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. 2012 Sep 1;84(1):e61-7.
doi: 10.1016/j.ijrobp.2012.02.054. Epub 2012 Apr 13.

Prognostic impact of radiation therapy to the primary tumor in patients with non-small cell lung cancer and oligometastasis at diagnosis

Jose Luis Lopez Guerra  1 , Daniel Gomez, Yan Zhuang, David S Hong, John V Heymach, Stephen G Swisher, Steven H Lin, Ritsuko Komaki, James D Cox, Zhongxing Liao
Affiliations

Prognostic impact of radiation therapy to the primary tumor in patients with non-small cell lung cancer and oligometastasis at diagnosis

Jose Luis Lopez Guerra et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: We investigated prognostic factors associated with survival in patients with non-small cell lung cancer (NSCLC) and oligometastatic disease at diagnosis, particularly the influence of local treatment to the primary site on prognosis.

Methods and materials: From January 2000 through June 2011, 78 consecutive patients with oligometastatic NSCLC (<5 metastases) at diagnosis underwent definitive chemoradiation therapy (≥45 Gy) to the primary site. Forty-four of these patients also received definitive local treatment for the oligometastases. Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses.

Results: Univariate Cox proportional hazard analysis revealed better overall survival (OS) for those patients who received at least 63 Gy of radiation to the primary site (P=.002), received definitive local treatment for oligometastasis (P=.041), had a Karnofsky performance status (KPS) score >80 (P=.007), had a gross tumor volume ≤124 cm³ (P=.002), had adenocarcinoma histology (P=.002), or had no history of respiratory disease (P=.016). On multivariate analysis, radiation dose, performance status, and tumor volume retained significance (P=.004, P=.006, and P<.001, respectively). The radiation dose also maintained significance when patients with and without brain metastases were analyzed separately.

Conclusions: Tumor volume, KPS, and receipt of at least 63 Gy to the primary tumor are associated with improved OS in patients with oligometastatic NSCLC at diagnosis. Our results suggest that a subset of such patients may benefit from definitive local therapy.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier curves for all 78 patients for overall survival (A), progression-free survival (B), local-regional control inside the radiation field (C), and distant metastasis-free survival (D).
Fig. 2
Fig. 2
Overall survival (A), progression-free survival (B), and local-regional control (C) according to the radiation dose to the primary tumor.
Fig. 3
Fig. 3
Overall survival according to radiation dose and Karnofsky performance score (KPS) (A) or radiation dose and gross tumor volume (GTV) (B).
See this image and copyright information in PMC

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