Background

Patients with stage IV oligometastatic (≤ 3 sites) non–small-cell lung cancer have a progression-free survival (PFS) and overall survival benefit when all sites of metastatic disease and the primary tumor are treated radically with consolidative radiotherapy (cRT). However, the optimal selection of patients most likely from cRT is yet to be defined.

Patients and Methods

Patients with metastatic non–small-cell lung cancer treated with definitive radiotherapy to all metastatic sites and primary tumor (2008-2019) were retrospectively identified. Univariable Cox proportional-hazards model was used to compare outcomes with demographic and clinical characteristics. A predictive nomogram model for selection of patients most likely to benefit from cRT was constructed.

Results

There were 91 patients identified with a total of 114 metastases treated. Median PFS from the start of cRT was 10.9 months (95% confidence interval [CI], 8.1-16.6), while the median survival time was 37.0 months (95% CI, 31.3-NR). On univariable modeling, patients with squamous histology (hazard ratio, 4.16; 95% CI, 1.99-8.71; P < .001) and those treated with non–stereotactic body radiotherapy hypofractionated therapy (hazard ratio, 5.43; 95% CI, 2.10-14.01; P < .001) had worse overall survival, while patients with targetable mutations (hazard ratio, 0.49; 95% CI, 0.25-0.98; P = .04) had a longer survival. Using a predictive nomogram model, patients with a solitary site of metastasis, targetable mutations, intracranial disease, and metachronous timing of oligometastases had a larger PFS benefit from cRT.

Conclusion

cRT is associated with favorable outcomes in PFS and overall survival. These results may aid in patient counseling, selection for aggressive local therapy, and stratification in future prospective clinical trials.

中文翻译：

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寡转移性肺癌的巩固放疗：使用预测列线图选择患者。

背景

当所有转移灶和原发肿瘤均接受巩固放疗 (cRT) 根治性治疗时，IV 期寡转移（≤ 3 个部位）非小细胞肺癌患者具有无进展生存期 (PFS) 和总生存期获益。然而，最有可能来自 cRT 的患者的最佳选择尚待确定。

患者和方法

对所有转移部位和原发肿瘤（2008-2019）接受根治性放疗的转移性非小细胞肺癌患者进行回顾性鉴定。使用单变量 Cox 比例风险模型将结果与人口统计学和临床​​特征进行比较。构建了用于选择最有可能从 cRT 中受益的患者的预测列线图模型。

结果

确定了 91 名患者，共治疗了 114 处转移灶。从 cRT 开始的中位 PFS 为 10.9 个月（95% 置信区间 [CI]，8.1-16.6），而中位生存时间为 37.0 个月（95% CI，31.3-NR）。在单变量模型中，鳞状组织学患者（风险比，4.16；95% CI，1.99-8.71；P  < .001）和接受非立体定向放疗大分割治疗的患者（风险比，5.43；95% CI，2.10- 14.01；P  < .001) 的总生存期较差，而具有可靶向突变的患者（风险比，0.49；95% CI，0.25-0.98；P = .04) 的存活时间更长。使用预测列线图模型，具有孤立转移部位、可靶向突变、颅内疾病和寡转移的异时时间的患者从 cRT 中获得更大的 PFS 益处。

结论

cRT 与 PFS 和总生存期的良好结果相关。这些结果可能有助于患者咨询、选择积极的局部治疗以及在未来的前瞻性临床试验中进行分层。