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Salari K, Lee JS, Ye H, Seymour ZA, Lee KC, Chinnaiyan P, Grills IS. Long-term survival in patients with brain-only metastatic non-small cell lung cancer undergoing upfront intracranial stereotactic radiosurgery and definitive treatment to the thoracic primary site. Radiother Oncol 2024; 196:110262. [PMID: 38556172 DOI: 10.1016/j.radonc.2024.110262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND PURPOSE To evaluate modern clinical outcomes for patients with brain-only metastatic non-small cell lung cancer (NSCLC) treated with intracranial stereotactic radiosurgery (SRS) with or without definitive treatment of the primary site. MATERIALS AND METHODS Patients with synchronously diagnosed NSCLC and brain-only metastatic disease treated with intracranial SRS at a single institution were retrospectively identified. Patients were stratified based on whether they did (A) or did not (B) receive definitive primary site treatment. Patient characteristics and clinical outcomes were compared. RESULTS From 2008 to 2022, 103 patients were identified, 53 of whom received definitive primary site treatment. Median follow-up was 2.1 y (A) and 0.8 y (B) (p < 0.001). 28 (53 %) patients in Group A received immune checkpoint inhibitor (ICI) therapy versus 19 (38 %) in Group B (p = 0.13) and there were no other statistically significant baseline or treatment characteristic differences between the groups. 5-year local-PFS was 34.5 % (A) versus 0 % (B) (p < 0.001). 5-year regional-PFS was 33.0 % (A) versus 0 % (B) (p < 0.001). 5-year distant body-PFS was 34.0 % (A) versus 0 % (B) (p < 0.001). 5-year CNS-PFS was 14.7 % (A) versus 0 % (B) (p = 0.12). 5-year OS was 40.2 % (A) versus 0 % (B) (p = 0.001). 5-year CSS was 67.6 % (A) versus 0 % (B) (p = 0.002). On multivariable analysis, lack of definitive treatment to the primary site (HR = 2.40), AJCC T3-4 disease (HR = 2.73), and lack of ICI therapy (HR = 2.86) were significant predictors of death. CONCLUSION Definitive treatment to the thoracic primary site in patients with brain-only metastatic NSCLC after intracranial radiosurgery was associated with slower progression of disease and improved survival.
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Affiliation(s)
- K Salari
- Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, United States.
| | - J S Lee
- Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, United States
| | - H Ye
- Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, United States
| | - Z A Seymour
- Department of Radiation Oncology, Corewell Health Dearborn Hospital, Dearborn, MI, United States
| | - K C Lee
- Department of Radiation Oncology, Corewell Health Troy Hospital, Troy, MI, United States
| | - P Chinnaiyan
- Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, United States
| | - I S Grills
- Department of Radiation Oncology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, United States
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Kumar A, Kumar S, Potter AL, Raman V, Kozono DE, Lanuti M, Jeffrey Yang CF. Surgical management of non-small cell lung cancer with limited metastatic disease involving only the brain. J Thorac Cardiovasc Surg 2024; 167:466-477.e2. [PMID: 37121537 DOI: 10.1016/j.jtcvs.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/18/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE The optimal primary site treatment modality for non-small cell lung cancer with brain oligometastases is not well established. This study sought to evaluate the long-term survival of patients with non-small cell lung cancer with isolated brain metastases undergoing multimodal therapy with or without thoracic surgery. METHODS Patients with cT1-3, N0-1, M1b-c non-small cell lung cancer with synchronous limited metastatic disease involving only the brain treated with brain stereotactic radiosurgery or neurosurgical resection in the National Cancer Database (2010-2017) were included. Long-term overall survival of patients who underwent multimodal therapy including thoracic surgery ("Thoracic Surgery") versus systemic therapy with or without radiation to the lung ("No Thoracic Surgery") was evaluated using Kaplan-Meier analysis, Cox proportional hazards modeling, and propensity score matching. RESULTS Of the 1240 patients with non-small cell lung cancer with brain-only metastases who received brain stereotactic radiosurgery or neurosurgery and met study inclusion criteria, 270 (21.8%) received primary site resection. The Thoracic Surgery group had improved overall survival compared with the No Thoracic Surgery group in Kaplan-Meier analysis (P < .001) and after multivariable-adjusted Cox proportional hazards modeling (P < .001). In a propensity score-matched analysis of 175 patients each in the Thoracic Surgery and No Thoracic Surgery groups, matching on 13 common prognostic variables, thoracic surgery was associated with better survival (P = .012). CONCLUSIONS In this national analysis, patients with cT1-3, N0-1, M1b-c non-small cell lung cancer with isolated limited brain metastases had better overall survival after multimodal therapy including thoracic surgery compared with systemic therapy without surgery. Multimodal thoracic treatment including surgery can be considered for carefully selected patients with non-small cell lung cancer and limited brain metastases.
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Affiliation(s)
- Arvind Kumar
- Icahn School of Medicine at Mt Sinai, New York, NY
| | - Sanjeevani Kumar
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Vignesh Raman
- Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - David E Kozono
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Mass
| | - Michael Lanuti
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
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Smyth EN, John J, Tiu RV, Willard MD, Beyrer JK, Bowman L, Sheffield KM, Han Y, Brastianos PK. Clinicogenomic factors and treatment patterns among patients with advanced non-small cell lung cancer with or without brain metastases in the United States. Oncologist 2023; 28:e1075-e1091. [PMID: 37358877 PMCID: PMC10628559 DOI: 10.1093/oncolo/oyad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/19/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND This retrospective, real-world study evaluated the prevalence of brain metastases, clinicodemographic characteristics, systemic treatments, and factors associated with overall survival among patients with advanced non-small cell lung cancer (aNSCLC) in the US. We also described the genomic characterization of 180 brain metastatic specimens and frequency of clinically actionable genes. MATERIALS AND METHODS De-identified electronic health records-derived data of adult patients diagnosed with aNSCLC between 2011 and 2017 were analyzed from a US-nationwide clinicogenomic database. RESULTS Of 3257 adult patients with aNSCLC included in the study, approximately 31% (n = 1018) had brain metastases. Of these 1018 patients, 71% (n = 726) were diagnosed with brain metastases at initial NSCLC diagnosis; 57% (n = 583) of patients with brain metastases received systemic treatment. Platinum-based chemotherapy combinations were the most common first-line therapy; single-agent chemotherapies, epidermal growth factor receptor tyrosine kinase inhibitors, and platinum-based chemotherapy combinations were used in second line. Patients with brain metastases had a 1.56 times greater risk of death versus those with no brain metastases. In the brain metastatic specimens (n = 180), a high frequency of genomic alterations in the p53, MAPK, PI3K, mTOR, and cell-cycle associated pathways was observed. CONCLUSION The frequency of brain metastases at initial clinical presentation and associated poor prognosis for patients in this cohort underscores the importance of early screening for brain metastasis in NSCLC. Genomic alterations frequently identified in this study emphasize the continued need for genomic research and investigation of targeted therapies in patients with brain metastases.
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Affiliation(s)
- Emily Nash Smyth
- Eli Lilly and Company, Value Evidence Outcomes - Research, Indianapolis, IN 46225, USA
| | - Jincy John
- Eli Lilly and Company, Value Evidence Outcomes - Research, Indianapolis, IN 46225, USA
| | - Ramon V Tiu
- Eli Lilly and Company, Value Evidence Outcomes - Research, Indianapolis, IN 46225, USA
| | - Melinda Dale Willard
- Eli Lilly and Company, Lilly Global Clinical Development, Indianapolis, IN 46225, USA
| | - Julie Kay Beyrer
- Eli Lilly and Company, Value Evidence Outcomes - Research, Indianapolis, IN 46225, USA
| | - Lee Bowman
- Eli Lilly and Company, Value Evidence Outcomes - Research, Indianapolis, IN 46225, USA
| | - Kristin M Sheffield
- Eli Lilly and Company, Value Evidence Outcomes - Research, Indianapolis, IN 46225, USA
| | - Yimei Han
- Eli Lilly and Company, Statistics RWE, Indianapolis, IN 46225, USA
| | - Priscilla K Brastianos
- Divisions of Hematology/Oncology and Neuro-Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
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Sammaddar D, Basu A, Roy P, Chowdhury H. Incidence and clinical profile of brain metastasis treated with whole brain radiotherapy in a tertiary hospital in eastern India: A retrospective audit. Indian J Cancer 2023; 60:337-344. [PMID: 36861704 DOI: 10.4103/ijc.ijc_1211_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction Management of brain metastases (BM) is witnessing marked advancement worldwide and modern technologies with better outcomes are gradually being adopted in developing countries. However, data regarding current practice in this field is lacking from the Indian subcontinent prompting us to plan the current study. Materials and Methods A retrospective, single institutional audit was performed on 112 patients with solid tumors metastasizing to the brain treated over the last 4 years at a tertiary care center in eastern India, of which 79 were ultimately evaluable. Demography, patterns of incidence, and overall survival (OS) were determined. Results The prevalence of BM was 5.65% among all patients with solid tumors. The median age was 55 years with a slight male preponderance. Lung followed by breast were the most common primary subsites. Multiple BM (54%), left-sided (61%), and frontal lobe lesions (54%) were the more common. Metachronous BM was found in 76% of patients. All patients received whole brain radiation therapy (WBRT). The median OS for the entire cohort was 7 months (95% confidence interval [CI]: 4 - 19 months). The median OS for lung and breast primaries were 6.5 and 8 months and for recursive partitioning analysis (RPA) classes I, II, and III the OS were 11.5, 7, and 3 months, respectively. Median OS did not differ by number of or other sites of metastases. Conclusions The outcomes from our series about BM from solid tumors in patients from eastern Indian are in congruence to those available in the literature. Patients with BM are still largely treated with WBRT in resource-limited settings.
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Affiliation(s)
- Debdeep Sammaddar
- Department of Radiation Oncology, R.G. Kar Medical College and Hospital, Kolkata, India
| | - Abhishek Basu
- Department of Radiation Oncology, Burdwan Medical College and Hospital, Purba Bardhaman, India
| | - Pritha Roy
- Department of Radiation Oncology, R.G. Kar Medical College and Hospital, Kolkata, India
| | - Hambir Chowdhury
- Department of Radiation Oncology, Medical College and Hospital, Kolkata, West Bengal, India
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Vedire YR, Shin S, Groman A, Hennon M, Dy GK, Yendamuri S. Survival Benefit of Perioperative Systemic Chemotherapy for Patients With N0 to N1 NSCLC Having Synchronous Brain Metastasis. JTO Clin Res Rep 2023; 4:100522. [PMID: 37275564 PMCID: PMC10238748 DOI: 10.1016/j.jtocrr.2023.100522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction In stage IV NSCLC with solitary or oligometastatic brain metastasis, surgical resection of the primary and definitive management of the brain metastasis is an accepted standard. However, the effect of systemic chemotherapy after surgical resection on overall survival is not well-established. Methods We used the National Cancer Database to retrospectively identify individuals with NSCLC as the primary tumor along with synchronous brain metastases who underwent thoracic resection with or without adjuvant chemotherapy. Chi-square and Wilcoxon rank sum tests were performed to compare categorical and continuous variables, respectively, across the treatment groups. Kaplan-Meier and Cox proportional modeling were done to determine the survival benefit. Results A total of 310 (71.9%) of the cohort received perioperative chemotherapy, most of whom (79.4%) received it in the adjuvant setting. Patients receiving chemotherapy were likely to be younger (p = 0.002), privately insured (p = 0.01), and receive radiation (p < 0.001). Perioperative chemotherapy was significantly associated with survival on both univariate (hazard ratio = 0.71[0.52 - 0.99]) and multivariable (hazard ratio = 0.66 [0.47 - 0.92]) in addition to age (p = 0.03), Charlson-Deyo score (p = 0.02), pathologic N stage (p = 0.02), and adenocarcinoma histology (p = 0.02). Kaplan-Meier analysis confirmed this result with a significantly better survival with perioperative chemotherapy (p = 0.02). Further subgroup analysis using pathologic N stage revealed similar effect in pN1 (p = 0.001), but not pN0 (p = 0.2) patients. Conclusions Perioperative chemotherapy for pN0-1 NSCLC with synchronous brain metastasis is associated with improved OS in this analysis.
