Stereotactic Body Radiation Therapy for Oligoprogressive and Oligorecurrent Non–Small-Cell Lung Cancer

• Published in: Clinical lung cancer 2023-11, Vol.24 (7), p.651-659
• Main Authors: Ebadi, Maryam, Ladbury, Colton, Liu, Jason, Rock, Adam, Onyshchenko, Mykola, Villaflor, Victoria, Villalona-Calero, Miguel, Salgia, Ravi, Massarelli, Erminia, Lee, Percy, Williams, Terence, Amini, Arya
• Format: Article
• Language: English
• Subjects: Metastasis; NSCLC; Oligoprogression; Oligorecurrence; SBRT
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2023.08.015

The role of stereotactic body radiation therapy (SBRT) in oligoprogressive non–small-cell lung cancer (NSCLC) is controversial. We evaluated whether SBRT in a subset of patients with oligoprogressive or oligorecurrent NSCLC offers a durable response, obviating the need to change systemic therapy. A retrospective analysis of 168 NSCLC patients who underwent SBRT for oligoprogressive or oligorecurrent disease was performed. Oligoprogression was defined as progression in ≤5 lesions during or after systemic therapy following an initial complete or partial response. Oligorecurrence was defined as progression while off systemic therapy. Progression-free survival (PFS), overall survival (OS) and time to next treatment or death (TNT-D) were estimated. Median age was 68 years. Sixty-seven percent of patients were on systemic therapy at the time of progression. Progression at the primary site was present in 31% of the patients. The number of sites of metastatic progression was 0 to 2 in 76% and 3 to 5 in 24% of the patients. Two-year OS and PFS were 56% (95%CI 46%-64%) and 14% (95%CI 8%-21%), respectively. Median TNT-D was 9 months (95%CI 6-11). No grade 4 or 5 toxicity was seen. In multivariable analysis, patients with 3 to 5 sites of metastatic progression had worse OS (HR 2.6, 95%CI 1.5-4.3, P < .001) and shorter TNT-D (HR 1.7, 95%CI 1.1-2.5, P = .01) than those with 0 to 2 sites. SBRT is a safe and viable treatment option for oligoprogressive and oligorecurrent NSCLC. Patients with 0 to 2 sites had better OS and longer TNT-D compared to those with 3 to 5 lesions. Stereotactic body radiotherapy (SBRT) in oligoprogressive and oligorecurrent non–small-cell lung cancer (NSCLC) is controversial. We performed a retrospective analysis of NSCLC patients who underwent SBRT for oligoprogressive disease. Two-year overall survival was 56%. The median time to the next treatment or death was 9 months. No grade 4 or 5 toxicity was seen. SBRT is a viable treatment option for oligoprogressive and oligorecurrent NSCLC.