Initial Results of a Multicenter Phase 2 Trial of Stereotactic Ablative Radiation Therapy for Oligometastatic Cancer

Abstract

Oligometastatic disease has emerged as a potentially curable state in the spectrum of cancer progression. Aggressive local therapy such as stereotactic ablative radiation therapy (SABR) may improve oncologic outcomes. Herein, we report the initial oncologic outcomes and patient-reported quality of life (PR-QoL) from a phase 2 multicenter trial for patients with oliogmetastatic disease. Patients with oligometastatic disease (1-5 metastases) were prospectively recruited between 2011 and 2017. SABR dose and fractionation was dependent on the lesion size and location. Patient follow-up occurred within 6weeks of completion of SABR and at 3-month intervals. Patients received a Functional Assessment of Cancer Therapy-General questionnaire at baseline and at each follow-up to assess for PR-QoL. Median follow-up was calculated by reverse Kaplan-Meier method. Overall survival (OS), local progression-free survival, and distant progression-free survival were calculated using the Kaplan-Meier method. We enrolled 147 patients with oligometastatic cancer with a median age of 66.4years (interquartile range, 59.9-74.6). The most common primary tumors included lung (21.8%, non-small cell: n=29, small cell: n=3), colorectal adenocarcinoma (21.1%), and head and neck (10.9%, squamous cell carcinoma: n=11). In a median follow-up of 41.3months (interquartile range: 14.6-59.0), the median OS was 42.3months (95% confidence interval: 27.4-∞) with 5-year OS of 43%. Five-year local progression-free survival and distant progression-free survival were 74% and 17%, respectively. Acute grade 2+and 3+toxicity were 7.5% and 2.0%, respectively, and late grade 2+and 3+toxicity were both 1.4%. There was no significant change in quality of life at completion and 6weeks, 3months, and 9months after treatment. At 6 and 12months, patients were found to have statistically significant improvement in PR-QoL. This multicenter prospective phase 2 study demonstrates that SABR for recurrent oligometastatic cancer is a feasible and tolerable treatment option with minimal acute and late grade 3 toxicity. Additionally, PR-QoL was not adversely affected.