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Affiliation(s)
- Yeshwanth R. Vedire
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York
| | - Sarah Shin
- Department of Medicine, Roswell Park Comprehensive Cancer Center at Buffalo, Buffalo, New York
| | - Adrienne Groman
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Mark Hennon
- Department of Medicine, Roswell Park Comprehensive Cancer Center at Buffalo, Buffalo, New York
| | - Grace K. Dy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York
| | - Sai Yendamuri
- Department of Medicine, Roswell Park Comprehensive Cancer Center at Buffalo, Buffalo, New York
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Chakrabarty N, Mahajan A, Patil V, Noronha V, Prabhash K. Imaging of brain metastasis in non-small-cell lung cancer: indications, protocols, diagnosis, post-therapy imaging, and implications regarding management. Clin Radiol 2023; 78:175-186. [PMID: 36503631 DOI: 10.1016/j.crad.2022.09.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/09/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
Increased survival (due to the use of targeted therapies based on genomic profiling) has resulted in the increased incidence of brain metastasis during the course of disease, and thus, made it essential to have proper imaging guidelines in place for brain metastasis from non-small-cell lung cancer (NSCLC). Brain parenchymal metastases can have varied imaging appearances, and it is pertinent to be aware of the various molecular risk factors for brain metastasis from NSCLC along with their suggestive imaging appearances, so as to identify them early. Leptomeningeal metastasis requires additional imaging of the spine and an early cerebrospinal fluid (CSF) analysis. Differentiation of post-therapy change from recurrence on imaging has a bearing on the management, hence the need for its awareness. This article will provide in-depth literature review of the epidemiology, aetiopathogenesis, screening, detection, diagnosis, post-therapy imaging, and implications regarding the management of brain metastasis from NSCLC. In addition, we will also briefly highlight the role of artificial intelligence (AI) in brain metastasis screening.
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Affiliation(s)
- N Chakrabarty
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India
| | - A Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India.
| | - V Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India
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Malkova AM, Gubal AR, Petrova AL, Voronov E, Apte RN, Semenov KN, Sharoyko VV. Pathogenetic role and clinical significance of interleukin-1β in cancer. Immunology 2023; 168:203-216. [PMID: 35462425 DOI: 10.1111/imm.13486] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/28/2022] [Indexed: 01/21/2023] Open
Abstract
In recent years, pro-oncogenic mechanisms of the tumour microenvironment (ТМЕ) have been actively discussed. One of the main cytokines of the TМЕ is interleukin-1 beta (IL-1β), which exhibits proinflammatory properties. Some studies have shown an association between an increase in IL-1β levels and tumour progression. The purpose of this review is to analyse the pathogenic mechanisms induced by IL-1β in the TМЕ, as well as the diagnostic significance of the presence of IL-1β in patients with cancer and the efficacy of treatment with IL-1β inhibitors. According to the literature, IL-1β can induce an increase in tumour angiogenesis due to its effects on the differentiation of epithelial cells, pro-angiogenic molecule secretion and expression of adhesion molecules, thus increasing tumour growth and metastasis. IL-1β is also involved in the suppression of anti-tumour immune responses. The expression and secretion of IL-1β has been noted in various types of tumours. In some clinical studies, an elevated level of IL-1β was found to be associated with low efficacy of anti-cancer therapy and a poor prognosis. In most experimental and clinical studies, the use of IL-1β inhibitors contributed to a decrease in tumour mass and an increase in the response to anti-tumour drugs.
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Affiliation(s)
- Anna M Malkova
- Saint Petersburg State University, Saint Petersburg, Russia.,Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Anna R Gubal
- Saint Petersburg State University, Saint Petersburg, Russia
| | | | - Elena Voronov
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ron N Apte
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Konstantin N Semenov
- Saint Petersburg State University, Saint Petersburg, Russia.,Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.,A. M. Granov Russian Research Centre for Radiology and Surgical Technologies, Saint Petersburg, Russia
| | - Vladimir V Sharoyko
- Saint Petersburg State University, Saint Petersburg, Russia.,Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.,A. M. Granov Russian Research Centre for Radiology and Surgical Technologies, Saint Petersburg, Russia.,Medicinal Chemistry Center, Togliatti State University, Togliatti, Russia
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8
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Cognitive changes are associated with increased blood-brain barrier leakage in non-brain metastases lung cancer patients. Brain Imaging Behav 2023; 17:90-99. [PMID: 36417126 PMCID: PMC9922230 DOI: 10.1007/s11682-022-00745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/24/2022]
Abstract
To explore the relationship between cognitive function and blood-brain barrier leakage in non-brain metastasis lung cancer and healthy controls. 75 lung cancers without brain metastasis and 29 healthy controls matched with age, sex, and education were evaluated by cognitive assessment, and the Patlak pharmacokinetic model was used to calculate the average leakage in each brain region according to the automated anatomical labeling atlas. After that, the relationships between cognitive and blood-brain barrier leakage were evaluated. Compared with healthy controls, the leakage of bilateral temporal gyrus and whole brain gyrus were higher in patients with lung cancers (P < 0.05), mainly in patients with advanced lung cancer (P < 0.05), but not in patients with early lung cancer (P > 0.05). The cognitive impairment of advanced lung cancers was mainly reflected in the damage of visuospatial/executive, and delayed recall. The left temporal gyrus with increased blood-brain barrier leakage showed negative correlations with delayed recall (r = -0.201, P = 0.042). An increase in blood-brain barrier leakage was found in non-brain metastases advanced lung cancers that corresponded to decreased delayed recall. With progression in lung cancer staging, blood-brain barrier shows higher leakage and may lead to brain metastases and lower cognitive development.
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King J, Patel K, Woolf D, Hatton MQ. The Use of Palliative Radiotherapy in the Treatment of Lung Cancer. Clin Oncol (R Coll Radiol) 2022; 34:761-770. [PMID: 36115746 DOI: 10.1016/j.clon.2022.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/07/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023]
Abstract
There have been significant advances in the systemic treatment of stage IV lung cancer, which is now recommended first line in patients with adequate fitness. This includes some patients with brain metastases due to the increased understanding of the central nervous system penetration of targeted therapies. The trials evidence base for palliative radiotherapy pre-dated this routine use of systemic therapy in our practice, which means that the sequence and role of palliative radiotherapy are not currently well defined in the first-line treatment setting. However, due to its efficacy in symptom control, radiotherapy remains a core component in the palliative management of lung cancer, particularly in the second-line setting and those unsuited to primary systemic treatment. This overview focuses on the evidence behind palliative radiotherapy to the thorax and brain for non-small cell and small cell lung cancer and the potential for future studies, including the TOURIST Trial Platform, to guide the future direction of these treatments.
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Affiliation(s)
- J King
- The Christie Hospital NHS Foundation Trust, Manchester, UK.
| | - K Patel
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - D Woolf
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - M Q Hatton
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Broomhall, Sheffield, UK
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Nistor CE, Ciuche A, Cucu AP, Nitipir C, Slavu C, Serban B, Cursaru A, Cretu B, Cirstoiu C. Management of Lung Cancer Presenting with Solitary Bone Metastasis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101463. [PMID: 36295624 PMCID: PMC9612355 DOI: 10.3390/medicina58101463] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
Lung neoplasm is the main cause of cancer-related mortality, and bone metastasis is among the most common secondary tumors. The vast majority of patients also present with multiple bone metastases, which makes systemic and adjuvant pain therapy preferable to surgery. The optimal approach for a resectable non-small-cell lung tumor that also presents a unique, resectable bone metastasis is not fully established. The number of papers addressing this subject is small, and most are case reports; nevertheless, survival rates seem to increase with radical surgery. The sequencing of local versus systemic treatment should always be discussed within the multidisciplinary team that will choose the best approach for each patient. As targeted systemic therapies become more accessible, radical surgery, together with existing reconstructive methods, will lead to an increase in life expectancy and a better quality of life.
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Affiliation(s)
- Claudiu-Eduard Nistor
- Department Thoracic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Adrian Ciuche
- Department Thoracic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Anca Pati Cucu
- Department Thoracic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Cornelia Nitipir
- Department of Medical Oncology, Carol Davila University Medicine & Pharmacy, Elias University Emergency Hospital, 011468 Bucharest, Romania
| | - Cristina Slavu
- Department of Medical Oncology, Carol Davila University Medicine & Pharmacy, Elias University Emergency Hospital, 011468 Bucharest, Romania
| | - Bogdan Serban
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Adrian Cursaru
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Bogdan Cretu
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
- Correspondence:
| | - Catalin Cirstoiu
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
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Efficacy and Safety of EGFR Tyrosine Kinase Inhibitors Combined with Cranial Radiotherapy for Brain Metastases from Non-Small-Cell Lung Cancer: A Protocol for a Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6531748. [PMID: 35872868 PMCID: PMC9301690 DOI: 10.1155/2022/6531748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/18/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
Introduction. Brain metastases (BMs) are common in non-small-cell lung cancer (NSCLC), which leads to a poor prognosis. As the two most effective strategies available, the use of combination of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and radiotherapy (RT) is still controversial. This protocol proposes a methodology for carrying out a systematic review and meta-analysis that is aimed at (1) focusing on the efficacy and safety role of EGFR-TKIs combined with RT for BMs from NSCLC and (2) displaying the difference in efficacy of EGFR-TKIs owing to the sites and number of BMs, different types of RT, EGFR mutation status, and the subtypes of EGFR mutations by subgroup analysis. Methods and Analysis. Electronic databases including PubMed, Embase, CENTRAL, Web of Science, CBM, CNKI, Wanfang database, and VIP database will be searched from their inception until May 2022. Only randomized controlled trials evaluating the clinical efficacy and safety of EGFR-TKIs combined with RT on BMs of NSCLC will be included. Two reviewers will select the articles, assess the risk of bias, and extract data independently and in duplicate. The RoB 2 tool will be used to assess the quality of included studies. The meta-analysis of data synthesis will be performed with Stata 16. Publication bias will be assessed with the funnel plot method and the Egger test. Quality of the evidence will be evaluated by the GRADE system. Discussion. The approval of an ethical committee is not required. All the included trials will comply with the current ethical standards and the Declaration of Helsinki. Given the ongoing controversies regarding the optimal sequencing of the available and expanding treatment options for EGFR-TKIs in NSCLC with BMs, a synthesis of available, high-quality clinical research evidence is essential to advance our understanding in the treatment of this complex and common disease. This systematic review will evaluate available evidence, will try to provide optimized advice in the applications of EGFR-TKIs, and will be published in a high-quality journal. This study is registered with PROSPERO registration number CRD42021291509.
