Multimodal therapy for synchronous bone oligometastatic NSCLC: The role of surgery

Abstract

Objectives The study aimed to assess the feasibility of radical surgical treatment for selected bone‐oligometastatic non‐small cell lung cancer (NSCLC) patients and to identify prognostic factors associated with survival. Materials and methods The clinical records of 27 patients with bone synchronous oligometastatic NSCLC were retrospectively analyzed. Results Thirteen (48.1%) bone metastases were treated by surgery and 14 (51.9%) by local radiotherapy. Eighteen (66.7%) patients underwent induction chemotherapy before lung surgery, and 3 (11.1%) concurrent radiotherapy. Pulmonary surgery was a major lung resection in 23 (85.2%) cases. Intraoperative and 30‐days mortality was null. Only one major (ARDS) and 10 (37.04%) mild complications (like air leakage, arrhythmia, and mucus retention) were recorded. 1‐year and 5‐years OS from the diagnosis and 1‐year, 3‐ years disease‐free survival (DFS) were 96%, 38%, and 66%, 30%, respectively. After stepwise Cox regression analysis, local recurrence (p = 0.05) and metachronous metastases (p = 0.04) maintained their independent prognostic value as overall survival negative determinants. Nodal upstaging (p = 0.04) and nonsurgical treatment of bone lesion (p = 0.03) turned out to be independent risk factors for shorter DFS; the vertebral localization of bone metastases showed only a remarkable trend towards significance (p = 0.06) as a risk factor for a worse DFS. Conclusions In selected patients, surgical treatment of primary NSCLC and bone synchronous metastasis seems to be safe and feasible and rewarding survivals may be expected.

Genomic features and its potential implication in bone oligometastatic NSCLC

“…Bone is the most common site of distant metastasis in patients with stage IV NSCLC and has a very poor prognosis. An increasing number of clinical trials have confirmed the effectiveness and feasibility of LCT in NSCLC patients with bone oligometastasis [ 26 , 27 ]. However, there is no consensus on the exact number of metastases to define oligometastasis [ 28 ].…”

Survival Benefits of Primary Tumor Surgery in Diverse Cancer Types with Synchronous Bone Metastases: A Retrospective Real-World Analysis Using Propensity Score Matching from a 3P Medicine Perspective

“…Furthermore, a retrospective analysis involving 27 patients with synchronous bone oligometastatic NSCLC also illustrated that surgical treatment is associated with anticipated survival bene ts [27] . Our study validated these points through analysis of the SEER database, but prostate cancer and liver cancer do not align with the conclusion, which underscores the importance of personalized treatment decisions based on each cancer type and patient.…”

Brain metastasis from non-small cell lung cancer: management and prognosis of primary lung tumor resection

“…And similar survival benefit was observed in other oligometastatic NS-CLC patients involving different organs. [24] Due to the complex nature of the metastatic disease and primary tumor, patient survival could be influenced by many aspects including the overall condition of the patient, tumor load and its biological behavior, and patient response to local and systemic treatment. Patient selection is one of the factors that impede a definite conclusion, as patients who are fit for surgical treatment usually have few comorbidities and less tumor burden.…”