Definitive local therapy for extracranial single-organ oligorecurrent non-small-cell lung cancer: A single institutional retrospective study

Abstract

Oligometastatic non-small-cell lung cancer (NSCLC) is potentially curable. Oligo-recurrence occurs with oligometastatic disease characterized by well-controlled primary lesion. The purpose of the present study was to explore the value of definitive local therapy (DLT) for extracranial single-organ oligorecurrent NSCLC. A total of 81 patients with NSCLC who had extracranial single-organ oligorecurrence after receiving radical treatment at the Cancer Hospital of the University of Chinese Academy of Sciences from January 2010 to December 2017 were analyzed. The primary endpoint was progression-free survival (PFS), and the secondary endpoint was overall survival (OS). The median follow-up time of the 81 patients was 65.8 months. A total of 39 patients received DLT. A large proportion of patients who did not accept DLTs received specific tyrosine kinase inhibitors (TKIs). The results of multivariate analysis showed that DLT and specific TKI therapy were favorable prognostic factors significantly related to PFS. Further analysis showed that for patients without specific TKI therapy, DLT significantly improved PFS and the 5-year PFS rate. The 5-year OS rate also improved, but the improvement was not significant. For extracranial single-organ oligorecurrent NSCLC, PFS was significantly superior in patients receiving DLT. Among them, for the subgroup of patients who did not receive specific TKI therapy, DLT is expected to improve long-term prognostic outcomes.

Complex situations in lung cancer: multifocal disease, oligoprogression and oligorecurrence

“…LAT has gained significant attention owing to their potential benefits on post-recurrence PFS and even OS [ 52 , 54 , 58 – 61 ]. However, despite several retrospective analyses suggesting an improvement in OS with LAT, its direct correlation has not yet been proven [ 61 ]. Research by S onoda et al .…”

“…[ 61 ] observed that clinicians are more inclined to perform LAT when there is no targetable driver gene mutation. Given the positive impact of LAT and TKIs on PFS [ 59 , 60 ], their combined use holds promise as an optimal approach for individuals harbouring targetable mutations [ 56 , 61 ]. However, a study by S onoda et al .…”

Oligo-Metastatic Cancers: Putative Biomarkers, Emerging Challenges and New Perspectives

“…Unfortunately, while DLTs, particularly SRT, are widely used in clinical practice to manage OMD, there is limited evidence to support their use. A review of scientific literature from PubMed in the past year (when a peak of publications is registered) reveals a high number of heterogeneous, retrospective, and small-scale clinical studies conducted in real-world settings [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. While these studies are important, their results cannot formally change the standard of therapy.…”

“…While these studies are important, their results cannot formally change the standard of therapy. The evidence ranges from case reports and retrospective series [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ] to phase III randomized trials [ 69 ] such as the SINDAS trial. This trial showed that adding SRT to TKIs significantly improves survival in 133 EGFR-mutated NSCLC OMD patients (median OS TKI plus SRT: 25.5 months vs. 17.4 months in TKI monotherapy).…”

“…This trial showed that adding SRT to TKIs significantly improves survival in 133 EGFR-mutated NSCLC OMD patients (median OS TKI plus SRT: 25.5 months vs. 17.4 months in TKI monotherapy). The studies range in size from 39 NSCLC OMD patients (in a study reporting an interesting retrospective comparison between DLTs, predominantly radiotherapy, vs. TKIs) [ 64 ] to 284 OMD patients with different cancers (a single-arm study performed predominantly in lung, colon, and breast OMD) [ 67 ]. The median survivals achieved in these studies with SRT are higher than those reported in the poly-metastatic setting, 30.8 and 53.4 months, respectively, confirming that OMD has a good prognosis.…”