Consolidative Radiotherapy for Limited Metastatic Non–Small Cell Lung Cancer: A Randomized Phase 2 Trial

Iyengar, Puneeth; Tumati, Vasu; Gerber, David E.; Wardak, Zabi; Ahn, Chul; Hughes, Randall; Dowell, Jonathan E.; Cheedella, Naga; Nedzi, Lucien A.; Westover, K.D.; Pulipparacharuvil, Suprabha; Choy, Hak; Timmerman, Robert

doi:10.1016/j.ijrobp.2017.09.010

Cited by 210 publications

(396 citation statements)

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“…Iyengar et al further complemented data in oligo‐progressive, that SBRT showed the potential for effective use as a salvage setting in shifting the pattern of failure from known sites to new sites . Small prospective and retrospective studies suggested that the outcomes of patients with oligometastatic stage IV NSCLC who received consolidative radiotherapy is more similar with the outcomes of patients with stage III disease . Our results of oligometastatic NSCLC patients treated with SBRT are consistent with above studies.…”

Section: Discussionsupporting

confidence: 89%

Stereotactic body radiotherapy improves the survival of patients with oligometastatic non‐small cell lung cancer

Ouyang

Shuake

et al. 2019

Cancer Medicine

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Purpose The aim of the study was to evaluate the efficacy and safety of stereotactic body radiotherapy (SBRT) for pulmonary lesions in oligometastatic non‐small cell lung cancer (NSCLC) patients, to explore prognostic factors of progression‐free survival (PFS) and overall survival (OS), to validate improved survival contributed by SBRT in oligometastatic NSCLC patients. Patients and methods A total of 71 oligometastatic NSCLC patients with 86 pulmonary lesions treated with SBRT in our institute between 2012 and 2018 were included. Local control (LC), progression‐free survival (PFS), and overall survival (OS) were calculated using Kaplan‐Meier method. Prognostic factors of PFS and OS were analyzed using univariate and multivariate Cox analyses. Subgroup analyses were performed to investigate the impact of SBRT on PFS and OS during first line systemic treatment. Results After a median follow‐up of 17.6 months, 2‐year LC and OS rates were 82.6% and 55.3%, respectively. No grade 4 or more toxicities were observed. Multivariate analysis showed systemic treatment regimen before SBRT was an independent prognostic factor of PFS, but not for OS. Among this cohort, patients receiving first line target therapy could show a better PFS and OS than those undergoing first line chemotherapy (target therapy vs chemotherapy, PFS, 26.4 m vs 6.9 m; OS, 34.8 m vs 15.5 m). Conclusions SBRT for pulmonary lesions was a feasible and tolerable option for oligometastatic NSCLC patients. Delivery of SBRT for pulmonary lesions improved outcomes of oligometastatic NSCLC patients. Finally, SBRT combined with first line target therapy might have optimal outcomes.

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Section: Discussionsupporting

confidence: 89%

Stereotactic body radiotherapy improves the survival of patients with oligometastatic non‐small cell lung cancer

Ouyang

Shuake

et al. 2019

Cancer Medicine

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“…Oligoprogressive disease defined as the progression occurs in only a limited number of sites during targeted therapy in patients with driver gene mutations including EGFR or ALK alterations . Emerging evidence suggested that the addition of local therapy could provide clinical benefit in NSCLC patients with oligometastatic or oligoprogressive disease . However, most of the published data focused on intracranial metastases and primary lesion progression.…”

Section: Introductionmentioning

confidence: 99%

EGFR‐TKIs plus local therapy demonstrated survival benefit than EGFR‐TKIs alone in EGFR‐mutant NSCLC patients with oligometastatic or oligoprogressive liver metastases

Jiang

Chu

Wang

et al. 2018

Intl Journal of Cancer

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To investigate whether addition of local therapy to EGFR‐TKIs could provide survival benefit than EGFR‐TKIs alone in EGFR‐mutant NSCLC patients with oligometastatic or oligoprogressive liver metastases (LM). Patients with EGFR‐mutant NSCLC and oligometastatic or oligoprogressive LM who met inclusion criteria were retrospectively identified. The primary endpoint was progression‐free survival (PFS); secondary endpoints included overall survival (OS) and patterns of failure. Addition of local therapy was associated with a significantly longer PFS (13.8 vs. 8.6 m, p <0.001) and OS (31.2 vs. 18.5 m, p <0.001) in whole group. In oligometastatic cohort, 20 patients received EGFR‐TKIs and 23 received EGFR‐TKIs plus local therapy as first‐line treatment. Addition of local therapy showed a significantly longer PFS (12.9 vs. 7.9 m, p = 0.041) and OS (36.8 vs. 21.3 m, p = 0.034) than EGFR‐TKIs alone. In oligoprogressive cohort, 24 patients received continuation of EGFR‐TKIs plus local therapy and 25 received switching chemotherapy. Median PFS2 (13.9 vs. 9.2 m, p = 0.007) and OS (28.3 vs. 17.1 m, p = 0.011) was significantly longer in combined group than in switching chemotherapy group. Distant metastatic sites progression was the major pattern of failure in combined group while locoregional recurrence was the major reason in monotherapy or switching chemotherapy group. Our study suggested that EGFR‐TKIs plus local therapy showed prolonged survival benefit than EGFR‐TKIs alone in EGFR‐mutant NSCLC patients with oligometastatic or oligoprogressive LM, indicating addition of local therapy would be alternative choice in this clinical scenario.

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“…Phase II study results from UT Southwestern published in September 2017 in JAMA Oncol showed a near threefold benefit to progression-free survival favoring local ablative radiation therapy, leading to a stopping in accrual earlier than anticipated (1). The study directly compared stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiation therapy (SBRT), with maintenance chemotherapy versus maintenance chemotherapy alone, both arms after receiving induction chemotherapy.…”

mentioning

confidence: 99%

Utility of stereotactic ablative radiotherapy/stereotactic body radiation therapy in the setting of oligometastatic non-small cell lung cancer

Song

Lü

2018

J. Thorac. Dis.

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Consolidative Radiotherapy for Limited Metastatic Non–Small Cell Lung Cancer: A Randomized Phase 2 Trial

Cited by 210 publications

References 0 publications

Stereotactic body radiotherapy improves the survival of patients with oligometastatic non‐small cell lung cancer

Stereotactic body radiotherapy improves the survival of patients with oligometastatic non‐small cell lung cancer

EGFR‐TKIs plus local therapy demonstrated survival benefit than EGFR‐TKIs alone in EGFR‐mutant NSCLC patients with oligometastatic or oligoprogressive liver metastases

Utility of stereotactic ablative radiotherapy/stereotactic body radiation therapy in the setting of oligometastatic non-small cell lung cancer

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