Prognostic Impact of Ablative Therapy in Oligometastatic Non-Small-Cell Lung Cancer (NSCLC) with Unresectable Primary Tumor

Abstract

Purpose: Patients with Oligometastatic (OM) non-small-cell lung cancer (NSCLC) (≤ 3 metastases) might benefit from radical ablative treatment of both primary tumor and metastases. However, the role of ablative therapy in OM patients with locally advance primary tumor has not been evaluated. The aim of our study was to analyze the efficacy and safety of ablative treatment in patients with unresectable primary tumor and synchronous Oligometastases, in terms of response rate, progression free survival (PFS) and overall survival (OS). Methods/Patients: Retrospective study of patients with Oligometastatic NSCLC (≤ 3 lesions in a unique location) and unresectable primary tumor, treated with radical intent (chemo-radiotherapy for primary tumor and surgery, radiotherapy, Stereotactic Body Radiation Therapy (SBRT) or radiofrequency for all known metastases) between October 2011 and March 2015. Results: Thirty patients met inclusion criteria. Median age was 58 years, 76.6% were male, and 96.6% had ECOG 0-1. Histology: Adenocarcinoma (63.6%), squamous carcinoma (20%), and other histology (13.4%). All patients had unresectable primary tumor and/or mediastinal lymph nodes. Site of metastases: brain (46.6%), lung (23.3%), bone (20%), other locations (9.9%). Sequential thoracic radiotherapy (40%) and concomitant radiotherapy (60%). Treatment of metastases: SBRT (53.3%), external radiotherapy (26.6%), surgery (13.6%), radiofrequency (3.3%), none (3.3%). Toxicity grade 3 (29.4%). Response rate was 69.9%, median PFS 11.1 months (IC 95%: 8.2-13.7), and median OS 20.2 months (IC: 15.6-20.3). Conclusions: Radical treatment for oligometastatic and unresectable NSCLC patients is a safe therapeutic strategy and it could be contemplated as an effective therapeutic alternative in selected patients.