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Clin Lung Cancer. 2019 Nov;20(6):e667-e677. doi: 10.1016/j.cllc.2019.06.024. Epub 2019 Jun 27.

Long-term Follow-up and Patterns of Recurrence of Patients With Oligometastatic NSCLC Treated With Pulmonary SBRT.

Author information

1
Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: juliane.hoerner-rieber@med.uni-heidelberg.de.
2
Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany.
3
Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
4
Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
5
Department of Radiation Oncology, University Muenster, Muenster, Germany.
6
Department of Radiation Oncology, LMU Ludwig Maximilians University Munich, Munich, Germany.
7
Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.
8
Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany.
9
Department of Radiotherapy and Special Oncology, Medical School Hannover, Hannover, Germany.
10
CyberKnife Center Erfurt, Erfurt, Germany.
11
Department of Radiation Oncology, University of Rostock, Rostock, Germany.
12
Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany.
13
Department of Radiation Oncology, Hospital Augsburg, Augsburg, Germany.
14
Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany; Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
15
Gamma Knife Centre Krefeld, Krefeld, Germany.
16
Department of Radiation Oncology, Helios Klinikum Berlin Buch, Berlin, Germany.
17
Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Marburg, Germany.
18
Department of Radiation Oncology, Medical Faculty and University Hospital C.G. Carus, Technical University Dresden, Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK) Partner Site Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
19
Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tuebingen, Tuebingen, Germany.
20
Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
21
Radiation Oncology, Freising, Germany.
22
Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
23
Department of Radiation Oncology, Hospital Heidenheim, Heidenheim, Germany.
24
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
25
Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Jena, Germany.
26
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Abstract

INTRODUCTION:

This multicenter study aims to analyze outcome as well as early versus late patterns of recurrence following pulmonary stereotactic body radiotherapy (SBRT) for patients with oligometastatic non-small-cell lung cancer (NSCLC).

MATERIALS AND METHODS:

This analysis included 301 patients with oligometastatic NSCLC treated with SBRT for 336 lung metastases. Although treatment of the primary tumor consisted of surgical resection, radiochemotherapy, and/or systemic therapy, pulmonary oligometastases were treated with SBRT.

RESULTS:

The median follow-up time was 16.1 months, resulting in 2-year overall survival (OS), local control (LC), and distant control (DC) of 62.2%, 82.0%, and 45.2%, respectively. Multivariate analysis identified age (P = .019) and histologic subtype (P = .028), as well as number of metastatic organs (P < .001) as independent prognostic factors for OS. LC was superior for patients with favorable histologic subtype (P = .046) and SBRT with a higher biological effective dose at isocenter (P = .037), whereas DC was inferior for patients with metastases in multiple organs (P < .001) and female gender (P = .027). Early (within 24 months) local or distant progression was observed in 15.3% and 36.5% of the patients. After 24 months, the risk of late local failure was low, with 3- and 4-year local failure rates of only 4.0%, and 7.6%. In contrast, patients remained at a high risk of distant progression with 3- and 4-year failure rates of 13.3% and 24.1%, respectively, with no plateau observed.

CONCLUSION:

SBRT for pulmonary oligometastatic NSCLC resulted in favorable LC and promising OS. The dominant failure pattern is distant with a continuously high risk of disease progression for many years.

KEYWORDS:

Local therapy; Non–small-cell lung cancer (NSCLC); Oligometastases; Patterns of recurrence; Stereotactic body radiotherapy

PMID:
31327644
DOI:
10.1016/j.cllc.2019.06.024
[Indexed for MEDLINE]

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