Prognosis of non-small cell lung cancer patients with bone oligometastases treated concurrently with thoracic three-dimensional radiotherapy and chemotherapy

Abstract

BackgroundTo evaluate the efficacy of three-dimensional radiotherapy for non-small cell lung cancer (NSCLC) patients with bone metastases.MethodsClinical data for 95 NSCLC patients with bone metastases were collected and prognostic factors were analyzed. All patients received radiation to their thoracic primary tumor and ≥2 cycles of chemotherapy.ResultsOf these 95 patients, 47 patients had only bone metastases and 48 had both bone metastases and other organ metastases. Univariate analysis showed that factors that statistically significantly contributed to patients having longer overall survival (OS) included receiving a radiation dose to the primary tumor ≥63 Gy, responding to treatment and receiving ≥4 cycles of chemotherapy (p = 0.001, p = 0.037 and p = 0.009, respectively). A radiation dose to the primary tumor ≥63 Gy remained significant for patients with bone metastases only as well as those with bone and other organ metastases when they were analyzed separately (p = 0.045 and p = 0.012, respectively). For patients with bone metastases only, those with T1-2 tumors had longer OS than those with T3-4 (p = 0.048); and patients who received ≥4 cycles chemotherapy compared with those who received <4 cycles had similar OS (p = 0.385). On multivariate analysis, only a radiation dose ≥63 Gy (p = 0.028) and having only bone metastases (p = 0.006) were independent prognostic factors for better OS.ConclusionsA radiation dose to the primary tumor ≥63 Gy and having only bone metastases were associated with better OS in NSCLC patients with bone metastases. For patients with bone metastases only, besides radiation dose, T status was also correlated with OS, whereas the number of chemotherapy cycles was not. Therefore, aggressive thoracic radiation may play an important role in improving OS.

The biology and treatment of oligometastatic cancer

“…There was one large study ( n = 2176), although it was retrospective and a nonconsecutive case series (Level 3iii) [ 76 ]. Of the remaining 17 studies, two were population-based consecutive case series (Level 3i) [ 82 , 83 ], two were non population–based consecutive case series (Level 3ii) [ 84 , 85 ], and twelve were nonconsecutive case series (Level 3iii) [ 76 , 86 – 97 ], one of which was prospective [ 98 ]. Therapies given varied not only among the studies but within most of them as well, for patients with diversely defined oligometastases.…”

“…Overall survival endpoints (level A) were reported in all but one study [ 90 ], however stronger study designs would have shown whether the survival endpoints were significant. OS was reported as MOS (11.7 [ 82 ], 17 [ 94 ], 20 [ 83 ], 26.4 [ 92 ], and 41months [ 91 ] and at four intervals in the remaining studies: 5-year (29.4% [ 84 ], 8.3–86% [ 76 ], 44.7% [ 98 ], 38% [ 96 ], 36% [ 86 ], and 24% [ 87 ]), 3-year (17.5% [ 81 ], 25% [ 85 ], and 15.8% [ 97 ]), 2-year (24% [ 93 ]and 38% [ 89 ]), 18-month (52.9%) [ 88 ] and 1-year (67% [ 80 ]and 75% [ 95 ]).…”

First-Line Tyrosine Kinase Inhibitors Combined With Local Consolidative Radiation Therapy for Elderly Patients With Oligometastatic Non-Small Cell Lung Cancer Harboring EGFR Activating Mutations

“…Clinical incidence for metastatic NSCLC among NSCLC patients is approximately 50%. Metastatic NSCLC is more common in older patients than in younger patients ( 12 ). This is because, in elderly patients, the disease is at a more advanced stage at the time of diagnosis.…”

Assessing efficacy and safety of stereotactic body radiation therapy for oligometastatic non-small cell lung cancer with epidermal growth factor receptor (EGFR) wild type

“…Lung cancer is the leading cause of cancer-associated death worldwide ( 1 ), among which non-small cell lung cancer (NSCLC) represents about 85% of all cases ( 2 , 3 ). More than half of the NSCLC patients initially diagnosed with distant metastases ( 4 ). Mehta et al reported that ( 5 , 6 ) patients with metastatic NSCLC could remain relatively stabilization and not be widely disseminated.…”