Might radiation therapy in addition to chemotherapy improve overall survival of patients with non-oligometastatic Stage IV non-small cell lung cancer?: Secondary analysis of two prospective studies

Abstract

BackgroundThe role of radiation therapy in addition to chemotherapy has not been well established in non-oligometastatic Stage IV non-small cell lung cancer (NSCLC). We aimed to investigate overall survival (OS) of non-oligometastatic Stage IV NSCLC treated with chemotherapy with concurrent radiation to the primary tumor.MethodsEligible patients were screened from two prospective studies. Oligometastatic and non-oligometastatic NSCLC were defined as having < 5 and ≥5 metastatic lesions, respectively. Prognostic factors for OS were identified by using univariate and multivariate analysis. Landmark analysis and propensity-score matching (PSM) were each performed to further adjust for confounding.ResultsA total of 274 patients were identified as the study cohort: 183 had non-oligometastatic disease. For all 274 patients, those who received a radiation dose ≥63 Gy to the primary tumor and had oligometastatic disease had better OS (P < 0.001 and P = 0.017, respectively). When patients were subdivided into those with oligometastatic or non-oligometastatic disease, a radiation dose ≥ 63 Gy remained a significant prognostic factor for better OS. For non-oligometastatic patients, multivariate analysis showed that receiving ≥63 Gy radiation, having a GTV <146 cm3, having response to chemotherapy, and having stable or increased post-treatment KPS independently predicted better OS (P = 0.018, P = 0.014, P = 0.014, and P = 0.001). After PSM in non-oligometastatic patients, a higher radiation dose (≥63 Gy) remained to be correlated with better OS. By landmark analysis, aggressive radiation (≥63 Gy) remained to be correlated with better OS in Pre-PSM cohort (P = 0.005) and Post-PSM cohort (P = 0.004).ConclusionsRadiation dose, primary tumor volume, response to chemotherapy and KPS after treatment are associated with OS in patients with non-oligometastatic disease; on basis of effective system chemotherapy, aggressive thoracic radiotherapy may prolong OS.

Radiotherapy improves the survival of patients with stage IV NSCLC: A propensity score matched analysis of the SEER database

“…13 Thus, radical treatment of extensive metastatic NSCLC might also improve prognosis in select cases. For example, we found that radiation treatment in patients with two or more organ metastases, which most likely indicates extensive metastases, 31 also leads to better OS and CSS. Palliative TRT was also shown to be safe and might be beneficial for metastatic NSCLC patients with controlled extra-thoracic diseases.…”

“…Thus, radical treatment of extensive metastatic NSCLC might also improve prognosis in select cases. For example, we found that radiation treatment in patients with two or more organ metastases, which most likely indicates extensive metastases, also leads to better OS and CSS.…”

“…SQC, LCC, and unspecified malignant neoplasm were found to be sensitive to RT regardless of metastatic sites, whereas ADs seemed less responsive to RT, except in cases of brain metastasis. Although selection bias could not be ruled out as the cause of the differences among affected organs, the utilization of PSM in the current study effectively reduced this possibility. Unsurprisingly, we found that AD patients had better survival than patients with other histological types for all metastatic sites regardless of therapy.…”

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

“…The researchers also reported that LCT was associated with a significantly longer time to appearance of new lesions. On the basis of these results, LCT appears to have a role in the management of oligometastatic stage IV NSCLC, in addition to traditional systemic therapy, although it is important to note that these data were derived from a few studies in American and French populations (Gomez et al 2019;Rusthoven et al 2009;Su et al 2016;Zhang et al 2018). Given the regional and ethnic differences in NSCLC cases, further studies are needed to confirm that LCT does indeed have a good efficacy, with acceptable side effects, in other populations.…”

The survival impact of concurrent chemotherapy and primary tumor radiotherapy on stage IV squamous non-small-cell lung cancer

“…Our previous study showed that treatment of IV NSCLC with joint administration of four to five cycles of chemotherapy and three-dimensional radiotherapy may prolong survival especially for patients with single metastatic sites [22][23][24]. However, the role of chemotherapy given concurrently with primary tumor radiotherapy for stage IV squamous NSCLC patients is not well-defined, and the independent prognostic factors for OS in stage IV squamous NSCLC patients treated with concurrent chemoradiotherapy remains to be answered.…”