Outcome of radical local treatment of non-small cell lung cancer patients with synchronous oligometastases

Abstract

Objectives: Patients with stage IV non-small cell lung cancer (NSCLC) are considered incurable and are mainly treated with palliative intent. This patient group has a poor overall survival (OS) and progression free survival (PFS). The purpose of this study was to investigate PFS and OS of NSCLC patients diagnosed with synchronous oligometastatic disease who underwent radical treatment of both intrathoracic disease and metastases.

Materials and methods: Patients with NSCLC and oligometastatic disease at diagnosis, who were treated with radical intent between 2008 and 2016, were included in this observational study. Treatment consisted of systemic treatment and radical radiotherapy or resection of the intrathoracic disease. Treatment of the metastases consisted of radical or stereotactic radiotherapy, surgical resection or radiofrequency ablation.

Results and conclusions: Ninety-one patients (52% men, mean age 60 years) in good performance status were included. Thirty-eight patients (42%) died during follow-up (median follow-up 35 months). The cause of dead was lung cancer in all patients, except one. Sixty-three (69%) patients developed recurrent disease. Eleven recurrences (17%) occurred within the irradiated area. For the whole group, the median PFS was 14 months (range 2-89, 95%CI 12-16) and the median OS was 32 months (range 3-89, 95%CI 25-39). The 1- and 2-year OS rates were 85% and 58% and the 1- and 2-year PFS rates were 55% and 27%, respectively. Radical local treatment of a selected group of NSCLC patients with good performance status presenting with synchronous oligometastatic disease resulted in favorable long-term PFS and OS.

Keywords: Lung cancer; NSCLC; Oligometastatic disease; Stereotactic radiotherapy; Surgery.