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Chen YH, Ho UC, Kuo LT. Oligometastatic Disease in Non-Small-Cell Lung Cancer: An Update. Cancers (Basel) 2022; 14:cancers14051350. [PMID: 35267658 PMCID: PMC8909159 DOI: 10.3390/cancers14051350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Approximately 7–50% of patients with non-small-cell lung cancer (NSCLC) develop oligometastases, which are new tumors found in another part of the body, arising from cancer cells of the original tumor that have travelled through the body. In recent years, these patients have been increasingly regarded as a distinct group that could benefit from treatment that intends to cure the disease, rather than palliative care, to achieve a better clinical outcome. Various treatment procedures have been developed for treating NSCLC patients with different oligometastatic sites. In addition, the newly proposed uniform definition for oligometastases as well as ongoing trials may lead to increased appropriate patient selection and evaluation of treatment effectiveness. The aim of this review article is to summarize the latest evidence regarding optimal management strategies for NSCLC patients with oligometastases. Abstract Oligometastatic non-small-cell lung cancer (NSCLC) is a distinct entity that is different from localized and disseminated diseases. The definition of oligometastatic NSCLC varies across studies in past decades owing to the use of different imaging modalities; however, a uniform definition of oligometastatic NSCLC has been proposed, and this may facilitate trial design and evaluation of certain interventions. Patients with oligometastatic NSCLC are candidates for curative-intent management, in which local ablative treatment, such as surgery or stereotactic radiosurgery, should be instituted to improve clinical outcomes. Although current guidelines recommend that local therapy for thoracic and metastatic lesions should be considered for patients with oligometastatic NSCLC with stable disease after systemic therapy, optimal management strategies for different oligometastatic sites have not been established. Additionally, the development of personalized therapies for individual patients with oligometastatic NSCLC to improve their quality of life and overall survival should also be addressed. Here, we review relevant articles on the management of patients with oligometastatic NSCLC and categorize the disease according to the site of metastases. Ongoing trials are also summarized to determine future directions and expectations for new treatment modalities to improve patient management.
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Affiliation(s)
- Yi-Hsing Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Douliu 640, Taiwan; (Y.-H.C.); (U.-C.H.)
| | - Ue-Cheung Ho
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Douliu 640, Taiwan; (Y.-H.C.); (U.-C.H.)
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456
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13
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Isaacs LL. Pancreatic Proteolytic Enzymes and Cancer: New Support for an Old Theory. Integr Cancer Ther 2022; 21:15347354221096077. [PMID: 35514109 PMCID: PMC9083047 DOI: 10.1177/15347354221096077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In 1905, the embryologist John Beard first proposed that pancreatic proteolytic enzymes had potential as a treatment for cancer. His theories were dismissed by the medical world a decade later, but various practitioners have kept the concept alive through the publication of case reports of cancer patients treated with pancreatic proteolytic enzymes. In the last 2 decades, studies of the role of proteases in physiology have made it clear that they do more than digest food. This article reviews the history of the clinical use of pancreatic proteolytic enzymes in cancer treatment, and recent research on protease activated receptors and their role in cancer.
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14
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Sundahl N, Lievens Y. Radiotherapy for oligometastatic non-small cell lung cancer: a narrative review. Transl Lung Cancer Res 2021; 10:3420-3431. [PMID: 34430377 PMCID: PMC8350107 DOI: 10.21037/tlcr-20-1051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/17/2021] [Indexed: 12/25/2022]
Abstract
Preclinical and early clinical evidence suggest that radical radiotherapy of oligometastatic disease in non-small cell lung cancer (NSCLC) patients can impact outcomes with relatively limited toxicity. Whilst data from phase 2 randomized trials suggesting an improved overall survival (OS) with this treatment is promising, it has also illustrated the heterogeneity in this patient population and treatment. Oligometastatic disease in itself comprises a broad spectrum of patients, in terms of tumor load and location, stage of the disease and treatment history. This real-life variety in patient characteristics is often reflected in studies to a certain extent, hinting to the fact that all might benefit from radical radiotherapy to limited metastatic disease, yet leaving the question unanswered as to whom the ideal candidate is. Furthermore, differences between and within studies with regards to treatment modality, timing, radiation technique, and radiation dose are substantial. Also, preclinical and early clinical trials suggest that radiotherapy can work synergistically with checkpoint inhibitors by acting as an in situ cancer vaccine, therefore the combination of these two treatments in oligometastatic patients might entail the largest benefit. Ongoing randomized controlled phase 3 trials and prospective registry trials will further elucidate the true extent of benefit of this local treatment strategy and aid in identifying the ideal patient population and therapy. The current narrative review summarizes the clinical evidence on radiotherapy for oligometastatic NSCLC and highlights the remaining unknowns.
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Affiliation(s)
- Nora Sundahl
- Department of Radiation Oncology, Ghent University Hospital & Ghent University, Ghent, Belgium
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital & Ghent University, Ghent, Belgium
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15
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Local Ablative Therapies for Oligometastatic and Oligoprogressive Non-Small Cell Lung Cancer. ACTA ACUST UNITED AC 2021; 26:129-136. [PMID: 32205537 DOI: 10.1097/ppo.0000000000000433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
More than half of all patients with non-small cell lung cancer (NSCLC) have metastatic disease at the time of diagnosis. A subset of these patients has oligometastatic disease, which exists in an intermediary state between locoregional and disseminated metastatic disease. In addition, some metastatic patients on systemic therapy may have limited disease progression, or oligoprogression. Historically, treatment of metastatic NSCLC was palliative in nature, with little expectation of long-term survival. However, an accumulation of evidence over the past 3 decades now demonstrates that local ablative therapy to sites of limited metastases or progression can improve patient outcomes for this complex disease. This review examines the evidence behind local ablative therapy in oligometastatic and oligoprogressive NSCLC, with a focus on surgery, stereotactic radiotherapy, and radiofrequency ablation.
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16
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Münsterberg J, Loreth D, Brylka L, Werner S, Karbanova J, Gandrass M, Schneegans S, Besler K, Hamester F, Robador JR, Bauer AT, Schneider SW, Wrage M, Lamszus K, Matschke J, Vashist Y, Uzunoglu G, Steurer S, Horst AK, Oliveira-Ferrer L, Glatzel M, Schinke T, Corbeil D, Pantel K, Maire C, Wikman H. ALCAM contributes to brain metastasis formation in non-small-cell lung cancer through interaction with the vascular endothelium. Neuro Oncol 2021; 22:955-966. [PMID: 32064501 PMCID: PMC7339886 DOI: 10.1093/neuonc/noaa028] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Brain metastasis (BM) in non-small-cell lung cancer (NSCLC) has a very poor prognosis. Recent studies have demonstrated the importance of cell adhesion molecules in tumor metastasis. The aim of our study was to investigate the role of activated leukocyte cell adhesion molecule (ALCAM) in BM formation in NSCLC. Methods Immunohistochemical analysis was performed on 143 NSCLC primary tumors and BM. A correlation between clinicopathological parameters and survival was developed. Biological properties of ALCAM were assessed in vitro by gene ablation using CRISPR/Cas9 technology in the NCI-H460 NSCLC cell line and in vivo by intracranial and intracardial cell injection of NCI-H460 cells in NMRI-Foxn1nu/nu mice. Results ALCAM expression was significantly upregulated in NSCLC brain metastasis (P = 0.023) with a de novo expression of ALCAM in 31.2% of BM. Moderate/strong ALCAM expression in both primary NSCLC and brain metastasis was associated with shortened survival. Functional analysis of an ALCAM knock-out (KO) cell line showed a significantly decreased cell adhesion capacity to human brain endothelial cells by 38% (P = 0.045). In vivo studies showed significantly lower tumor cell dissemination in mice injected with ALCAM-KO cells in both mouse models, and both the number and size of BM were significantly diminished in ALCAM depleted tumors. Conclusions Our findings suggest that elevated levels of ALCAM expression promote BM formation in NSCLC through increased tumor cell dissemination and interaction with the brain endothelial cells. Therefore, ALCAM could be targeted to reduce the occurrence of BM. Key Points 1. ALCAM expression associates with poor prognosis and brain metastasis in NSCLC. 2. ALCAM mediates interaction of NSCLC tumor cells with brain vascular endothelium. 3. ALCAM might represent a novel preventive target to reduce the occurrence of BM in NSCLC.
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Affiliation(s)
- Justine Münsterberg
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Desirée Loreth
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Brylka
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Werner
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Karbanova
- Biotechnology Center and Center for Molecular and Cellular Bioengineering, Technical University Dresden, Dresden, Germany
| | - Monja Gandrass
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Svenja Schneegans
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Besler
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabienne Hamester
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - José Ramon Robador
- Experimental Dermatology, Department of Dermatology, Venereology and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Dermatology and Venerology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Thomas Bauer
- Experimental Dermatology, Department of Dermatology, Venereology and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Dermatology and Venerology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Werner Schneider
- Department of Dermatology and Venerology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Michaela Wrage
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Matschke
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yogesh Vashist
- General, Visceral and Thoracic Surgery Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Güntac Uzunoglu
- General, Visceral and Thoracic Surgery Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Kristina Horst
- Institute for Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Markus Glatzel
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Denis Corbeil
- Biotechnology Center and Center for Molecular and Cellular Bioengineering, Technical University Dresden, Dresden, Germany
| | | | - Cecile Maire
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Chen BT, Jin T, Ye N, Mambetsariev I, Wang T, Wong CW, Chen Z, Rockne RC, Colen RR, Holodny AI, Sampath S, Salgia R. Predicting Survival Duration With MRI Radiomics of Brain Metastases From Non-small Cell Lung Cancer. Front Oncol 2021; 11:621088. [PMID: 33747933 PMCID: PMC7973105 DOI: 10.3389/fonc.2021.621088] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Brain metastases are associated with poor survival. Molecular genetic testing informs on targeted therapy and survival. The purpose of this study was to perform a MR imaging-based radiomic analysis of brain metastases from non-small cell lung cancer (NSCLC) to identify radiomic features that were important for predicting survival duration. Methods: We retrospectively identified our study cohort via an institutional database search for patients with brain metastases from EGFR, ALK, and/or KRAS mutation-positive NSCLC. We segmented the brain metastatic tumors on the brain MR images, extracted radiomic features, constructed radiomic scores from significant radiomic features based on multivariate Cox regression analysis (p < 0.05), and built predictive models for survival duration. Result: Of the 110 patients in the cohort (mean age 57.51 ± 12.32 years; range: 22–85 years, M:F = 37:73), 75, 26, and 15 had NSCLC with EGFR, ALK, and KRAS mutations, respectively. Predictive modeling of survival duration using both clinical and radiomic features yielded areas under the receiver operative characteristic curve of 0.977, 0.905, and 0.947 for the EGFR, ALK, and KRAS mutation-positive groups, respectively. Radiomic scores enabled the separation of each mutation-positive group into two subgroups with significantly different survival durations, i.e., shorter vs. longer duration when comparing to the median survival duration of the group. Conclusion: Our data supports the use of radiomic scores, based on MR imaging of brain metastases from NSCLC, as non-invasive biomarkers for survival duration. Future research with a larger sample size and external cohorts is needed to validate our results.
