Abstract
Local radiotherapy (LRT) is reported to be of survival benefit for advanced non-small cell lung cancer (NSCLC) in accumulating evidence, but research on the optimal initial time point remains scarce. This IRB-approved retrospective analysis identified patients diagnosed with stage IIIb–IV unresectable lung adenocarcinoma who initiated front-line LRT at our institution between 2017 and 2020. The receiver operating characteristic (ROC) curve analyses were used to cut off the initial time of LRT (before and beyond 53 days). Patients were divided into two groups: one early to initiate radiotherapy group (≤53 days, EAR group) and one deferred radiotherapy group (>53 days, DEF group). The Kaplan–Meier method was used to estimate time-to-event endpoints; the Cox proportional hazard model was used to find out predictors of progression-free survival (PFS) and overall survival (OS). A total of 265 patients with a median age of 57 were enrolled. The median follow-up time was 26.4 months (ranging from 2.2 to 69.7 months). The mOS was 38.6 months and mPFS was 12.7 months. Age >60, bone and brain metastases, multisite metastases, and EGFR 19 mutation were independent predictors associated with OS. Early initiation of local radiotherapy within 53 days after diagnosis resulted in better PFS, but not in OS. A better OS was observed in patients with bone metastasis who underwent local radiotherapy initiated within 53 days.
Highlights
Lung cancer ranks only second to breast cancer in incidence and the top above any other cancer in mortality around the world, accounting for 18% of cancer deaths, according to GLOBOCAN 2020 data
We investigate the initial timing of radiation therapy and survival outcome of patients with stage IIIb–IV unresectable lung adenocarcinoma, with or without oncogenic mutations
38.1% patients bore no mutations, 25.7% patients bore EGFR 21, 19.2% EGFR 19, 3.8% ALK, and 13.2% other rare mutations. 154 patients who initiated radiotherapy within 53 days were allocated into the EAR group, and 111 patients that initiated radiotherapy beyond 53 days were allocated into the DEF group
Summary
Lung cancer ranks only second to breast cancer in incidence and the top above any other cancer in mortality around the world, accounting for 18% of cancer deaths, according to GLOBOCAN 2020 data. Several remarkable prospective randomized trials have demonstrated the profit from local consolidative intervention not merely in local control and in survival outcome for patients with advanced NSCLC. The first multi-institutional randomized trial led by the MD Anderson Cancer Center demonstrated the progression-free survival and overall survival benefit in local consolidative therapy compared with standard maintenance therapy [15, 16]. Another randomized trial contemporaneously led by investigators at the University of Texas revealed that stereotactic ablative radiotherapy (SABR) in addition to induction systemic therapy and maintenance therapy prolonged progression-free survival (PFS) from 3.5 to 9.7 months [17]. The third randomized trial that showed a considerable improvement in survival with the implementation of SABR for patients with oligometastatic disease was the SABR-COMET trial, of which NSCLC patients took up approximately 18% patients enrolled [18]
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