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.

中文翻译：

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巩固性局部消融治疗可提高接受一线 EGFR-TKI 治疗的 EGFR 激活突变同时性寡转移性 NSCLC 患者的生存率

简介：本研究的目的是探讨巩固性局部消融疗法 (LAT) 是否可以提高接受一线 EGFR-酪氨酸激酶抑制剂 (TKI) 治疗的寡转移的 IV 期 EGFR 突变 NSCLC 患者的生存率. 方法：鉴定出诊断后 2 个月内转移灶不超过 5 处的 IV 期 EGFR 突变型 NSCLC 患者。所有患者均接受一线 EGFR-TKI 治疗。巩固性 LAT 包括放疗、手术或两者兼而有之。总生存期（OS）和无进展生存期（PFS）通过 Kaplan-Meier 曲线估计。结果：2010 年 10 月至 2016 年 5 月，共纳入 145 例患者，其中 51 例（35.2%）接受了所有寡转移部位的巩固 LAT（全 LAT 组），55 例（37. 9%) 接受了原发性肿瘤或寡转移部位的巩固性 LAT（部分 LAT 组），39 名（26.9%）未接受任何巩固性 LAT（非 LAT 组）。全 LAT、部分 LAT 和非 LAT 组的中位 PFS 分别为 20.6、15.6 和 13.9 个月（p < 0.001）。全 LAT、部分 LAT 和非 LAT 组的中位 OS 分别为 40.9、34.1 和 30.8 个月（p < 0.001）。全 LAT 组和部分 LAT 或非 LAT 组之间的差异具有统计学意义，但部分 LAT 和非 LAT 组之间没有差异。对于原发性肿瘤（40.5 对 31.5 个月，p < 0.001）、脑转移（38.2 对 29.2 个月，p = 0.002）和肾上腺转移（37.1 对 29.2 个月，p = 0.032）的巩固 LAT 的中位 OS 显着改善。放疗引起的不良事件（≥ 3 级）包括肺炎 (7.7%) 和食管炎 (16.9%)。结论：目前的研究表明，所有转移部位的巩固 LAT 是一线 EGFR-TKI 治疗期间 EGFR 突变寡转移性 NSCLC 患者的可行选择，与局部部位的巩固 LAT 或单独观察相比，PFS 和 OS 显着改善.