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Affiliation(s)
- Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Taihao Jin
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Ningrong Ye
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Isa Mambetsariev
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, United States
| | - Tao Wang
- Departments of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chi Wah Wong
- Applied AI and Data Science, City of Hope National Medical Center, Duarte, CA, United States
| | - Zikuan Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Russell C Rockne
- Division of Mathematical Oncology, City of Hope National Medical Center, Duarte, CA, United States
| | - Rivka R Colen
- Department of Radiology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, United States
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18
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Suzuki K, Shiono S, Hasumi T, Sakurada A, Minowa M, Sato N, Uramoto H, Deguchi H, Suzuki J, Okada Y. Clinical significance of bifocal treatment for synchronous brain metastasis in T1-2 non-small-cell lung cancers: JNETS0301. Gen Thorac Cardiovasc Surg 2021; 69:967-975. [PMID: 33400200 DOI: 10.1007/s11748-020-01568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The treatment of patients with brain metastases associated with non-small-cell lung cancer (NSCLC) is frequently challenging. Starting in 2003, we conducted a phase II study of surgery for patients with clinical T1-2N0-1 NSCLC with oligometastasis. The aim of this subset study was to assess the clinical significance of bifocal treatment for synchronous brain metastases in T1-2N0-1 NSCLC using prospectively collected data. METHODS In this phase II study of clinical T1-2N0-1 NSCLC patients with oligometastasis, 47 patients were enrolled from December 2003 to December 2016. Among them, 18 NSCLC patients with synchronous brain metastases were investigated in this subset analysis. RESULTS Fourteen patients underwent complete resection, and 4 underwent incomplete resection of the primary lung cancer. The number of synchronous brain metastases was one in 14 and multiple in 4 patients. After surgery for the primary lung cancer, 12 of 18 patients underwent treatment for their brain lesions, including stereotactic radiosurgery (SRS) in 10, surgical resection in 1, and SRS followed by surgical resection in 1. In 5 of the 18 patients (28%), the brain lesion was diagnosed as benign on follow-up radiological imaging. The 5-year overall survival rate after enrollment was 31.8% for all 18 patients and 35.2% for the 13 patients with brain metastases. Univariate analysis showed that having multiple brain lesions was a significant factor related to a worse prognosis. CONCLUSION For patients with suspected brain metastases associated with NSCLC, bifocal local treatment could be an acceptable therapeutic strategy, especially for solitary brain metastasis.
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Affiliation(s)
- Katsuyuki Suzuki
- Japan Northern East Area Thoracic Surgery Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata, 1800, Japan
| | - Satoshi Shiono
- Japan Northern East Area Thoracic Surgery Study Group (JNETS), Sendai, Japan. .,Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata, 1800, Japan.
| | - Tohru Hasumi
- Japan Northern East Area Thoracic Surgery Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Sendai Medical Center, Sendai, Japan
| | - Akira Sakurada
- Japan Northern East Area Thoracic Surgery Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Muneo Minowa
- Japan Northern East Area Thoracic Surgery Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Ohta-Nishinouchi Hospital, Kooriyama, Japan
| | - Nobuyuki Sato
- Japan Northern East Area Thoracic Surgery Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Hidetaka Uramoto
- Japan Northern East Area Thoracic Surgery Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroyuki Deguchi
- Japan Northern East Area Thoracic Surgery Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Iwate Medical University, Morioka, Japan
| | - Jun Suzuki
- Japan Northern East Area Thoracic Surgery Study Group (JNETS), Sendai, Japan.,Department of Surgery II, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yoshinori Okada
- Japan Northern East Area Thoracic Surgery Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
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19
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Jia J, Guo B, Yang Z, Liu Y, Ga L, Xing G, Zhang S, Jin A, Ma R, Wang J. Outcomes of local thoracic surgery in patients with stage IV non-small-cell lung cancer: A SEER-based analysis. Eur J Cancer 2020; 144:326-340. [PMID: 33388490 DOI: 10.1016/j.ejca.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/09/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The outcomes of thoracic surgery for patients with stage IV non-small-cell lung cancer (NSCLC) are controversial and uncertain. PATIENTS AND METHODS The National Cancer Institute's Surveillance, Epidemiology, and End Results was queried for patients with stage IV NSCLC, including those treated with surgery-participated therapy modalities. Overall survival (OS) was evaluated using a variety of statistical analyses. RESULTS The analysis was carried out for 90,982 patients from 1975 to 2016 who had been diagnosed as stage IV NSCLC. Propensity score-matched (PSM) analyses that were well-balanced with all the important confounding covariates revealed improved OS (median survival time [MST]) with patients receiving surgery versus non-surgery (MST: 15 versus 8 months, P < 0.001); undergoing surgery plus chemotherapy versus chemotherapy (MST: 19 versus 11 months, P < 0.001); and having surgery plus chemoradiation versus chemoradiation (MST: 18 versus 11 months, P < 0.001). Sequential landmark analyses for long-term survivors of ≥1 and ≥3 years all indicated improved OS (P < 0.001) on univariate and multivariate analyses for the patients receiving the three surgery-related treatment patterns listed earlier, relative to the corresponding surgery-absent treatment modalities. For synchronous presentations of varied treatment paradigms, surgical intervention significantly led to increased OS (MST, months) benefits following treatment paradigms: surgery plus chemotherapy (22), surgery plus chemoradiation (18), chemotherapy (10), surgery only (9), chemoradiation (9), surgery plus radiation (6) and radiation alone (2). The subgroup analysis demonstrated that the elevated OS associated with local thoracic surgery in addition to chemotherapy (versus chemotherapy) or chemoradiation (versus chemoradiation) fell in the subcategories of T0-3, N0-2 and 0-1 (metastatic sites) tumours. The comparison of the aforementioned two types of treatment patterns indicated that the optimal patients for the surgery were those with any combination of T1-4, N0-3, Msite0-1 and adeno- or squamous carcinoma. CONCLUSIONS The patients with T1-4, N0-3, Msite0-1 and adeno- or squamous carcinoma of stage IV NSCLC had a longer OS with local thoracic surgery in combination with chemotherapy or chemoradiation.
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Affiliation(s)
- Jianlong Jia
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Bin Guo
- Department of Urologic Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhiyi Yang
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Yang Liu
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Latai Ga
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Guangming Xing
- Department of General Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Shiqing Zhang
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Aquan Jin
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Ruichen Ma
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Jun Wang
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China.
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20
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Prabhash K. Treatment of advanced nonsmall cell lung cancer: First line, maintenance and second line - Indian consensus statement update. South Asian J Cancer 2020; 8:1-17. [PMID: 30766843 PMCID: PMC6348782 DOI: 10.4103/sajc.sajc_227_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The management of advanced nonsmall cell lung cancer (NSCLC) patients is becoming increasingly complex with the identification of driver mutations/rearrangements and development/availability of appropriate targeted therapies. In 2017, an expert group of medical oncologists with expertise in treating lung cancer used data from published literature and experience to arrive at practical consensus recommendations on treatment of advanced NSCLC for use by the community oncologists. This was published subsequently in the Indian Journal of Cancer with a plan to be updated annually. The present document is an update to the 2017 document.
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Affiliation(s)
- Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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21
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Newman S, Bucknell N, Bressel M, Tran P, Campbell BA, David S, Haghighi N, Hanna GG, Kok D, MacManus M, Phillips C, Plumridge N, Shaw M, Wirth A, Wheeler G, Ball D, Siva S. Long-term Survival with 18-Fluorodeoxyglucose Positron Emission Tomography-directed Therapy in Non-small Cell Lung Cancer with Synchronous Solitary Brain Metastasis. Clin Oncol (R Coll Radiol) 2020; 33:163-171. [PMID: 33129655 DOI: 10.1016/j.clon.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/28/2020] [Accepted: 10/13/2020] [Indexed: 11/27/2022]
Abstract
AIMS At diagnosis, <1% of patients with non-small cell lung cancer (NSCLC) have synchronous solitary brain metastasis (SSBM). In prior cohorts without 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) staging, definitive treatment to intracranial and intrathoracic disease showed a 5-year overall survival (OS) of 11-21%. We investigated the long-term survival outcomes for patients with SSBM NSCLC, diagnosed in the FDG-PET/CT era and treated definitively with local therapies to both intracranial and intrathoracic sites of disease. MATERIALS AND METHODS This retrospective study assessed patients staged with FDG-PET/CT who received definitive lung and SSBM treatment from February 1999 to December 2017. A lung-molecular graded prognostic assessment (lung-molGPA) score was assigned for each patient using age, performance status score, and, where carried out, molecular status. Overall survival and progression-free survival (PFS) were calculated using Kaplan-Meier methods. Cox proportional hazard models determined OS and PFS prognostic factors. RESULTS Forty-nine patients newly diagnosed with NSCLC and SSBM had a median age of 63 years (range 34-76). The median follow-up of all patients was 3.9 years. Thirty-three patients (67%) had ≥T2 disease, 23 (47%) had ≥N2. At 2 years, 45% of first failures were intracranial only (95% confidence interval 30-59). At 3 and 5 years, OS was 45% (95% confidence interval 32-63) and 30% (95% confidence interval 18-51), respectively. In ≥N1 disease, 5-year OS was 34% (95% confidence interval 18-63). The 3- and 5-year PFS was 8% (95% confidence interval 3-22) and 0%, respectively. Higher lung-molGPA was associated with longer OS (hazard ratio 0.26, 95% confidence interval 0.11-0.61, P = 0.002). Higher lung-molGPA (hazard ratio 0.33, 95% confidence interval 0.15-0.71, P = 0.005) and lower N-stage (hazard ratio 1.56, 95% confidence interval 1.13-2.15, P = 0.007) were associated with longer PFS. CONCLUSIONS Definitive treatment of patients with NSCLC and SSBM staged with FDG-PET/CT can result in 5-year survivors, including those with ≥N1 disease.
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Affiliation(s)
- S Newman
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - N Bucknell
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - M Bressel
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - P Tran
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - B A Campbell
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - S David
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - N Haghighi
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - G G Hanna
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - D Kok
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - M MacManus
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - C Phillips
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - N Plumridge
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - M Shaw
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - A Wirth
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - G Wheeler
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - D Ball
- Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - S Siva
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia.
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22
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Chen XR, Hou X, Li DL, Sai K, Dinglin XX, Chen J, Wang N, Li MC, Wang KC, Chen LK. Management of Non-Small-Cell Lung Cancer Patients Initially Diagnosed With 1 to 3 Synchronous Brain-Only Metastases: A Retrospective Study. Clin Lung Cancer 2020; 22:e25-e34. [PMID: 32839132 DOI: 10.1016/j.cllc.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/17/2020] [Accepted: 07/25/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The treatment options for newly diagnosed non-small-cell lung cancer (NSCLC) patients with 1 to 3 synchronous brain metastases (BM) remain controversial. The current study aimed to comprehensively analyze the characteristics, local treatment paradigms, and survival outcomes in these populations. PATIENTS AND METHODS A total of 252 NSCLC patients initially diagnosed with 1 to 3 synchronous brain-only metastases were enrolled onto this study. Local therapy (LT) to primary lung tumors (PLT) and BM included surgery, radiotherapy, or both. Median overall survival (mOS) was measured among patients who received LT to both PLT and BM (all-LT group), patients who were treated with LT to either PLT or BM (part-LT group), and patients who did not receive any LT (non-LT group). RESULTS The mOS for all-LT (n = 70), part-LT (n = 113), and non-LT (n = 69) groups was 33.2, 18.5, and 16.8 months, respectively (P = .002). The OS rates at 5 years for the all-LT, part-LT, and non-LT groups were 25.5%, 16.2%, and 0, respectively. Multivariable analysis revealed that all-LT versus non-LT, pretreatment Karnofsky performance status > 70, histology of adenocarcinoma, thoracic stage I-II, EGFR mutation, ALK positive, and second-line systemic therapies were independent prognostic factors for improved mOS. CONCLUSIONS The current study showed that LT for both PLT and BM is associated with superior OS in appropriately selected NSCLC patients initially diagnosed with 1 to 3 synchronous BM. Prospective trials are urgently needed to confirm this finding.
