Abstract
Metastatic non-small cell lung cancer (NSCLC) is associated with a limited survival when treated with palliative intent platinum-based chemotherapy alone. Recent advances in imaging and therapeutic strategy have identified a subset of patients with limited metastases who may benefit from early local ablative therapy with either surgery or radiotherapy, in addition to standard treatment. Stereotactic body radiotherapy (SBRT) is increasingly used in the treatment of extra-cranial oligometastatic NSCLC (OM-NSCLC) due its non-invasive conduct and ability to deliver high doses. Clinical evidence supporting the use of SBRT in OM-NSCLC is emerging and consistently demonstrates significant benefit in local control and progression-free survival. Here, we discuss the definition of oligometastases (OM), review current available data on SBRT treatment in extra-cranial OM-NSCLC including evidence for site-specific SBRT in lung, liver, and adrenal metastases.
Highlights
Lung cancer continues to be the leading cause of cancer death in many countries [1]
Stage IV Non-small Cell Lung Cancer (NSCLC) represents a heterogenous group of patients with an overall poor outcome
All authors wrote sections of the manuscript, contributed to manuscript revision, read, and approved the submitted version
Summary
Lung cancer continues to be the leading cause of cancer death in many countries [1]. about two-thirds of non-small cell lung cancer (NSCLC) patients present with metastatic disease (Stage IV) at diagnosis and are considered incurable [2]. In terms of classifying oligometastatic cancer, there are three possible scenarios: 1) Synchronous oligometastatic disease: Patients who present with up to 5 metastatic lesions (in one or a few organs) at first or within 6 months of diagnosis These typically occur in the brain, lung parenchyma, liver or bone [15]. A) Lung: Prior studies on SBRT in primary NSCLC have reported local control rate comparable to surgery when the biologically effective dose (BED) of SBRT was at least 100 Gy [29,30,31,32]. Milano et al evaluated the use of 50 Gy in 5 fractions for SBRT to treat hepatic metastases (∼20% lung primary) and reported a 2-year local control rate of 67% [39]. SBRT for adrenal metastases is reasonably tolerated with previous studies reporting grade 1–2 toxicities including gastrointestinal toxicity, fatigue, rarely duodenal ulcers, and possibly late adrenal insufficiency [42, 44, 45]
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