small cell lung cancer (NSCLC) is the most frequent form of lung cancer and is commonly diagnosed at locally advanced or metastatic stages (1). Systemic therapies for advanced NSCLC (aNSCLC) have markedly evolved during the last years due to the increasing number of molecularly targeted agents approved for the treatment of patients whose tumors harbor specific oncogenic alterations, such as mutations of EGFR, and ALK or ROS1 rearrangements, and to the advent of the immune checkpoint inhibitors, including monoclonal antibodies directed against the PD1-PD-L1 pathway (2, 3). Approximately 25% of aNSCLC patients may present at diagnosis with oligometastatic disease, which is characterized by the presence of metastatic lesions limited in number and location. Although oligo-metastases has not been defined (4-7), the oligometastatic state is described as "an intermediate clinical state between locally confined and widely disseminated metastatic cancer" (8). In the real world, this term encompasses a broad spectrum of clinical entities, with varying numbers and sites of metastatic lesions, for which the optimal therapeutic strategies have not yet been determined. Oligometastatic tumors present a more indolent biology and have not yet gained the ability to spread to multiple organs, suggesting that, despite being metastatic, they can be associated with favorable prognosis. This observation is also underlined by the last edition of the TNM staging system by the International Association for the Study of Lung Cancer (IASLC), in which the M1b includes a single extrathoracic metastatic lesion versus widespread extra thoracic M1c disease (9). Oligo-progression is very common in oncogene-addicted aNSCLC. Indeed, despite the 2009 This article is freely accessible online.

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Managing Patients With Oligometastatic Non–Small-Cell Lung Cancer

Cited by 46 publications

References 61 publications

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

Long‐term outcomes of combining prostate brachytherapy and metastasis‐directed radiotherapy in newly diagnosed oligometastatic prostate cancer: A retrospective cohort study

High-dose Radiotherapy for Oligo-progressive NSCLC Receiving EGFR Tyrosine Kinase Inhibitors: Real World Data

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