Ashworth, Allison B; Senan, Suresh; Palma, David A; Riquet, Marc; Ahn, Yong Chan; Ricardi, Umberto; Congedo, Maria T; Gomez, Daniel R; Wright, Gavin M; Melloni, Giulio; Milano, Michael T; Sole, Claudio V; De Pas, Tommaso M; Carter, Dennis L; Warner, Andrew J; Rodrigues, George B
Clinical lung cancer
2014Sep ; 15 ( 5 ) :346-55.
PMID : 24894943
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Ashworth, Allison B - Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Senan, Suresh - Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
Palma, David A - Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Riquet, Marc - Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris, France.
Ahn, Yong Chan - Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ricardi, Umberto - Department of Oncology, University of Turin, Turin, Italy.
Congedo, Maria T - Department of General Thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy.
Gomez, Daniel R - Division of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX.
Wright, Gavin M - University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Australia.
Melloni, Giulio - Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy.
Milano, Michael T - Department of Radiation Oncology, University of Rochester, Rochester, NY.
Sole, Claudio V - Department of Radiation Oncology, Instituto Madrileno de Oncologia, Madrid, Spain.
De Pas, Tommaso M - Thoracic Oncology Division, European Institute of Oncology, Milan, Italy.
Carter, Dennis L - Department of Radiation Oncology, Rocky Mountain Cancer Centers, Aurora, CO.
Warner, Andrew J - Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Rodrigues, George B - Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada. Electronic address george.rodrigues@lhsc.on.ca.
ABSTRACT
INTRODUCTION/BACKGROUND: An individual patient data metaanalysis was performed to determine clinical outcomes, and to propose a risk stratification system, related to the comprehensive treatment of patients with oligometastatic NSCLC. MATERIALS AND
METHODS: After a systematic review of the literature, data were obtained on 757 NSCLC patients with 1 to 5 synchronous or metachronous metastases treated with surgical metastectomy, stereotactic radiotherapy/radiosurgery, or radical external-beam radiotherapy, and curative treatment of the primary lung cancer, from hospitals worldwide. Factors predictive of overall survival (OS) and progression-free survival were evaluated using Cox regression. Risk groups were defined using recursive partitioning analysis (RPA). Analyses were conducted on training and validating sets (two-thirds and one-third of patients, respectively).
RESULTS: Median OS was 26 months, 1-year OS 70.2%, and 5-year OS 29.4%. Surgery was the most commonly used treatment for the primary tumor (635 patients [83.9%]) and metastases (339 patients [62.3%]). Factors predictive of OS were: synchronous versus metachronous metastases (P < .001), N-stage (P = .002), and adenocarcinoma histology (P = .036); the model remained predictive in the validation set (c-statistic = 0.682). In RPA, 3 risk groups were identified: low-risk, metachronous metastases (5-year OS, 47.8%); intermediate risk, synchronous metastases and N0 disease (5-year OS, 36.2%); and high risk, synchronous metastases and N1/N2 disease (5-year OS, 13.8%). CONCLUSION: Significant OS differences were observed in oligometastatic patients stratified according to type of metastatic presentation, and N status. Long-term survival is common in selected patients with metachronous oligometastases. We propose this risk classification scheme be used in guiding selection of patients for clinical trials of ablative treatment. CI - Copyright ??2014 Elsevier Inc. All rights reserved.
keyword
Metastectomy; NSCLC; Oligometastases; Radiotherapy; SABR/SBRT
MESH
Adenocarcinoma/pathology/*therapy, Carcinoma, Non-Small-Cell Lung/pathology/*therapy, Disease-Free Survival, Humans, Lung Neoplasms/pathology/*therapy, Neoplasm Metastasis, Prognosis, Proportional Hazards Models, Risk, Survival Rate
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