Outcomes of extracranial stereotactic body radiation therapy for induced oligometastatic non-small cell lung cancer on novel systemic therapy

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Abstract

Background

Stereotactic body radiation therapy (SBRT) is often delivered in patients with oligometastatic disease (OMD). However, the specific subset of patients with polymetastatic non-small cell lung cancer (NSCLC) on novel systemic therapies who develop induced oligopersistant disease (OpersisD) or oligoprogressive disease (OprogD), as defined by the European Organisation for Research and Treatment of Cancer (EORTC) OMD classification, has not been well described. This study explores the outcomes of patients treated with this strategy.

Methods

Patients with stage IV NSCLC being treated with osimertinib or immune checkpoint inhibitors (ICIs) who received extracranial SBRT for OpersisD or OprogD were identified in our retrospective analysis. Outcomes reported include progression-free survival (PFS), time to change of systemic treatment (TTCST), overall survival (OS), local control (LC) and treatment-related toxicity.

Results

Forty-nine patients received SBRT for OpersisD (34.7%) or OprogD (65.3%) at a median of 5.8 and 15.3 months after start of systemic therapy, respectively. 55.1% received concurrent osimertinib and 44.9% received ICI. Seventy-seven extracranial lesions were treated with various fractionation schemas. At a median of 18.8 months follow-up from first SBRT, LC was achieved in 92.2% of total lesions treated (71). The 1-year OS was 91.7% for OpersisD and 83.3% for OprogD. OpersisD compared to OprogD had a longer median PFS (18.3 vs. 6.1 months) and longer median TTCST (23.6 vs. 13.5 months), median OS was not reached for either cohort. On multivariate analysis, patients treated with osimertinib had shorter PFS (HR: 2.20; 95% CI: 1.01–4.82; P=0.048) and shorter TTCST (HR: 2.83; 95% CI: 1.09–7.33; P=0.032). One patient (2%) experienced grade 3 pneumonitis after SBRT, and no grade 4–5 toxicities were reported with SBRT treatment.

Conclusions

This study indicates that SBRT for OpersisD or OprogD in Stage IV NSCLC patients on osimertinib or ICIs is safe, very well tolerated, and may prolong the time before needing a shift in systemic therapy. Further prospective research is needed to validate and expand upon these findings.

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Author and article information

Journal

Journal ID (nlm-ta): Transl Lung Cancer Res

Journal ID (iso-abbrev): Transl Lung Cancer Res

Journal ID (publisher-id): TLCR

Title: Translational Lung Cancer Research

Publisher: AME Publishing Company

ISSN (Print): 2218-6751

ISSN (Electronic): 2226-4477

Publication date (Electronic): 22 March 2024

Publication date (Print): 29 March 2024

Volume: 13

Issue: 3

Pages: 465-474

Affiliations

[1 ]Department of Military Medicine, “Tzameret”, and Medical Corps, Israel Defense Forces, Ramat Gan, Israel;

[2 ]deptDepartment of Medicine , Hebrew University of Jerusalem , Jerusalem, Israel;

[3 ]deptDepartment of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine , Hebrew University of Jerusalem , Jerusalem, Israel;

[4 ]deptDepartment of Medical Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine , Hebrew University of Jerusalem , Jerusalem, Israel;

[5 ]deptDepartment of Cardiothoracic Surgery, Hadassah Medical Center and Faculty of Medicine , Hebrew University of Jerusalem , Jerusalem, Israel;

[6 ]deptDepartment of Developmental Biology and Cancer Research Institute for Medical Research Israel-Canada , Hebrew University Medical School , Jerusalem, Israel

Author notes

Contributions: (I) Conception and design: E Tsur, P Blumenfeld, TF Michaeli; (II) Administrative support: A Popovtzer; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: E Tsur, P Blumenfeld, TF Michaeli; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

[#]

These authors contributed equally to this work.

Correspondence to: Philip Blumenfeld, MD. Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Kalman Ya’akov Man St., POB 12272 Jerusalem, Israel. Email: philipb@ 123456hadassah.org.il .

Author information

Philip Blumenfeld https://orcid.org/0000-0003-4672-6862

Article

Publisher ID: tlcr-13-03-465

DOI: 10.21037/tlcr-23-802

PMC ID: 11002507

SO-VID: 5878d27c-8f8d-468a-bf95-8aa71e4427f7

License:

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

Outcomes of extracranial stereotactic body radiation therapy for induced oligometastatic non-small cell lung cancer on novel systemic therapy

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