Cancer Res Treat.  2024 Jan;56(1):115-124. 10.4143/crt.2023.600.

Aggressive Local Ablative Radiotherapy Mitigates Progression Risk in Oligometastatic Lung Adenocarcinoma

• Yang G
• Kim KH
• Lee CG
• Hong MH
• Kim HR
• Cho Y
• Yoon HI

• KMID: 2550328
• DOI: http://doi.org/10.4143/crt.2023.600

Abstract

Purpose
This study aimed to determine the role of local ablative radiotherapy (LART) in oligometastatic/oligoprogressive lung adenocarcinoma.
Materials and Methods
Patients (n=176) with oligometastatic lung adenocarcinoma treated with LART were identified, and those treated with LART at the initial diagnosis of synchronous oligometastatic disease (OMD group) or treated with LART when they presented with repeat oligoprogression (OPD group) were included.
Results
In the OMD group (n=54), the 1- and 3-year progression-free survival (PFS) were 50.9% and 22.5%, respectively, whereas the 1- and 3-year overall survival in the OPD group were 75.9% and 58.1%, respectively. Forty-one patients (75.9%) received LART at all gross disease sites. Tyrosine kinase inhibitor (TKI) use and all-metastatic site LART were significant predictors of higher PFS (p=0.018 and p=0.046, respectively). In patients treated with TKIs at the time of LART (n=23) and those treated with all-metastatic site LART, the 1-year PFS was 86.7%, while that of patients not treated with all-metastatic site LART was 37.5% (p=0.006). In the OPD group (n=122), 67.2% of the patients (n=82) maintained a systemic therapy regimen after LART. The cumulative incidence of changing systemic therapy was 39.6%, 62.9%, and 78.5% at 6 months, 1 year, and 2 years after LART, respectively.
Conclusion
Aggressive LART can be an option to improve survival in patients with oligometastatic disease. Patients with synchronous oligometastatic disease receiving TKI and all-metastatic site LART may have improved PFS. In patients with repeat oligoprogression, LART might potentially extend survival by delaying the need to change the systemic treatment regimen.

Keyword

Lung neoplasms; Adenocarcinoma; Radiosurgery; Progression-free survival

Figure

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  Fig. 1. Probability of progression-free survival (A) and overall survival (B) in the oligometastasis group (n=54). LART, local ablative radiotherapy.

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  Fig. 2. (A) Progression-free survival of the patients in the oligometastasis group treated with tyrosine kinase inhibitors (TKIs, n=23) with all-metastatic site local ablative radiotherapy (LART) or not all-metastatic site LART. (B) Progression-free survival of patients who were treated with or without TKIs in the oligometastasis group (n=54).

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  Fig. 3. Cumulative incidence of changing systemic therapy in the oligoprogression group (n=122). LART, local ablative radiotherapy.

Reference

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