Improved Overall Survival With Comprehensive Local Consolidative Therapy in Synchronous Oligometastatic Non–Small-Cell Lung Cancer

Mitchell, Kyle G.; Farooqi, Ahsan; Ludmir, Ethan B.; Corsini, Erin M.; Zhang, Jiexin; Sepesi, Boris; Vaporciyan, Ara A.; Swisher, Stephen G.; Heymach, John V.; Gomez, Daniel R.; Antonoff, Mara B.

doi:10.1016/j.cllc.2019.07.007

Cited by 44 publications

(53 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinically relevant variables from previous trials included the number of metastatic lesions, targetable mutation status, and presence of central nervous system disease. 16,23,29 All statistical tests were 2 sided, and statistical significance was set at P .05. Statistical analysis was performed by R 3.5.3 (https://www.r-project.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, long-term follow-up from a phase 2 trial has reported both a 5-year PFS and OS of only 8%, highlighting the importance for proper patient selection in the use of aggressive local therapy. 19 Previous studies have identified both negative and positive prognostic factors associated with survival [20][21][22][23][24][25][26][27][28][29] ; however, to our knowledge, no other studies have attempted to predict specific PFS based on clinical patient and treatment characteristics.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Consolidative Radiotherapy in Oligometastatic Lung Cancer: Patient Selection With a Prediction Nomogram

Friedes

Mai

Hazell

et al. 2020

Clinical Lung Cancer

View full text Add to dashboard Cite

Using definitive radiotherapy to treat oligometastatic nonesmall-cell lung cancer has shown promising results in multiple clinical trials; however, identification of the ideal candidate for this radical treatment is still largely unknown. Using a prediction nomogram, we identified patient characteristics that may extend progressionfree survival in the setting of definitively treated oligometastatic disease. Background: Patients with stage IV oligometastatic (3 sites) nonesmall-cell lung cancer have a progression-free survival (PFS) and overall survival benefit when all sites of metastatic disease and the primary tumor are treated radically with consolidative radiotherapy (cRT). However, the optimal selection of patients most likely from cRT is yet to be defined. Patients and Methods: Patients with metastatic nonesmall-cell lung cancer treated with definitive radiotherapy to all metastatic sites and primary tumor (2008-2019) were retrospectively identified. Univariable Cox proportional-hazards model was used to compare outcomes with demographic and clinical characteristics. A predictive nomogram model for selection of patients most likely to benefit from cRT was constructed. Results: There were 91 patients identified with a total of 114 metastases treated. Median PFS from the start of cRT was 10.9 months (95% confidence interval [CI], 8.1-16.6), while the median survival time was 37.0 months (95% CI, 31.3-NR). On univariable modeling, patients with squamous histology (hazard ratio, 4.16; 95% CI, 1.99-8.71; P < .001) and those treated with nonestereotactic body radiotherapy hypofractionated therapy (hazard ratio, 5.43; 95% CI, 2.10-14.01; P < .001) had worse overall survival, while patients with targetable mutations (hazard ratio, 0.49; 95% CI, 0.25-0.98; P ¼ .04) had a longer survival. Using a predictive nomogram model, patients with a solitary site of metastasis, targetable mutations, intracranial disease, and metachronous timing of oligometastases had a larger PFS benefit from cRT. Conclusion: cRT is associated with favorable outcomes in PFS and overall survival. These results may aid in patient counseling, selection for aggressive local therapy, and stratification in future prospective clinical trials.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Consolidative Radiotherapy in Oligometastatic Lung Cancer: Patient Selection With a Prediction Nomogram

Friedes

Mai

Hazell

et al. 2020

Clinical Lung Cancer

View full text Add to dashboard Cite

show abstract

“…Sub-lobar resection is enough to get adequate biopsy for diagnostic and palliative purposes; however, lobectomy and lymph node dissection means a more aggressive comprehensive reduction of primary tumor, which might be associated with a better survival outcome. Mitchell et al [5] found that T stage is also the significant prognostic factor in stage IV NSCLC patients, and comprehensive local consolidative therapy would bring survival benefit both according to OS (HR = 0.67, 95% CI 0.46-0.97, P = 0.034). These evidences also supported a more aggressive and thorough local treatment strategy for metastasis NSCLC.…”

Section: Discussionmentioning

confidence: 99%

“…But more recently several clinical studies have shown that local consolidative therapy may be beneficial for stage IV non-small cell lung cancer (NSCLC) patients and improve their survival. [5,6] Daniel et al [7] conducted the first phase II clinical trial considering the effects of local consolidative therapy in combination with systemic treatment. The updated long-term outcomes indicated local consolidative therapy favored progression free survival (PFS) (14.2 months vs 4.4 months; p = 0.022) and overall survival (OS) (41.2 months vs 17.0 months; p = 0.017).…”

Section: Introductionmentioning

confidence: 99%

Surgery for Stage IV Non-Small Cell Lung Cancer: Lobectomy or Sub-lobar Resection?

