Prognostic Impact of Radiation Therapy to the Primary Tumor in Patients With Non-small Cell Lung Cancer and Oligometastasis at Diagnosis

Abstract

Purpose We investigated prognostic factors associated with survival in patients with non-small cell lung cancer (NSCLC) and oligometastatic disease at diagnosis, particularly the influence of local treatment to the primary site on prognosis. Methods and Materials From January 2000 through June 2011, 78 consecutive patients with oligometastatic NSCLC (<5 metastases) at diagnosis underwent definitive chemoradiation therapy (≥45 Gy) to the primary site. Forty-four of these patients also received definitive local treatment for the oligometastases. Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results Univariate Cox proportional hazard analysis revealed better overall survival (OS) for those patients who received at least 63 Gy of radiation to the primary site (P=.002), received definitive local treatment for oligometastasis (P=.041), had a Karnofsky performance status (KPS) score >80 (P=.007), had a gross tumor volume ≤ 124 cm3 (P=.002), had adenocarcinoma histology (P=.002), or had no history of respiratory disease (P=.016). On multivariate analysis, radiation dose, performance status, and tumor volume retained significance (P=.004, P=.006, and P<.001, respectively). The radiation dose also maintained significance when patients with and without brain metastases were analyzed separately. Conclusions Tumor volume, KPS, and receipt of at least 63 Gy to the primary tumor are associated with improved OS in patients with oligometastatic NSCLC at diagnosis. Our results suggest that a subset of such patients may benefit from definitive local therapy.

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

“…Aggressive therapy for the primary tumor and metastatic lesions in NSCLC patients with oligometastases may produce better OS [9,10,14]. Our results also showed that radiation to metastatic sites displayed a trend towards improving OS in patients with only bone oligometastases.…”

“…Lopez et al reported that patients who had smaller tumor volumes had longer OS [9]. Our results showed that patients with a GTV <159 cm 3 tended to have longer OS than those with a GTV ≥159 cm 3 .…”

“…Nearly 50% of stage IV NSCLC patients experienced local recurrence in initially involved sites, and local control and status of the primary tumor has been associated with OS [12,16,17]. Several publications have confirmed that a higher radiation dose was associated with improved local tumor control and OS in patients with NSCLC [9,18]. Although the relationship between OS and local tumor control was not evaluated in this study, our results showed that the higher radiation dose to the primary tumor was correlated with OS.…”

Multidisciplinary Tumor Board Recommendations for Oligometastatic Malignancies: A Prospective Single-Center Analysis

“…The proportion of patients who are recommended to receive regional treatment comprises more than 50% of all patients with oligometastatic disease. For these recommendations, a biologically proven concept does not exist and only in a few cases are these recommendations supported by prospective trials [36,39,40]. Both translational and prospective clinical trials are urgently needed to validate this clinical practice, supported by further advancements in molecular cancer subtyping that will help to define curable oligometastatic disease states [41].…”

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

“…In recent years, the general opinion is that patients with 1-5 metastases is oligometastases [7–9, 13]. In general consideration, pharmacotherapy was the main treatment modality, and, radiation to primary tumor not affect survival and should be only given to alleviate symptoms (hemoptysis, cough, pain, and others) in non-oligometastatic Stage IV NSCLC.…”