Sublobar Resection, Stereotactic Body Radiation Therapy, and Percutaneous Ablation Provide Comparable Outcomes for Lung Metastasis-Directed Therapy

Abstract

BackgroundProlonged survival of patients with metastatic disease has furthered interest in metastasis-directed therapy (MDT). Research QuestionThere is a paucity of data comparing lung MDT modalities. Do outcomes among sub-lobar resection (SLR), stereotactic body radiation therapy (SBRT), and percutaneous ablation (PA) for lung metastases vary in terms of local control and survival? Study Design and MethodsMedical records of patients undergoing lung MDT at a single cancer center between January 2015 and December 2020 were reviewed. Overall survival (OS), local progression (LP), and toxicity outcomes were collected. Patient and lesion characteristics were used to generate multivariable models with propensity weighted analysis. ResultsLung MDT courses (644 total: 243 SLR, 274 SBRT, 127 PA) delivered to 511 patients were included with a median follow-up of 22 months. There were 47 LP events in 45 patients, and 159 patients had died. Two-year OS and LP were 80.3%, 63.3%, 83.8% and 9.6%, 4.1%, 11.7% for SLR, SBRT, and PA, respectively. Lesion size per 1 cm was associated with worse OS (hazard ratio [HR] 1.24, p=0.003) and LP (HR 1.50, p<0.001). There was no difference in OS by modality. Relative to SLR, there was no difference in risk of LP with PA, although SBRT was associated with a decreased risk (HR 0.26, p=0.023). Rates of severe toxicity were low (2.1-2.6%) and not different among groups. InterpretationThe current study performs a propensity weighted analysis of SLR, SBRT, and PA and shows no impact of lung MDT modality on OS. Given excellent local control across MDT options, a multidisciplinary approach is beneficial for patient triage and longitudinal management.