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Affiliation(s)
- Xin-Ru Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Xue Hou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - De-Lan Li
- Department of Chemotherapy, Zhongshan City People's Hospital, Zhongshan, PR China
| | - Ke Sai
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Xiao-Xiao Dinglin
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, PR China
| | - Jing Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Na Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Mei-Chen Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Kai-Cheng Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Li-Kun Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China.
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Affiliation(s)
- Carlos A Puig
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dennis Wigle
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Li T. Managing the Isolated Central Nervous System Progression in Patients With Oncogene-Driven Metastatic NSCLC: Does Circulating Tumor DNA Add to Management? J Thorac Oncol 2020; 15:314-316. [PMID: 32093852 DOI: 10.1016/j.jtho.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Tianhong Li
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, California.
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25
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Lan Q, Ji C, Yao Y. [Basis of Tumor Microenvironment Relevant to Immunotherapies for Brain Metastases of NSCLC]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 22:512-519. [PMID: 31451142 PMCID: PMC6717868 DOI: 10.3779/j.issn.1009-3419.2019.08.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
脑是非小细胞肺癌(non-small cell lung cancer, NSCLC)最常见的远处转移部位,脑转移也是晚期肺癌致残致死的主要原因。近年来,小分子酪氨酸激酶抑制剂的应用和疗效奠定了驱动基因突变阳性的NSCLC脑转移的治疗基础。随着程序性死亡受体1(programmed cell death protein 1, PD-1)/程序性死亡受体配体1(programmed cell death protein ligand 1, PD-L1)抑制剂及相应联合疗法的不断发展,免疫治疗已成为驱动基因突变泛阴性的NSCLC脑转移患者的重要选择,相关生物标志物的价值也日益凸显。由于NSCLC脑转移肿瘤及其微环境的免疫病理特征具有一定的特殊性,本文旨在回顾相关研究进展,并为免疫治疗联合策略的探索与新型免疫疗法的开发提供参考。
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Affiliation(s)
- Qing Lan
- Immunology Laboratory, Neurosurgical Institute of Fudan University; Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chunxia Ji
- Immunology Laboratory, Neurosurgical Institute of Fudan University; Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu Yao
- Immunology Laboratory, Neurosurgical Institute of Fudan University; Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
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Nikitas J, Roach M, Robinson C, Bradley J, Huang J, Perkins S, Tsien C, Abraham C. Treatment of oligometastatic lung cancer with brain metastases using stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Clin Transl Radiat Oncol 2019; 21:32-35. [PMID: 31956701 PMCID: PMC6956672 DOI: 10.1016/j.ctro.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 12/30/2022] Open
Abstract
Background There is increasing interest in treating oligometastatic non-small cell lung cancer (NSCLC) patients with stereotactic radiation. We aimed to address whether patients definitively treated with synchronous thoracic stereotactic body radiation therapy (SBRT) and brain stereotactic radiosurgery (SRS) had favorable outcomes with local therapy. Materials and methods We reviewed a database of patients receiving lung SBRT as well as a database for brain metastasis patients treated with SRS between June 2004 and January 2016. We selected for cT1-2aN0M1 NSCLC patients with brain metastases and calculated their overall survival (OS), freedom from progression (FFP), and local control (LC) rates. Results Six patients had oligometastatic NSCLC with 1-3 synchronous brain metastases treated with lung SBRT and brain SRS. No patients received immunotherapy and two-thirds did not receive systemic therapy. Median follow-up was 9 months for the entire cohort (range, 2-95 months) and 95 months for the surviving patient. Median OS was 12.4 months (95% confidence interval [CI], 7-18 months). At 1 year, patients had 67% OS (95% CI, 29-100%), 17% FFP (95% CI, 0-46%), and 100% LC. Their brain disease had 80% 1-year LC (95% CI, 45-100%) and 53% 1-year FFP (95% CI, 5-100%). Two patients had no distant progression, two had brain progression, one had adrenal gland progression, and one had bone and liver progression. Conclusion In patients presenting with oligometastatic lung cancer limited to the brain, treatment with both lung SBRT and brain SRS achieves good LC of all sites with encouraging OS.
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Affiliation(s)
- John Nikitas
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Michael Roach
- Department of Radiation Oncology, Cancer Center of Hawaii, Honolulu, HI 96817, United States
| | - Cliff Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Jeffrey Bradley
- Department of Radiation Oncology, Emory School of Medicine, Atlanta, GA 30322, United States
| | - Jiayi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Stephanie Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Christina Tsien
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Christopher Abraham
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, United States
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Couñago F, Luna J, Guerrero LL, Vaquero B, Guillén-Sacoto MC, González-Merino T, Taboada B, Díaz V, Rubio-Viqueira B, Díaz-Gavela AA, Marcos FJ, del Cerro E. Management of oligometastatic non-small cell lung cancer patients: Current controversies and future directions. World J Clin Oncol 2019; 10:318-339. [PMID: 31799148 PMCID: PMC6885452 DOI: 10.5306/wjco.v10.i10.318] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/30/2019] [Accepted: 09/15/2019] [Indexed: 02/06/2023] Open
Abstract
Oligometastatic non-small cell lung cancer (NSCLC) describes an intermediate stage of NSCLC between localized and widely-disseminated disease. This stage of NSCLC is characterized by a limited number of metastases and a more indolent tumor biology. Currently, the management of oligometastatic NSCLC involves radical treatment (radiotherapy or surgery) that targets the metastatic lesions and the primary tumor to achieve disease control. This approach offers the potential to achieve prolonged survival in patients who, in the past, would have only received palliative measures. The optimal therapeutic strategies for the different scenarios of oligometastatic disease (intracranial vs extracranial disease, synchronous vs metachronous) remain undefined. Given the lack of head-to-head studies comparing radiotherapy to surgery in these patients, the decision to apply surgery or radiotherapy (with or without systemic treatment) must be based on prognostic factors that allow us to classify patients. This classification will allow us to select the most appropriate therapeutic strategy on an individualized basis. In the future, the molecular or microRNA profiles will likely improve the treatment selection process. The objective of the present article is to review the most relevant scientific evidence on the management of patients with oligometastatic NSCLC, focusing on the role of radiotherapy and surgery. We also discuss areas of controversy and future directions.
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Affiliation(s)
- Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28223, Spain
| | - Javier Luna
- Department of Radiation Oncology, Hospital Fundación Jiménez Díaz, Madrid 28040, Spain
| | | | - Blanca Vaquero
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
| | | | | | - Begoña Taboada
- Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Verónica Díaz
- Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Cádiz 11009, Spain
| | - Belén Rubio-Viqueira
- Department of Medical Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
| | - Ana Aurora Díaz-Gavela
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28223, Spain
| | - Francisco José Marcos
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28223, Spain
| | - Elia del Cerro
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28223, Spain
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Uhlig J, Case MD, Blasberg JD, Boffa DJ, Chiang A, Gettinger SN, Kim HS. Comparison of Survival Rates After a Combination of Local Treatment and Systemic Therapy vs Systemic Therapy Alone for Treatment of Stage IV Non-Small Cell Lung Cancer. JAMA Netw Open 2019; 2:e199702. [PMID: 31433481 PMCID: PMC6707019 DOI: 10.1001/jamanetworkopen.2019.9702] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE As many as 55% of patients with non-small cell lung cancer (NSCLC) present with stage IV disease at diagnosis. Although systemic therapy is the cornerstone for treatment of these patients, growing evidence suggests that local treatment of the primary tumor site may improve survival. OBJECTIVE To assess whether addition of local treatment for primary tumor site in stage IV NSCLC provides a survival benefit over systemic therapy alone. DESIGN, SETTING, AND PARTICIPANTS In this comparative effectiveness research study, the National Cancer Database (NCDB; 2018 version) was retrospectively queried from January 1, 2010, through December 31, 2015, for patients with a histopathologic diagnosis of stage IV NSCLC. Exclusion criteria were being younger than 18 years and missing information on tumor characteristics and follow-up data. Data were analyzed from November 1, 2018, through January 1, 2019. EXPOSURES Treatment groups were stratified as (1) surgical resection plus systemic therapy; (2) external beam radiotherapy (EBRT) or thermal ablation (TA; including cryosurgery and radiofrequency ablation) plus systemic therapy; and (3) systemic therapy alone. MAIN OUTCOMES AND MEASURES Overall survival was compared between treatment groups using multivariable Cox proportional hazards regression models and after propensity score matching. Subgroup analyses were planned a priori according to patient and tumor characteristics. RESULTS A total of 34 887 patients met inclusion criteria (19 002 male [54.5%]; median age, 68 years [interquartile range, 60-75 years]), among whom 835 underwent surgical resection plus systemic therapy; 9539, EBRT/TA plus systemic therapy; and 24 513, systemic therapy alone. Demographic and cancer-specific factors were associated with treatment allocation with a higher likelihood of surgical resection for oligometastatic NSCLC. After multivariable adjustment, surgical resection was associated with superior overall survival compared with EBRT/TA or systemic therapy alone (hazard ratio [HR] for EBRT/TA, 0.62; 95% CI, 0.57-0.67; P < .001; HR for systemic therapy alone, 0.59; 95% CI, 0.55-0.64; P < .001). Treatment with EBRT/TA demonstrated superior overall survival compared with systemic therapy alone (HR, 0.95; 95% CI, 0.93-0.98; P = .002). Interaction analyses identified heterogeneous associations with treatment; the EBRT/TA survival benefit was especially pronounced in stage IV squamous cell carcinoma with limited T and N category disease and oligometastases (HR, 0.68; 95% CI, 0.57-0.80; P < .001), with overall survival rates of 60.4% vs 45.4% at 1 year, 32.6% vs 19.2% at 2 years, and 20.2% vs 10.6% at 3 years for combination therapy vs systemic therapy alone. CONCLUSIONS AND RELEVANCE In stage IV NSCLC, surgical resection or EBRT/TA of the primary tumor site may provide survival benefits in addition to systemic therapy alone in selected patients. Specifically, EBRT/TA may be considered as a treatment option in select patients who are ineligible for surgical resection.
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Affiliation(s)
- Johannes Uhlig
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Meaghan Dendy Case
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Justin D. Blasberg
- Section of Thoracic Surgery, Department of Surgery, Yale New Haven Hospital, Yale University, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Daniel J. Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale New Haven Hospital, Yale University, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Anne Chiang
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
- Section of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Scott N. Gettinger
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
- Section of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Hyun S. Kim
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
- Section of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
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29
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Muñoz Molina GM, Ovejero Díaz AP, Gorospe Sarasúa L. Surgical approach of non-small cell lung cancer with extrapulmonary metastasis. Med Clin (Barc) 2019; 153:115-121. [PMID: 31151683 DOI: 10.1016/j.medcli.2019.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/18/2022]
Abstract
Bronchogenic carcinoma is the leading cause of death due to cancer worldwide. Nearly 75% of patients have a disseminated carcinoma at diagnosis. Up to 50% of patients with a localized disease will develop metastasis. Nevertheless, the current scientific evidence has demonstrated that when the metastatic disease is limited, particularly in specific locations such as the brain and the adrenal glands, a multidisciplinary approach with radical intent could achieve a longer survival. This review analyses the clinical evidence available in the literature that supports the treatment of both the primary and the metastatic disease, as well as the preoperative study and the most widely accepted indications.
