Comparison of outcomes in patients with stage III versus limited stage IV non-small cell lung cancer

Abstract

BackgroundStandard therapy for metastatic non small cell lung cancer (NSCLC) includes palliative systemic chemotherapy and/or radiotherapy. Recent studies of patients with limited metastases treated with curative-intent stereotactic body radiation therapy (SBRT) have shown encouraging survival. We hypothesized that patients treated with SBRT for limited metastases have comparable outcomes with those treated with curative-intent radiation for Stage III NSCLC.MethodsWe retrospectively reviewed the records of NSCLC patients treated with curative-intent radiotherapy at the University of Rochester from 2000-2008. We identified 3 groups of patients with NSCLC: stage III, stage IV, and recurrent stage IV (initial stage I-II). All stage IV NSCLC patients treated with SBRT had ≤ 8 lesions.ResultsOf 146 patients, 88% had KPS ≥ 80%, 30% had > 5% weight loss, and 95% were smokers. The 5-year OS from date of NSCLC diagnosis for stage III, initial stage IV and recurrent stage IV was 7%, 14%, and 27% respectively. The 5-year OS from date of metastatic diagnosis was significantly (p < 0.00001) superior among those with limited metastases (≤ 8 lesions) versus stage III patients who developed extensive metastases not amenable to SBRT (14% vs. 0%).ConclusionStage IV NSCLC is a heterogeneous patient population, with a selected cohort apparently faring better than Stage III patients. Though patients with limited metastases are favorably selected by virtue of more indolent disease and/or less bulky disease burden, perhaps staging these patients differently is appropriate for prognostic and treatment characterization. Aggressive local therapy may be indicated in these patients, though prospective clinical studies are needed.

BAP1 is a good prognostic factor in advanced non-small cell lung cancer

“…e 7th AJCC Staging system was used to categorize patients and two groups of patients were used in this study: stage III NSCLC and stage IV NSCLC. Among patients with Stage III NSCLC, metastatic recurrence was characterized as limited metastatic or extensive metastatic disease as described in a previous report [15]. All patients were assessed with diagnostic CT or PET/CT imaging to identify metastatic lesions.…”

SABR for aggressive local therapy of metastatic cancer: A new paradigm for metastatic non-small cell lung cancer

“…This is a more difficult question to answer at this time, but from several retrospective and single institution studies, it is apparent that local treatment could add survival value in this patient population [40,41,44,[46][47][48]. Part of the reason for the difficulty in identifying if a limited metastatic disease state exists in NSCLC is that traditional systemic therapy trials for stage IV NSCLC did not provide details of number of disease sites as long as there was disease that was measurable for treatment response.…”

“…According to our recently completed phase II study, there are indeed patients with limited sites of metastatic disease who can have significant PFS and OS when treated aggressively locally in comparison to historical values [45]. Multiple retrospective studies have demonstrated significant PFS times when oligometastatic disease of multiple pathologies, including NSCLC, was treated with radiation [40,41,44,[46][47][48]. Our recommendations would be to use SABR in the second or beyond line setting in patients with limited metastatic disease who have progressed in less than or equal to 6 sites (including primary disease location) after systemic therapy based on our published phase II experience [45].…”

Treatment of metastatic small-cell lung cancer in 2012

“…Dans cette étude, il existait un avantage de survie chez les malades ayant présenté une réponse complète à la chimiothé-rapie initiale [14]. D'autres études, le plus souvent rétrospectives ont rapporté une efficacité chez des patients répondeurs à la chimiothé-rapie initiale et présentant un nombre peu important de métastases [5,10,24]. Dans tous les cas les doses de radiothérapies étaient supérieures à 30 Gy.…”