Liang

Zhang

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background : A survival benefit was observed in metastatic non-small cell lung cancer (NSCLC) patients that underwent operation. But no evidence to support whether lobectomy would further prolong these patients' live than sub-lobar resection. Methods:Patients that underwent primary tumor resection with metastatic NSCLC were identified from the Surveillance, Epidemiology and End Results (SEER) database and then divided into lobectomy and sub-lobar resection groups. A 1:1 propensity score matching (PSM) was performed to balance characters. Cancer specific survival (CSS) was estimated.Results: A total of 24,268 patients with metastatic NSCLC were identified; 4,114 (16.95%) received primary tumor surgery, of which 2,045 (49.71%) underwent lobectomy and 1,766 (42.93%) underwent sub-lobar resection. After PSM, 644 patients in each group were included. Lobectomy was independently correlated with longer median CSS time (HR=0.70, 95% CI 0.61-0.80, P<0.001). The 1, 2 and 3-year survival rate after PSM also favored the lobectomy group. However, no significant survival difference was found in wedge resection and segmentectomy (HR=0.96, 95% CI 0.70-1.31, P=0.490). The 1, 2 and 3-year survival rate after PSM also showed no difference within the sub-lobar group. We explore whether lymph node dissection would provide a further survival benefit for stage IV NSCLC patients. According to the multivariate Cox analysis of the matched population, lymph node dissection was independently associated with better CSS (HR=0.76, 95% CI 0.66-0.88, P<0.001) and OS (HR=0.74, 95% CI 0.65-0.86, P<0.001). We confirmed this result in different types of surgery and found lymph node dissection group persist to have better survival outcomes both in lobectomy group and sub-lobar resection population. According to subgroup analysis, except for stage T4 and brain metastasis patients, all subtype of patients would benefit more from lobectomy than sub-lobar resection.Conclusions: Lobectomy brings survival benefit in metastatic NSCLC patients compared with sublobar resection.

show abstract

“…As SBRT becomes a new standard approach for treating tumors throughout the body in the oligometastatic setting, the incidence of RT-induced bone toxicity is forecasted to increase over time [15][16][17][18][19]. While dose-response relationships have been described and will be reviewed in detail below, it is important to note that RT-induced bone injury is not limited to just ribs and vertebrae or high doses of RT per fraction.…”

Section: Introductionmentioning

confidence: 99%

Bench to Bedside: Animal Models of Radiation Induced Musculoskeletal Toxicity

Farris

Helis

Hughes

et al. 2020

Cancers

View full text Add to dashboard Cite

Ionizing radiation is a critical aspect of current cancer therapy. While classically mature bone was thought to be relatively radio-resistant, more recent data have shown this to not be the case. Radiation therapy (RT)-induced bone loss leading to fracture is a source of substantial morbidity. The mechanisms of RT likely involve multiple pathways, including changes in angiogenesis and bone vasculature, osteoblast damage/suppression, and increased osteoclast activity. The majority of bone loss appears to occur rapidly after exposure to ionizing RT, with significant changes in cortical thickness being detectable on computed tomography (CT) within three to four months. Additionally, there is a dose–response relationship. Cortical thinning is especially notable in areas of bone that receive >40 gray (Gy). Methods to mitigate toxicity due to RT-induced bone loss is an area of active investigation. There is an accruing clinical trial investigating the use of risderonate, a bisphosphonate, to prevent rib bone loss in patients undergoing lung stereotactic body radiation therapy (SBRT). Additionally, several other promising therapeutic/preventative approaches are being explored in preclinical studies, including parathyroid hormone (PTH), amifostine, and mechanical loading of irradiated bones.

show abstract

Improved Overall Survival With Comprehensive Local Consolidative Therapy in Synchronous Oligometastatic Non–Small-Cell Lung Cancer

Cited by 44 publications

References 38 publications

Consolidative Radiotherapy in Oligometastatic Lung Cancer: Patient Selection With a Prediction Nomogram

Consolidative Radiotherapy in Oligometastatic Lung Cancer: Patient Selection With a Prediction Nomogram

Surgery for Stage IV Non-Small Cell Lung Cancer: Lobectomy or Sub-lobar Resection?

Bench to Bedside: Animal Models of Radiation Induced Musculoskeletal Toxicity

Contact Info

Product

Resources

About