Stereotactic body radiotherapy for lung oligometastases impacts on systemic treatment-free survival: a cohort study

Abstract

To analyze the impact of SBRT on systemic treatment-free survival in patients affected by lung oligometastases. Inclusion criteria of the study were (a) KPS > 70, (b) 1-5 lung oligometastases underwent SBRT with a BED ≥ 100 Gy, (c) absence of extra-thoracic disease, (d) controlled primary tumor, (e) metachronous oligorecurrences for whom SBRT was adopted as primary treatment option, (f) oligoprogressive lung metastases who progressed following a disease remission after a first-line therapy, (g) oligopersistent disease after systemic therapy, and (h) at least 6 months of follow-up post-SBRT. Primary study endpoint was the systemic treatment-free survival for each group, whereas distant progression-free survival (DPFS), local failure-free survival (LFFS), and overall survival (OS) were the secondary endpoints. Seventy-eight patients and 114 lung metastases were analyzed. Of these, 32 patients were treated with SBRT in the oligorecurrence group, whereas the remaining patients underwent SBRT for oligoprogressive disease (n = 35) oligopersistent disease (n = 11). In the whole cohort of patients, the median systemic treatment-free survival was 16 months (3-46 months), the median LFFS was 18 months (12-46 months), the median DPFS was 14 months (3-43 months), and the median OS was 19.6 months (12-47 months). Oligorecurrence group had better clinical outcomes in terms of systemic treatment-free survival (log-rank test p = 0.0035) and DPFS (log-rank test p = 0.0017) compared to the other groups. In the present experience, SBRT allowed to delay the administration of systemic treatments in several settings of lung oligometastasis.

Keywords: Lung oligometastases; Oligometastases; Radiotherapy; SBRT; Systemic therapy.