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30
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Gong HY, Wang Y, Han G, Song QB. Radiotherapy for oligometastatic tumor improved the prognosis of patients with non-small cell lung cancer (NSCLC). Thorac Cancer 2019; 10:1136-1140. [PMID: 30957423 PMCID: PMC6501008 DOI: 10.1111/1759-7714.13054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/01/2019] [Accepted: 03/10/2019] [Indexed: 12/12/2022] Open
Abstract
Background This study was conducted to investigate if radiotherapy improved the overall survival (OS) of patients with oligometastatic non‐small cell lung cancer (NSCLC). Methods From January 2012 to August 2015, 323 NSCLC patients with distant metastasis were administered radiotherapy. Ninety‐five patients with oligometastatic NSCLC who were sensitive to the initial chemotherapy were treated with radiotherapy for the residual lesions. Initial treatment consisted of four to six cycles of induction chemotherapy. If the patients responded to the initial treatment without developing new metastases, the residual sites were radiated at a total dose of 56–66 Gy, including the primary and metastatic sites. OS, progression‐free survival, and sites of progression were assessed. The Kaplan–Meier method was used to estimate the OS and progression‐free survival probabilities. Results The median survival of the whole cohort was 15 months (95% confidence interval 6–40) and the median time to progression was 11 months (95% confidence interval 4–24). Sixty‐seven patients had died by the end of follow‐up. The one‐year and two‐year OS rates were 58% and 23%, respectively. Patients progressed either with brain (n = 14), bone (n = 11), lung (n = 10), liver (n = 7), adrenal gland (n = 5), or seven other sites of metastases (n = 3). Acute grade III esophageal toxicity was observed in 17 patients (18%) and grade III pulmonary toxicity in seven patients (7%). Conclusion Oligometastatic non‐progressive NSCLC patients may benefit from aggressive radiotherapy to the residual lesions with acceptable toxicity after systemic chemotherapy.
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Affiliation(s)
- Hong-Yun Gong
- Department of Oncology, Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yi Wang
- Department of Oncology, Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Guang Han
- Department of Oncology, Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qi-Bin Song
- Department of Oncology, Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
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31
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Smith DR, Bian Y, Wu CC, Saraf A, Tai CH, Nanda T, Yaeh A, Lapa ME, Andrews JIS, Cheng SK, McKhann GM, Sisti MB, Bruce JN, Wang TJC. Natural history, clinical course and predictors of interval time from initial diagnosis to development of subsequent NSCLC brain metastases. J Neurooncol 2019; 143:145-155. [PMID: 30874953 DOI: 10.1007/s11060-019-03149-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/09/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Non-small cell lung cancer (NSCLC) brain metastases are associated with substantial morbidity and mortality. During recent years, accompanying dramatic improvements in systemic disease control, NSCLC brain metastases have emerged as an increasingly relevant clinical problem. However, optimal surveillance practices remain poorly defined. This purpose of this study was to further characterize the natural history, clinical course and risk factors associated with earlier development of subsequent NSCLC brain metastases to better inform clinical practice and help guide survivorship care. METHODS We retrospectively reviewed all institutional NSCLC brain metastasis cases treated with radiotherapy between 1997 and 2015. Exclusion criteria included presence of brain metastases at initial NSCLC diagnosis and incomplete staging information. Interval time to brain metastases and subsequent survival were characterized using Kaplan-Meier and multivariate Cox regression analyses. RESULTS Among 105 patients within this cohort, median interval time to development of brain metastases was 16 months. Median interval times were 29, 19, 16 and 13 months for Stage I-IV patients, respectively (P = 0.016). Additional independent predictors for earlier development of NSCLC brain metastases included non-adenocarcinomatous histopathology (HR 3.036, P < 0.001), no prior surgical resection (HR 1.609, P = 0.036) and no prior systemic therapy (HR 3.560, P = 0.004). Median survival following intracranial progression was 16 months. Delayed development of brain metastases was associated with better prognosis (HR 0.970, P < 0.001) but not survival following intracranial disease onset. CONCLUSIONS Collectively, our results provide valuable insights into the natural history of NSCLC brain metastases. NSCLC stage, histology, prior surgical resection and prior systemic therapy emerged as independent predictors for interval time to brain metastases.
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Affiliation(s)
- Deborah R Smith
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA
| | - Yandong Bian
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA
| | - Anurag Saraf
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA
| | - Cheng-Hung Tai
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA
| | - Tavish Nanda
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA
| | - Andrew Yaeh
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA
| | - Matthew E Lapa
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA
| | - Jacquelyn I S Andrews
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA
| | - Simon K Cheng
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Guy M McKhann
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Michael B Sisti
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jeffrey N Bruce
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, 10032, USA.
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32
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Gerber DE. Oligometastatic Non-Small-Cell Lung Cancer: How Should We Define and Manage It? J Oncol Pract 2019; 14:32-34. [PMID: 29324207 DOI: 10.1200/jop.2017.028290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David E Gerber
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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33
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Indian consensus statement for treatment of advanced non small cell lung cancer: First line, maintenance, and second line. Indian J Cancer 2018; 54:89-103. [PMID: 29199671 DOI: 10.4103/ijc.ijc_136_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The management of advanced nonsmall cell lung cancer (NSCLC) patients is becoming complex with the identification of driver mutations and targeted therapies. The expert group of academic medical oncologists used data from published literature, practical experience to arrive at practical consensus recommendations to treat advanced NSCLC for use by the community oncologists.
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Li S, Zhu R, Li D, Li N, Zhu X. Prognostic factors of oligometastatic non-small cell lung cancer: a meta-analysis. J Thorac Dis 2018; 10:3701-3713. [PMID: 30069368 DOI: 10.21037/jtd.2018.05.105] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The prognostic factors of oligometastatic non-small cell lung cancer (NSCLC) are uncertain. We performed a meta-analysis to assess the prognostic factors of oligometastatic NSCLC patients who are most likely to achieve long-term survival. Methods We searched PubMed, EMBASE, the Cochrane to identify eligible articles and performed the meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies revealing the prognostic factors of oligometastatic NSCLC. The primary endpoint of interest was overall survival (OS). Results We analyzed data from twenty-four eligible studies, including data from 1,935 patients with oligometastatic NSCLC. In the univariate analysis, we found no significant difference in OS of prognostic factors including age [hazard ratios (HRs) 1.02, 95% CI: 0.80-1.31, P=0.86], smoking status (HR 1.08, 95% CI: 0.80-1.46, P=0.62), type of metastases (HR 1.61, 95% CI: 0.86-3.03, P=0.14), but significantly positive prognoses containing female (HR 1.21, 95% CI: 1.02-1.45, P=0.03), (y)pN0 stage (HR 1.82, 95% CI: 1.40-2.36, P<0.00001), adenocarcinoma (HR 1.44, 95% CI: 1.10-1.88, P=0.008). In the multivariate analysis, patients with (y)pN0 stage had an obvious survival benefit compared with (y)pN1 (HR 1.63, 95% CI: 1.27-2.10, P=0.001), but no significant survival in contrast with (y)pN2 (HR 2.01, 95% CI: 0.80-5.03, P=0.14). In subgroup analyses, neither thoracic stage (HR 2.06, 95% CI: 1.52-2.78, P=0.55), (y)pT-stage of primary lung cancer (HR 1.38, 95% CI: 0.86-2.21, P=0.14) nor tumorous histology (HR 2.99, 95% CI: 2.10-4.28, P=0.91) and oligometastatic number (HR 1.25, 95% CI: 0.97-1.62, P=0.98) were significantly different in OS. However, patients with aggressive thoracic treatment (ATT) had improved survival (HR 0.56, 95% CI: 0.37-0.83, P=0.001), and notably, different strategies of ATT received by oligometastatic NSCLC patients might significantly influence survival (HR 0.54, 95% CI: 0.36-0.82, P<0.00001). Conclusions Overall, factors including age, smoking status, type of metastasis were not associated with long-term survival of oligometastatic NSCLC patients. However, our finding suggests that aggressive therapies in the primary lung cancer, as well as female, (y)pT-stage, absence of nodal diseases, adenocarcinoma histology have been clarified as positive prognosis. Further studies of prospective study for these patients are warranted.
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Affiliation(s)
- Shangbiao Li
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Rui Zhu
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Dianhe Li
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Na Li
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xiaoxia Zhu
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Consolidative Local Ablative Therapy Improves the Survival of Patients With Synchronous Oligometastatic NSCLC Harboring EGFR Activating Mutation Treated With First-Line EGFR-TKIs. J Thorac Oncol 2018; 13:1383-1392. [PMID: 29852232 DOI: 10.1016/j.jtho.2018.05.019] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The aim of the current study was to investigate whether consolidative local ablative therapy (LAT) can improve the survival of patients with stage IV EGFR-mutant NSCLC who have oligometastatic disease treated with first-line EGFR-tyrosine kinase inhibitor (TKI) therapy. METHODS Patients with stage IV EGFR-mutant NSCLC and no more than five metastases within 2 months of diagnosis were identified. All patients were treated with first-line EGFR-TKIs. Consolidative LAT included radiotherapy, surgery, or both. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier curves. RESULTS From October 2010 to May 2016, 145 patients were enrolled, including 51 (35.2%) who received consolidative LAT to all oligometastatic sites (all-LAT group), 55 (37.9%) who received consolidative LAT to either primary tumor or oligometastatic sites (part-LAT group), and 39 (26.9%) who did not receive any consolidative LAT (non-LAT group). The median PFS in all-LAT, part-LAT, and non-LAT groups were 20.6, 15.6, and 13.9 months, respectively (p < 0.001). The median OS in all-LAT, part-LAT, and non-LAT groups were 40.9, 34.1, and 30.8 months, respectively (p < 0.001). The difference was statistically significant between the all-LAT group and part-LAT or non-LAT group but was not between the part-LAT and non-LAT group. The median OS was significantly improved with consolidative LAT for primary tumor (40.5 versus 31.5 months, p < 0.001), brain metastases (38.2 versus 29.2 months, p = 0.002), and adrenal metastases (37.1 versus 29.2 months, p = 0.032). Adverse events (grade ≥ 3) due to radiotherapy included pneumonitis (7.7%) and esophagitis (16.9%). CONCLUSIONS The current study showed that consolidative LAT to all metastatic sites was a feasible option for patients with EGFR-mutant oligometastatic NSCLC during first-line EGFR-TKI treatment, with significantly improved PFS and OS compared with consolidative LAT to partial sites or observation alone.
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Zhou J, Gong Z, Jia Q, Wu Y, Yang ZZ, Zhu B. Programmed death ligand 1 expression and CD8 + tumor-infiltrating lymphocyte density differences between paired primary and brain metastatic lesions in non-small cell lung cancer. Biochem Biophys Res Commun 2018. [PMID: 29526752 DOI: 10.1016/j.bbrc.2018.03.053] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Immunotherapy targeting the programmed cell death-1/programmed death ligand 1(PD-L1) pathway has shown promising antitumor activity in brain metastases (BMs) of non-small cell lung cancer (NSCLC) patients with an acceptable safety profile; however, the response rates often differ between primary lesions and intracranial lesions. Studies are necessary to identify detailed characterizations of the response biomarkers. In this study, we aimed to compare the differences of PD-L1 expression and CD8+ tumor-infiltrating lymphocyte (TIL) density, two major response biomarkers of PD-1/PD-L1 blockade, between paired primary and brain metastatic lesions in advanced NSCLC. We observed that among primary lesions or BMs, only a small number of patients harbored common PD-L1 expression on both tumor cells and tumor-infiltrating immune cells. Additionally, we found that the numbers of CD8+ TILs were significantly fewer in BMs than in primary lung cancers. Low stromal CD8+ TIL numbers in BMs were associated with significantly shorter overall survival compared to high stromal CD8+ TIL counts. Notably, we demonstrated a discrepancy in PD-L1 expression and CD8+ TIL density between primary lung cancers and their corresponding BMs. Such heterogeneities are significantly associated with the time at which BMs occurred. Our study emphasizes the spatial and temporal heterogeneity of biomarkers for anti-PD-1/PD-L1 therapy, which should be concerned in clinical practice.
