Allison B Ashworth1, Suresh Senan2, David A Palma1, Marc Riquet3, Yong Chan Ahn4, Umberto Ricardi5, Maria T Congedo6, Daniel R Gomez7, Gavin M Wright8, Giulio Melloni9, Michael T Milano10, Claudio V Sole11, Tommaso M De Pas12, Dennis L Carter13, Andrew J Warner1, George B Rodrigues14. 1. Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada. 2. Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands. 3. Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris, France. 4. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 5. Department of Oncology, University of Turin, Turin, Italy. 6. Department of General Thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy. 7. Division of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX. 8. University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Australia. 9. Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy. 10. Department of Radiation Oncology, University of Rochester, Rochester, NY. 11. Department of Radiation Oncology, Instituto Madrileño de Oncología, Madrid, Spain. 12. Thoracic Oncology Division, European Institute of Oncology, Milan, Italy. 13. Department of Radiation Oncology, Rocky Mountain Cancer Centers, Aurora, CO. 14. 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.
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 NSCLCpatients 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.
Authors: Concetta Elisa Onesti; Daniela Iacono; Silvia Angelini; Salvatore Lauro; Marco Mazzotta; Mario Alberto Occhipinti; Raffaele Giusti; Paolo Marchetti Journal: Transl Lung Cancer Res Date: 2016-12