Local ablative radiotherapy for oligometastatic non-small cell lung cancer

Abstract

In metastatic non-small cell lung cancer (NSCLC), the role of radiotherapy (RT) has been limited to palliation to alleviate the symptoms. However, with the development of advanced RT techniques, recent advances in immuno-oncology therapy targeting programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) and targeted agents for epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) translocation allowed new roles of RT in these patients. Within this metastatic population, there is a subset of patients with a limited number of sites of metastatic disease, termed as oligometastasis that can achieve long-term survival from aggressive local management. There is no consensus on the definition of oligometastasis; however, most clinical trials define oligometastasis as having 3 to 5 metastatic lesions. Recent phase II randomized clinical trials have shown that ablative RT, including stereotactic ablative body radiotherapy (SABR) and hypofractionated RT, to primary and metastatic sites improved progression-free survival (PFS) and overall survival (OS) in patients with oligometastatic NSCLC. The PEMBRO-RT study, a randomized phase II study comparing SABR prior to pembrolizumab therapy and pembrolizumab therapy alone, revealed that the addition of SABR improved the overall response, PFS, and OS in patients with advanced NSCLC. The efficacy of RT in oligometastatic lung cancer has only been studied in phase II studies; therefore, large-scale phase III studies are needed to confirm the benefit of local ablative RT in patients with oligometastatic NSCLC. Local intensified RT to primary and metastatic lesions is expected to become an important treatment paradigm in the near future in patients with metastatic lung cancer.

Small cell lung cancer with thyroid gland oligometastasis: A case report

“…as a transitional state between the localized and polymetastatic states, oligometastasis is the state most favorable for local therapy to impact long‐term survival 5 . Recovery rates from oligometastasis have been confirmed in locally treated cases of colorectal cancer as well as in non‐SCLC patients 6,7 . However, since ED‐SCLC is a systemic disease, oligometastatic cases are rare.…”

Oligometastatic Disease in Non-Small-Cell Lung Cancer: An Update

“…For patients with advanced NSCLC and no targetable gene alterations, platinum-based doublet chemotherapy remains the standard first-line treatment [ 1 , 2 , 7 ]. Despite the recent progress in the management of advanced NSCLC, the prognosis of these patients remains poor, and the reported median overall survival is only 8–12 months [ 1 , 7 , 14 ]. By contrast, in patients with targetable gene alterations [ 15 , 16 , 17 , 18 , 19 ], targeted therapies have improved the median overall survival to 26–46 month.…”

Cellular bases of hypofractionated radiotherapy protocols for lung cancer

“…In this sense, attempts are currently being made to impose ablative (stereotactic body radiation therapy, SBRT) or moderate hypofractionated RT (HRT) protocols both in early stages without surgical resolution and in advanced stages (Iyengar et al 2018). The efficacy of these regimens has been shown through phase II clinical trials, which demonstrated better progression-free survival and overall patient survival (Suh & Cho 2019, Folkert & Timmerman 2017, Cuccia et al 2020. Although still under debate, few innovations in RT have had the impact of these modalities, which achieved 85-90% local control (Choi 2019, Murray et al 2017, Weder et al 2018.…”