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Affiliation(s)
- Jie Zhou
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Zhihua Gong
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Qingzhu Jia
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Yan Wu
- Institute of Cancer Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, 400042, Chongqing, China
| | - Zhen-Zhou Yang
- Department of Oncology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China.
| | - Bo Zhu
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China.
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Divisi D, Barone M, Zaccagna G, Gabriele F, Crisci R. Surgical approach in the oligometastatic patient. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:94. [PMID: 29666817 DOI: 10.21037/atm.2018.01.19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In the setting of a stage IV non-small cell lung cancer (NSCLC), oligometastatic patients represent a heterogeneous group whose incidence is increasing as far as with the adoption of new therapeutic regimens, the improvement of the molecular characterization assays and the increasing number of long-survivor patients. The oligometastatic state undergone a major revision with the introduction of the new TNM lung cancer staging system, being characterized by a different prognosis compared to multi-metastatic patients. Furthermore, the presence of a limited number of metastases imposes a local control especially when clonal selections occur during adjuvant therapy. In this regard, the review seeks to clarify the indications for surgical treatment by organ according to recent guidelines, by analyzing prognostic factors and outcome of patients. Although accurate patient stratification is mandatory, aggressive local control strategies represent a valid therapeutic approach in patients with oligometastatic NSCLC. At the same time, persevering with ablative strategies raises both medical and ethical issues about limits and reiteration, which certainly requires a deep reflection, being, on the other hand, in front of a metastatic disease.
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Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
| | - Mirko Barone
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
| | - Gino Zaccagna
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
| | - Francesca Gabriele
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
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Sato J, Horinouchi H, Goto Y, Kanda S, Fujiwara Y, Nokihara H, Yamamoto N, Ohe Y. Long-term survival without surgery in NSCLC patients with synchronous brain oligometastasis: systemic chemotherapy revisited. J Thorac Dis 2018; 10:1696-1702. [PMID: 29707323 DOI: 10.21037/jtd.2018.03.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Among patients with metastatic non-small-cell lung cancer (NSCLC), patients with TNM stage N0 to N1 and brain oligometastases (BOM) (less than 5 metastases) as the sole distant lesion (N0-1 BOM) who receive surgical treatments for the primary and metastatic sites reportedly have a better prognosis. Little data is available regarding the outcomes of patients treated with only systemic chemotherapy for the primary site and definitive treatment for synchronous BOM, compared with the outcomes of patients receiving surgical treatment for the primary site. Methods Stage IV NSCLC patients with or without N0-1 BOM, who underwent chemotherapy for the primary site between January 2000 and December 2010 were identified from the records of our institution. Results Among 936 advanced NSCLC patients treated with systemic chemotherapy, 19 patients had N0-1 BOM at presentation. The median overall survival (OS) period of the N0-1 BOM patients was 16.0 months (95% CI, 11.8-20.2 months), while that of the N2-3 BOM + non-BOM patients was 14.5 months (95% CI, 13.2-15.8 months), compared with 7-9 months in previous reports. The median 3- and 5-year survival rates of the N0-1 BOM patients were 28% and 19%. Conclusions The treatment outcomes of the N0-1 BOM patients who did not receive surgery for the primary site were better than those of the N2-3 BOM + non-BOM patients. A randomized trial evaluating the efficacy of surgery for the primary site in N0-1 BOM patients is warranted.
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Affiliation(s)
- Jun Sato
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hidehito Horinouchi
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Goto
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shintaro Kanda
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Fujiwara
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Nokihara
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Yamamoto
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Ning MS, Gomez DR, Heymach JV, Swisher SG. Stereotactic ablative body radiation for oligometastatic and oligoprogressive disease. Transl Lung Cancer Res 2018; 8:97-106. [PMID: 30788239 DOI: 10.21037/tlcr.2018.09.21] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Stage IV non-small cell lung cancer (NSCLC) exists on a spectrum, with a subset of patients presenting with oligometastatic disease involving only a limited number of distant sites. For these patients, local consolidative therapy (LCT) has been demonstrated to improve outcomes through ablation or cytoreduction of metastatic disease, as shown in an increasing number of randomized controlled trials. In particular, stereotactic ablative body radiation (SABR) has emerged as a feasible treatment modality for elimination of oligometastatic sites. This focused review examines the underlying biologic mechanisms and clinical data in support of SABR in the setting of oligometastatic NSCLC. Following a comprehensive evaluation of the pertinent retrospective, prospective, and anticipated trials to date, we summarize the evidence regarding patient selection, treatment safety, and technical considerations to provide guidance of this approach for clinicians.
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Affiliation(s)
- Matthew S Ning
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel R Gomez
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John V Heymach
- Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen G Swisher
- Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Systematic Review of Brain Metastases in Patients With Non–Small-Cell Lung Cancer in the United States, European Union, and Japan. Clin Lung Cancer 2017; 18:607-614. [DOI: 10.1016/j.cllc.2017.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/03/2017] [Accepted: 04/18/2017] [Indexed: 11/17/2022]
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Xia B, Zhang S, Ma S. Management of non-small cell lung cancer with EGFR mutation: the role of radiotherapy in the era of tyrosine kinase inhibitor therapy-opportunities and challenges. J Thorac Dis 2017; 9:3385-3393. [PMID: 29221323 DOI: 10.21037/jtd.2017.09.67] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In recent years, the treatment of advanced non-small cell lung cancer (NSCLC) was greatly promoted by the discovery of oncogenic drivers and the development of targeted therapies specific for these drivers. Somatic mutations in epidermal growth factor receptor (EGFR) are the most common type in patients with NSCLC. Small-molecule tyrosine kinase inhibitor (TKI) targeting EGFR produced relatively high response rate and long duration with acceptable toxicity profile. Also, the life expectancy in patients with active EGFR mutation has been significantly prolonged than the past. Additionally, evolution of advanced imaging and radiation techniques has expanded the indications for radiotherapy in complex clinical situation. All of those factors contributed to the widely use of radiotherapy for advanced NSCLC treated with TKI therapy. In this review, we will discuss how to integrate radiotherapy into the comprehensive treatment of patients with TKI therapy in order to maximize the therapeutics effect.
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Affiliation(s)
- Bing Xia
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology and Toxicology, School of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China.,Translational Medicine Research Center, Nanjing Medical University, Affiliated Hangzhou Hospital, Hangzhou First People's Hospital, Hangzhou 310006, China.,Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou 310006, China
| | - Shirong Zhang
- Translational Medicine Research Center, Nanjing Medical University, Affiliated Hangzhou Hospital, Hangzhou First People's Hospital, Hangzhou 310006, China
| | - Shenglin Ma
- Translational Medicine Research Center, Nanjing Medical University, Affiliated Hangzhou Hospital, Hangzhou First People's Hospital, Hangzhou 310006, China
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Noonan C, James M. A case of isolated small cell carcinoma of the brain. Acta Oncol 2017; 56:1133-1135. [PMID: 28562202 DOI: 10.1080/0284186x.2017.1290273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. Noonan
- Department of Oncology, Canterbury District Health Board, Christchurch, New Zealand
| | - M. James
- Department of Oncology, Canterbury District Health Board, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Validation of the Disease-Specific GPA for Patients With 1 to 3 Synchronous Brain Metastases in Newly Diagnosed NSCLC. Clin Lung Cancer 2017; 19:e141-e147. [PMID: 28739316 DOI: 10.1016/j.cllc.2017.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The disease-specific graded prognostic assessment (DS-GPA) for brain metastases is a powerful prognostic tool but has not been validated for patients with synchronous brain metastases (SBM) in newly diagnosed non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS We identified patients with newly diagnosed NSCLC with 1 to 3 SBM treated with stereotactic radiosurgery (SRS) between 1997 and 2012. We included patients whose brain metastases were treated with SRS alone or combined SRS and whole-brain radiotherapy (WBRT). Patients were stratified according to NSCLC DS-GPA to evaluate the accuracy of survival estimates. RESULTS One hundred sixty-four patients were treated with either SRS alone (n = 85; 52%) or SRS and WBRT (n = 79; 48%). Median overall survival (OS) stratified according to DS-GPA of 0 to 1, 1.5 to 2, 2.5 to 3, and 3.5 to 4 were 2.8, 6.7, 9.8, and 13.2 months, respectively, consistent with OS reported for brain metastases in NSCLC DS-GPA (3.0, 6.5, 11.3, and 14.8 months, respectively). No difference in median progression-free survival or OS was noted with combined use of SRS and WBRT: 6.0 versus 6.1 months (P = .81) and 8.5 versus 9.1 months (P = .093), respectively. In multivariable analysis, Karnofsky performance status (hazard ratio [HR], 0.98; P = .008), extracranial metastases (HR, 0.498; P = .0003), squamous histology (HR, 1.81; P = .02), and number of brain metastases (2 vs. 1; HR, 1.504; P = .04, and 3 vs. 1; HR, 1.66; P = .05) were significant predictors of OS. CONCLUSION The DS-GPA accurately estimates the prognosis of patients with SBM in newly diagnosed NSCLC. Patients with synchronous brain metastasis in newly diagnosed NSCLC should be carefully stratified for consideration of aggressive therapy.
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Sauter M, Vavricka SR, Keilholz G, Heinrich H, Winder T, Kranzbühler H, Lombriser N, Misselwitz B. Surveillance of anal carcinoma after radiochemotherapy. Strahlenther Onkol 2017; 193:639-647. [DOI: 10.1007/s00066-017-1159-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/23/2017] [Indexed: 02/07/2023]
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The TNM 8 M1b and M1c classification for non-small cell lung cancer in a cohort of patients with brain metastases. Clin Transl Oncol 2017; 19:1141-1146. [PMID: 28357633 DOI: 10.1007/s12094-017-1651-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/18/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE According to the recent TNM 8 classification, patients with metastatic non-small cell lung cancer (NSCLC) and single extrathoracic metastasis should be classified as stage M1b, while those with 2 or more metastases comprise stage M1c. The purpose of this study was to analyze the impact of this classification in patients with brain metastases. MATERIALS AND METHODS This retrospective study included 172 patients treated with individualized approaches. Actuarial survival was calculated. Uni- and multivariate analyses were performed. RESULTS Thirty patients (17%) were staged as M1b. Those with squamous cell cancer were more likely to harbor M1b disease (29%, adenocarcinoma 14%, other histology 17%, p = 0.16). Median survival was 5.4 months (8.0 months in case of M1b disease and 4.5 months in case of M1c disease, p = 0.001). Multivariate analysis confirmed the role of M1b stage. M1b patients managed with upfront surgery or radiosurgery had significantly longer median survival than those who received whole-brain irradiation (21.0 vs. 3.5 months, p = 0.0001) and the potential to survive beyond 5 years. CONCLUSIONS We found the M1b classification to provide clinically relevant information. The multivariate analysis suggested that patients with M1b disease, better performance status and younger age have better survival.
