Stereotactic ablative radiotherapy and systemic treatments for extracerebral oligometastases, oligorecurrence, oligopersistence and oligoprogression from lung cancer

Manon Kissel,Radj Gervais,Delphine Lerouge,Jean-Michel Grellard,Victor Barraux,Cédric Loiseau,Isabelle Martel-Lafay,Justine Lequesne,Dinu Stefan,Christos Chouaid,Serge Danhier,Cécile Le Péchoux,Juliette Thariat,Jean-Christophe Faivre

doi:10.1186/s12885-019-6449-8

Abstract

BackgroundStereotactic irradiation (SBRT) is a standard of care for inoperable stage I lung cancer and brain oligometastases from lung cancer but is controversial for extracranial oligometastases. We assessed outcomes of lung cancer patients with extracranial metastases in oligometastatic, oligorecurrent, oligopersistent and oligoprogressive settings (“oligometastatic spectrum”) under strategies using SBRT +/− systemic treatments.MethodsA retrospective multicentric study of consecutive lung cancer adult patients with 1–5 extracranial metastases treated with SBRT was conducted.ResultsOf 91 patients (99 metastases, median age 63, 64.8% adenocarcinomas, 19.8% molecular alterations), 11% had oligometastases, 49.5% oligorecurrence, 19.8% oligopersistence and 19.8% oligoprogression. Of 36% of patients under systemic treatments at initiation of SBRT, systemic treatment interruption was performed in 58% of them. With median follow up of 15.3 months, crude local control at irradiated metastases was 91%, while median distant progression-free survival (dPFS) and overall survival were 6.3 and 28.4 months (2-year survival 54%). Initial nodal stage and oligometastatic spectrum were prognostic factors for dPFS; age, initial primary stage and oligometastatic spectrum were prognostic factors for survival on multivariate analysis. Patients with oncogene-addicted tumors more frequently had oligoprogressive disease. Repeat ablative irradiations were preformed in 80% of patients who had oligorelapses. Worst acute toxicities consisted of 5.5% and one late toxic death occurred.ConclusionThe oligometastatic spectrum is a strong prognosticator in patients undergoing SBRT for extracranial metastases. Median survival was over two years but dPFS was about 6 months. Continuation of systemic therapy in oligoprogressive patients should be investigated.

Highlights

Stereotactic irradiation (SBRT) is a standard of care for inoperable stage I lung cancer and brain oligometastases from lung cancer but is controversial for extracranial oligometastases
Patients over 18 were included after ablative stereotactic irradiation on all extracranial oligometastatic lesions from their lung cancer in the following situations of the oligometastatic spectrum: oligometastases at diagnosis, oligorecurrence defined as oligometastatic relapse after primary, oligopersistence defined as stable residual disease sites after systemic treatment and oligoprogression in a polymetastatic context with progressive lesions while all other lesions are controlled with systemic treatment (Fig. 1) [6, 8]
With 28.2-month overall survival and five-year survival rate of 23%, our results are similar to those of clinical trials involving patients not selected on their response to systemic therapy [9]

Summary

Introduction

Stereotactic irradiation (SBRT) is a standard of care for inoperable stage I lung cancer and brain oligometastases from lung cancer but is controversial for extracranial oligometastases. We assessed outcomes of lung cancer patients with extracranial metastases in oligometastatic, oligorecurrent, oligopersistent and oligoprogressive settings (“oligometastatic spectrum”) under strategies using SBRT +/− systemic treatments. Lung cancer is the primary cause of death from cancer among men and second leading cause among women, both in France and worldwide This is primarily due to propensity for metastases. Recent retrospective data suggest that lung metastases from various primaries may benefit from various combinations of stereotactic ablation and systemic treatments that can be personalized based on disease progression and number of metastases [6]. Recent prospective data suggest that consolidative stereotactic irradiation improves survival in primarily polymetastatic lung cancers that have been downstaged to oligometastatic stage after chemotherapy [7]. Series on extracranial metastases from lung cancer are still rare

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Conclusion