Treatment patterns and survival after 18F-fluorodeoxyglucose positron emission tomography/computed tomography-guided local consolidation therapy for oligometastatic non-small cell lung cancer: a two-center propensity score-matched analysis

Abstract

Purpose In this retrospective study, we evaluated the treatment patterns and survival after positron emission tomographycomputed tomography (PET/CT)-guided local consolidation therapy (LCT) for oligometastatic non-small cell lung cancer (NSCLC). Methods We reviewed the medical records of Chinese patients with oligometastatic stage IV non-small cell lung cancer (≤ 5 metastases) who had undergone PET/CT and were eligible for systemic therapy at two centers between May 2005 and August 2019. Propensity score matching (1:1) was used to reduce selection bias and imbalanced distribution of confounding factors. Results We identified 84 eligible patients and used propensity scores to create well-matched groups of 35 patients who did or did not undergo LCT. Among all patients, the 1-year overall survival (OS) rate was 47.6% and the 2-year OS rate was 22.6%. Relative to the group that did not receive LCT, the LCT group had a significantly higher OS rate (13 months vs. 7 months, p = 0.002). The two groups had similar incidences and classifications of LCT-related side effects. In multivariable analysis, LCT was found to be strongly associated with a favorable OS (hazard ratio: 0.508, 95% confidence interval: 0.311-0.828, p = 0.001). Conclusion We concluded that LCT was significantly associated with improved clinical outcomes among the Chinese patients with oligometastatic NSCLC who were eligible for systemic treatment and could undergo PET/CT evaluation.

Thorax radiotherapy using 18F-positron emission tomography/computed tomography-guided precision radiotherapy is a prognostic factor for survival in patients with extracranial oligometastatic non-small cell lung cancer:A two-center propensity score-matched analysis

“…Both trials reported a significant increase in PFS by increasing aggressive local therapy. Moreover, our previous study showed that PET/CT-guided LCT was significantly effective in patients with oligometastatic advanced lung cancer [7]. Overall survival rates were much higher in the LCT group than in the chemotherapy alone group (13 months vs. 7 months, (p = 0.002).…”

“…In patients with nonsmall-cell lung cancer (NSCLC) receiving systemic therapy such as chemotherapy, the most common progression site is the original disease site (3)(4)(5)(6). Our previous studies have shown that aggressive local consolidation therapy may destroy lesions, slow disease progression, and even improve patient survival (7). The results of a recent meta-analysis showed that combination local therapy in patients with metastatic NSCLC improved patient progression-free survival (PFS) and overall survival (OS) and did not increase grade ≥3 adverse events.…”

“…We demonstrated that local consolidation therapy (LCT) is superior to maintenance therapy in patients with oligometastatic NSCLC receiving PET/CT guidance ( 7 ). However, we did not directly compare NSCLC patients who underwent PET/CT to those who underwent conventional CT, and there is no direct evidence to confirm a significant difference in the prognostic benefit between these two screening methods in patients with oligometastatic NSCLC.…”

In 18F-positron emission tomography/computed tomography-guided precision radiotherapy for centrally located non-small cell lung cancer, tumor related atelectasis is a prognostic factor of survival

“…The purpose of consolidation radiation is to improve the control rate of the primary tumor area and prevent distant metastasis. In our previous study, local consolidation treatment for patients with stage IV oligometastatic NSCLC can improve patient outcomes to some extent ( 20 ). Local consolidation treatment may cause modest toxicity, but can improve overall survival.…”

International consensus on radiotherapy in metastatic non-small cell lung cancer

“…Accumulating evidence suggests local consolidative radiotherapy could improve survival in patients with metastatic NSCLC ( 93 ). A multicenter, retrospective study reviewed 84 cases of stage IV NSCLC treated with systemic therapy and found the OS was significantly higher in patients undergoing local consolidative radiotherapy than in those who did not (13 vs. 7 months, P=0.002) ( 94 ). The survival benefit of consolidative radiotherapy is more apparent in highly selected patients, and in patients with limited metastatic NSCLC without EGFR- or ALK-mutations, SBRT prior to maintenance chemotherapy nearly tripled PFS to 9.7 months compared with maintenance therapy alone, with no difference in toxic effects ( 11 ).…”