Long-term Follow-up and Patterns of Recurrence of Patients With Oligometastatic NSCLC Treated With Pulmonary SBRT

• Published in: Clinical lung cancer 2019-11, Vol.20 (6), p.e667-e677
• Main Authors: Hörner-Rieber, Juliane, Bernhardt, Denise, Blanck, Oliver, Duma, Marciana, Eich, Hans Th, Gerum, Sabine, Gkika, Eleni, Hass, Peter, Henkenberens, Christoph, Herold, Hans-Ulrich, Hildebrandt, Guido, Imhoff, Detlef, Kahl, Henning, Janssen, Stefan, Jurianz, Katrin, Krempien, Robert, Lautenschläger, Stefan Friedrich, Lohaus, Fabian, Mueller, Arndt-Christian, Petersen, Cordula, Sackerer, Irina, Scafa, Davide, Schrade, Elsge, Uhlmann, Lorenz, Wittig, Andrea, Guckenberger, Matthias
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - radiotherapy; Disease Progression; Female; Follow-Up Studies; Humans; Local therapy; Lung - pathology; Lung - radiation effects; Lung Neoplasms - diagnosis; Lung Neoplasms - mortality; Lung Neoplasms - radiotherapy; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Non–small-cell lung cancer (NSCLC); Oligometastases; Patterns of recurrence; Radiosurgery - methods; Stereotactic body radiotherapy; Survival Analysis; Time Factors; Treatment Outcome
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2019.06.024

This multicenter study aims to analyze outcome as well as early versus late patterns of recurrence following pulmonary stereotactic body radiotherapy (SBRT) for patients with oligometastatic non–small-cell lung cancer (NSCLC). This analysis included 301 patients with oligometastatic NSCLC treated with SBRT for 336 lung metastases. Although treatment of the primary tumor consisted of surgical resection, radiochemotherapy, and/or systemic therapy, pulmonary oligometastases were treated with SBRT. The median follow-up time was 16.1 months, resulting in 2-year overall survival (OS), local control (LC), and distant control (DC) of 62.2%, 82.0%, and 45.2%, respectively. Multivariate analysis identified age (P = .019) and histologic subtype (P = .028), as well as number of metastatic organs (P < .001) as independent prognostic factors for OS. LC was superior for patients with favorable histologic subtype (P = .046) and SBRT with a higher biological effective dose at isocenter (P = .037), whereas DC was inferior for patients with metastases in multiple organs (P < .001) and female gender (P = .027). Early (within 24 months) local or distant progression was observed in 15.3% and 36.5% of the patients. After 24 months, the risk of late local failure was low, with 3- and 4-year local failure rates of only 4.0%, and 7.6%. In contrast, patients remained at a high risk of distant progression with 3- and 4-year failure rates of 13.3% and 24.1%, respectively, with no plateau observed. SBRT for pulmonary oligometastatic NSCLC resulted in favorable LC and promising OS. The dominant failure pattern is distant with a continuously high risk of disease progression for many years. This multicenter analysis included 301 patients with oligometastatic non–small-cell lung cancer treated with pulmonary stereotactic body radiotherapy for 336 lung metastases. In routine clinical practice, stereotactic body radiotherapy for pulmonary oligometastatic non–small-cell lung cancer achieved favorable local control and promising overall survival. The dominant failure pattern was distant with a continuously high risk of disease progression for many years. Prospective studies should therefore combine local therapy with novel systemic treatments.