Abstract
BackgroundStereotactic body radiotherapy (SBRT) is increasingly used to treat oligometastatic disease (OMD), but the effect of metastasis timing on patient outcomes remains uncertain.MethodsAn international database of patients with OMD treated with SBRT was assembled with rigorous quality assurance. Early versus late metastases were defined as those diagnosed ≤24 versus >24 months from the primary tumor. Overall survival (OS), progression‐free survival (PFS), and incidences of wide‐spread progression (WSP) were estimated using multivariable Cox proportional hazard models stratified by primary tumor types.ResultsThe database consists of 1033 patients with median follow‐up of 24.1 months (0.3–104.7). Late metastatic presentation (N = 427) was associated with improved OS compared to early metastasis (median survival 53.6 vs. 33.0 months, hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.47–0.72, p < 0.0001). Patients with non‐small cell lung cancer (NSCLC, N = 255, HR 0.49, 95% CI: 0.33–0.74, p = 0.0005) and colorectal cancer (N = 235, HR 0.50, 95% CI: 0.30–0.84, p = 0.008) had better OS if presenting with late metastasis. Late metastasis correlated with longer PFS (median 17.1 vs. 9.0 months, HR 0.71, 95% CI: 0.61–0.83, p < 0.0001) and lower 2‐year incidence of WSP (26.1% vs. 43.6%, HR 0.60, 95% CI: 0.49–0.74, p < 0.0001). Fewer WSP were observed in patients with NSCLC (HR 0.52, 95% CI: 0.33–0.83, p = 0.006) and kidney cancer (N = 63, HR 0.37, 95% CI: 0.14–0.97, p = 0.044) with late metastases. Across cancer types, greater SBRT target size was a significant predictor for worse OS.ConclusionLate metastatic presentation is associated with improved survival and delayed progression in patients with OMD treated with SBRT.
Highlights
Patients with limited metastatic disease may benefit from aggressive metastasis- directed local therapy (MDT)
To understand whether the superior Overall survival (OS) in patients with late metastatic presentation was due to delayed disease progression, we examined progression-free survival (PFS) (Figure 2; Table 3) and incidences of wide-spread progression (WSP) (Figure 3; Table 4) in relation to metastasis timing
Using the definition of early (≤24 months of primary tumor diagnosis) versus late metastasis (>24 months), metastatic presentation was a significant predictor for disease progression and survival after Stereotactic body radiotherapy (SBRT) for oligometastatic disease (OMD) in a large, diverse, and well-characterized patient cohort
Summary
Patients with limited metastatic disease may benefit from aggressive metastasis- directed local therapy (MDT). Prospective clinical trials have demonstrated the efficacy of stereotactic body radiotherapy (SBRT) in patients with oligometastatic disease (OMD).1–6 The recently updated SABR-C OMET study demonstrated significantly higher 5- year overall survival (OS) among patients receiving SBRT than those who did not.[7] Incorporating SBRT into the treatment paradigm of OMD may slow disease progression, delay the need to initiate or change systemic therapy, and prolong survival.3,8–11 appropriate selection criteria for patients who may benefit most from metastasis-directed SBRT remains elusive Relevant clinical markers, such as timing of metastatic presentation, may be useful indicators of the underlying tumor biology and inform patient selection.
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