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Juan O, Popat S. Ablative Therapy for Oligometastatic Non-Small Cell Lung Cancer. Clin Lung Cancer 2017; 18:595-606. [PMID: 28377206 DOI: 10.1016/j.cllc.2017.03.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/22/2017] [Accepted: 03/06/2017] [Indexed: 12/19/2022]
Abstract
The oligometastatic state represents a distinct entity among those with metastatic disease and consists of patients with metastases limited in number and location, representing an intermediate state between locally confined and widely metastatic cancer. Although similar, "oligorecurrence" (limited number of metachronous metastases under conditions of a controlled primary lesion) and "oligoprogressive" (disease progression at a limited number of sites with disease controlled at other disease sites) states are distinct entities. In non-small cell lung cancer (NSCLC), the oligometastatic state is relatively common, with 20% to 50% of patients having oligometastatic disease at diagnosis. This subgroup of patients when receiving ablative therapy, such as surgery or stereotactic body radiation radiotherapy, can obtain markedly long progression-free and overall survival. The role of radical treatment for intracranial oligometastases is well established. Fewer data exist regarding radical treatment of extracranial metastases in lung cancer; however, retrospective series using surgery or stereotactic body radiotherapy for extracranial oligometastatic disease in NSCLC have shown excellent local control, with a suggestion of improvement in progression-free survival. In the present report, we have reviewed the data on the treatment of brain metastases in oligometastatic NSCLC and the results of ablative treatment of extracranial sites. Recently, the first randomized trial comparing ablative treatment versus control in oligometastatic disease was reported, and those data are reviewed in the context of smaller series. Finally, areas of controversy are discussed and a therapeutic approach for patients with oligometastatic disease is proposed.
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Affiliation(s)
- Oscar Juan
- Department of Medical Oncology, University Hospital La Fe, Valencia, Spain.
| | - Sanjay Popat
- Lung Unit, Royal Marsden Hospital, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom; and the Institute of Cancer Research, London, United Kingdom
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Patla A, Walasek T, Jakubowicz J, Blecharz P, Mituś JW, Mucha-Małecka A, Reinfuss M. Methods and results of locoregional treatment of brain metastases in patients with non-small cell lung cancer. Contemp Oncol (Pozn) 2016; 20:358-364. [PMID: 28373816 PMCID: PMC5371699 DOI: 10.5114/wo.2015.51825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/01/2014] [Indexed: 11/17/2022] Open
Abstract
This article presents methods and results of surgery and radiotherapy of brain metastases from non-small cell lung cancer (BMF-NSCLC). Patients with single BMF-NSCLC, with Karnofsky score ≥ 70 and controlled extracranial disease are the best candidates for surgery. Stereotactic radiosurgery (SRS) is recommended in patients with 1-3 BMF-NSCLC below 3-3.5 cm, with minor neurological symptoms, located in parts of the brain not accessible to surgery, with controlled extracranial disease. Whole brain radiotherapy (WBRT) following SRS reduces the risk of local relapse; in selected patients median survival reaches more than 10 months. Whole brain radiotherapy alone is a treatment in patients with multiple metastases, poor performance status, uncontrolled extracranial disease, disqualified from surgery or SRS with median survival 3 to 6 months. There is no doubt that there are patients with BMF-NSCLC who should receive only the best supportive care. There is a debate in the literature on how to select these patients.
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Affiliation(s)
- Anna Patla
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Tomasz Walasek
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Jerzy Jakubowicz
- Department of Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Paweł Blecharz
- Department of Gynaecological Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Jerzy Władysław Mituś
- Department of Surgical Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Anna Mucha-Małecka
- Department of Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Marian Reinfuss
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
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Onesti CE, Iacono D, Angelini S, Lauro S, Mazzotta M, Occhipinti MA, Giusti R, Marchetti P. Unexpected long survival of brain oligometastatic non-small cell lung cancer (NSCLC) treated with multimodal treatment: a single-center experience and review of the literature. Transl Lung Cancer Res 2016; 5:712-719. [PMID: 28149766 DOI: 10.21037/tlcr.2016.09.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death worldwide. Fifty percent of the cases are metastatic at diagnosis and about 20% develop brain metastasis. The brain involvement represents a negative prognostic factor. However, some patients could benefit from locoregional treatments of metastatic foci and experience an unexpected long survival or healing. In the previous years some classifications were proposed to identify patients' prognostic category, according to stage of the primary tumor, the timing of metastases occurrence (synchronous or metachronous) and the number of metastatic sites. Several data show a benefit in patients receiving resection of both the primary tumor and brain metastases. Whole brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) are the selected options in most cases. Overall, literature data showed highly variable outcome, with an overall survival (OS) ranging from 5.9 to 68 months. No data from randomized and homogeneous trials are currently available. Therefore, a growing interest in this field is observed. Different trials investigating the effectiveness of local treatments and studies analyzing biological mechanisms are ongoing. In this report we analyze literature data and we explore the current field of study. Furthermore, we show a single institutional experience of multimodal management of stage IV NSCLC with brain metastases, experiencing an unexpected long survival. We conclude that a better knowledge of this subpopulation of patients and new studies in this field can lead to distinguish the patients who can benefit from local treatment from those with poor prognosis.
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Affiliation(s)
| | - Daniela Iacono
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Silvia Angelini
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Salvatore Lauro
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Marco Mazzotta
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | | | - Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
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Gomez DR, Blumenschein GR, Lee JJ, Hernandez M, Ye R, Camidge DR, Doebele RC, Skoulidis F, Gaspar LE, Gibbons DL, Karam JA, Kavanagh BD, Tang C, Komaki R, Louie AV, Palma DA, Tsao AS, Sepesi B, William WN, Zhang J, Shi Q, Wang XS, Swisher SG, Heymach JV. Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study. Lancet Oncol 2016; 17:1672-1682. [PMID: 27789196 PMCID: PMC5143183 DOI: 10.1016/s1470-2045(16)30532-0] [Citation(s) in RCA: 761] [Impact Index Per Article: 95.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/07/2016] [Accepted: 09/14/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Evidence from retrospective studies suggests that disease progression after first-line chemotherapy for metastatic non-small-cell lung cancer (NSCLC) occurs most often at sites of disease known to exist at baseline. However, the potential effect of aggressive local consolidative therapy for patients with oligometastatic NSCLC is unknown. We aimed to assess the effect of local consolidative therapy on progression-free survival. METHODS In this multicentre, randomised, controlled, phase 2 study, eligible patients from three hospitals had histological confirmation of stage IV NSCLC, three or fewer metastatic disease lesions after first-line systemic therapy, an Eastern Cooperative Oncology Group performance status score of 2 or less, had received standard first-line systemic therapy, and had no disease progression before randomisation. First-line therapy was four or more cycles of platinum doublet therapy or 3 or more months of EGFR or ALK inhibitors for patients with EGFR mutations or ALK rearrangements, respectively. Patients were randomly assigned (1:1) to either local consolidative therapy ([chemo]radiotherapy or resection of all lesions) with or without subsequent maintenance treatment or to maintenance treatment alone, which could be observation only. Maintenance treatment was recommended based on a list of approved regimens, and observation was defined as close surveillance without cytotoxic treatment. Randomisation was not masked and was balanced dynamically on five factors: number of metastases, response to initial therapy, CNS metastases, intrathoracic nodal status, and EGFR and ALK status. The primary endpoint was progression-free survival analysed in all patients who were treated and had at least one post-baseline imaging assessment. The study is ongoing but not recruiting participants. This study is registered with ClinicalTrials.gov, number NCT01725165. FINDINGS Between Nov 28, 2012, and Jan 19, 2016, 74 patients were enrolled either during or at the completion of first-line systemic therapy. The study was terminated early after randomisation of 49 patients (25 in the local consolidative therapy group and 24 in the maintenance treatment group) as part of the annual analyses done by the Data Safety Monitoring Committee of all randomised trials at MD Anderson Cancer Center, and before a planned interim analysis of 44 events. At a median follow-up time for all randomised patients of 12·39 months (IQR 5·52-20·30), the median progression-free survival in the local consolidative therapy group was 11·9 months (90% CI 5·7-20·9) versus 3·9 months (2·3-6·6) in the maintenance treatment group (hazard ratio 0·35 [90% CI 0·18-0·66], log-rank p=0·0054). Adverse events were similar between groups, with no grade 4 adverse events or deaths due to treatment. Grade 3 adverse events in the maintenance therapy group were fatigue (n=1) and anaemia (n=1) and in the local consolidative therapy group were oesophagitis (n=2), anaemia (n=1), pneumothorax (n=1), and abdominal pain (n=1, unlikely related). INTERPRETATION Local consolidative therapy with or without maintenance therapy for patients with three or fewer metastases from NSCLC that did not progress after initial systemic therapy improved progression-free survival compared with maintenance therapy alone. These findings suggest that aggressive local therapy should be further explored in phase 3 trials as a standard treatment option in this clinical scenario. FUNDING MD Anderson Lung Cancer Priority Fund, MD Anderson Cancer Center Moon Shot Initiative, and Cancer Center Support (Core), National Cancer Institute, National Institutes of Health.
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Affiliation(s)
- Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - George R Blumenschein
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mike Hernandez
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rong Ye
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Ross Camidge
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert C Doebele
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ferdinandos Skoulidis
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laurie E Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Don L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian D Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander V Louie
- Department of Medical Oncology, London Health Sciences Center, London, ON, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Center, London, ON, Canada
| | - Anne S Tsao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William N William
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen G Swisher
- Department of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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50
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Yamaguchi M, Edagawa M, Suzuki Y, Toyozawa R, Hirai F, Nosaki K, Seto T, Takenoyama M, Ichinose Y. Pulmonary Resection for Synchronous M1b-cStage IV Non-Small Cell Lung Cancer Patients. Ann Thorac Surg 2016; 103:1594-1599. [PMID: 27863731 DOI: 10.1016/j.athoracsur.2016.08.098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We wanted to assess the efficacy of curative intent pulmonary resection for non-small cell lung cancer (NSCLC) patients with synchronous M1b-distant metastases in a single organ or lesion. METHODS Between 1995 and 2015, 23 consecutive synchronous M1b-cStage IV NSCLC patients who underwent any treatment for metastases and curative intent pulmonary resection were retrospectively analyzed. RESULTS Sixteen patients were men and 7 were women, with a median age of 56 years (range: 41 to 76 years). There were 17 adenocarcinoma, 4 large-cell carcinoma, 1 large-cell neuroendocrine cancer, and 1 carcinosarcoma. Thirteen patients had no lymph node metastasis. Fourteen patients received preoperative chemotherapy, and 10 received postoperative chemotherapy. The metastatic sites were the brain in 13 patients; bone in 3 patients; adrenal glands and extrathoracic lymph nodes in 2 patients each; and the liver, small intestine, and subcutaneous tissue in 1 patient each. Nineteen patients underwent lobectomy, and the other 4 patients underwent pneumonectomy. Seventeen patients experienced recurrence as follows: local recurrence in 3 patients, distant recurrence in 13 patients, and both in 1 patient. The 5-year progression-free survival rates in the 23 patients was14.5% (95% confidence interval: 0% to 30.6%), and the 5-year overall survival rate was 41.7% (95% confidence interval: 19.6% to 63.8%). CONCLUSIONS Some M1b-cStage IV NSCLC patients achieved longer survival than others with the same stage disease by using local treatment for distant metastases and curative intent pulmonary resection. Oligometastatic patients might have been inadvertently included in the present cohort. However, at present, the optimum method for patient selection remains unclear.
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Affiliation(s)
- Masafumi Yamaguchi
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan.
| | - Makoto Edagawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yuzo Suzuki
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Ryo Toyozawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Fumihiko Hirai
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kaname Nosaki
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | | | - Yukito Ichinose
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
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