Abstract
Background and PurposeFor metastatic non-small cell lung cancer (NSCLC) patients with controlled extrathoracic disease after systemic treatment, stable or progressive primary lung lesions may cause respiratory symptoms and increase comorbidities. In the present study, we sought to investigate whether aggressive palliative thoracic radiotherapy (RT) can enhance local control and improve the survival for this subgroup of patients.Materials and MethodsBetween March 2006 and December 2014, 56 patients with metastatic NSCLC who had responsive or stable extrathoracic diseases after chemotherapy and/or molecular targets, and received thoracic RT for stable and progressive primary lung lesions were included. RT with a median dose of 55 Gy (range, 40–62 Gy) was administered in 1.8–2.5 Gy fractions to primary lung tumor and regional mediastinal lymph nodes using modern RT technique. Overall survival (OS) from diagnosis, and locoregional progression-free survival (LRPFS), and survival calculated from radiotherapy (OS-RT) were estimated using the Kaplan-Meier method.ResultsThere were 37 men and 19 women with a median age of 60 years at diagnosis. The median interval from the diagnosis of metastatic disease to thoracic RT was 8 months. Following thoracic RT, 26 patients (46%) achieved complete or partial response (overall response rate, ORR). Patients with squamous cell carcinoma or poorly-differentiated carcinoma had a higher ORR than those with adenocarcinoma (63% vs. 34%, P = 0.034). EGFR mutations was closely associated with a better ORR (45% vs. 29%, P = 0.284). At a median follow-up time of 44 months, the median OS, LRPFS after RT, and OS-RT were 50 months, 15 months, and 18 months.ConclusionRadical palliative throractic RT is safe and might be beneficial for primary lung lesions of metastatic NSCLC patients with controlled extrathoracic diseases.
Highlights
Approximately 50% of patients with non-small cell lung cancer (NSCLC) presented with metastatic disease at initial diagnosis; and the outcome of these patients is poor with a median overall survival of less than 1 year [1]
A total of 56 patients with metastatic NSCLC were included in this study
Our results demonstrate that in patients with metastatic NSCLC with controlled extrathoracic disease, radical thoracic RT with a median dose of 55 Gy resulted in an ORR of 46% and 2-year locoregional progression-free survival (LRPFS) and Overall survival (OS) of 27% and 41%, respectively, after the completion of RT
Summary
Approximately 50% of patients with non-small cell lung cancer (NSCLC) presented with metastatic disease at initial diagnosis; and the outcome of these patients is poor with a median overall survival of less than 1 year [1]. Considering the additional thoracic RT may enhance local control, in clinical practice, we usually treat metastatic NSCLC patients who had controlled metastatic disease with aggressive RT for residual and progressive primary lung and mediastinal lesions in our institute. For metastatic non-small cell lung cancer (NSCLC) patients with controlled extrathoracic disease after systemic treatment, stable or progressive primary lung lesions may cause respiratory symptoms and increase comorbidities. We sought to investigate whether aggressive palliative thoracic radiotherapy (RT) can enhance local control and improve the survival for this subgroup of patients
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