Abstract
BackgroundSuccessful local therapy for oligometastases may lead to longer survival. The purpose of this multicentre retrospective study was to investigate factors affecting the local control (LC) of pulmonary oligometastases treated by stereotactic body radiotherapy (SBRT) and to investigate the impact of LC on survival.MethodsThe inclusion criteria included 1 to 5 metastases, the primary lesion and other extrathoracic metastases were controlled before SBRT, and the biological effective dose (BED10) of the SBRT was 75 Gy or more. The Cox proportional hazards model was used for analyses.ResultsData of 1378 patients with 1547 tumours from 68 institutions were analysed. The median follow-up period was 24.2 months. The one-year, 3-year and 5-year LC rates were 92.1, 81.3 and 78.6%, respectively, and the 1-year, 3-year and 5-year overall survival rates were 90.1, 60.3 and 45.5%, respectively. Multivariate analysis for LC showed that increased maximum tumour diameter (p = 0.011), type A dose calculation algorithm (p = 0.005), shorter overall treatment time of SBRT (p = 0.035) and colorectal primary origin (p < 0.001 excluding oesophagus origin) were significantly associated with a lower LC rate. In the survival analysis, local failure (p < 0.001), worse performance status (1 vs. 0, p = 0.013; 2–3 vs. 0, p < 0.001), oesophageal primary origin (vs. colorectal origin, p = 0.038), squamous cell carcinoma (vs. adenocarcinoma, p = 0.006) and increased maximum tumour diameter (p < 0.001) showed significant relationships with shorter survival.ConclusionsSeveral factors of oligometastases and SBRT affected LC. LC of pulmonary oligometastases by SBRT showed a significant survival benefit compared to patients with local failure.
Highlights
Successful local therapy for oligometastases may lead to longer survival
Control of the primary lesion is important in the oligometastatic state, and the classification of oligometastases according to the activity of the primary lesion is important when metastasis-directed therapy is to be performed
An investigation to determine whether there is a survival difference between patients with pulmonary oligorecurrences and patients with sync-oligometastases after establishing control of the primary lesion was performed in Japan, and it was shown by our group that patients with oligo-recurrences had a survival advantage compared with those with sync-oligometastases [13]
Summary
Successful local therapy for oligometastases may lead to longer survival The purpose of this multicentre retrospective study was to investigate factors affecting the local control (LC) of pulmonary oligometastases treated by stereotactic body radiotherapy (SBRT) and to investigate the impact of LC on survival. Some prospective trials and many retrospective studies of metastatic disease have shown improvement in the survival of patients treated with surgery or radiotherapy for the primary lesion, systemic therapy has been the standard treatment [1,2,3,4,5]. Some phase 2 studies have revealed that intensive local therapy for the primary lesion and for all known oligometastases improved overall survival and disease-free survival of patients, and the results of a future phase 3 trial are awaited [8,9,10]. The question is whether successful local therapy for pulmonary oligometastases leads to longer survival or not and what factors affect local control (LC)
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