Abstract:Objective To evaluate the efficacy and safety of consolidation chemotherapy after thoracic radical concurrent chemoradiotherapy for patients with oligometastatic non-small cell lung cancer (NSCLC). Methods Sixty-six NSCLC patients with more than five metastases from 2008 to 2013 were enrolled, and image-guided radiotherapy with conventionally fractionated or hypofractionated doses were performed for these patients. Platinum-based doublets chemotherapy was applied for both concurrent chemoradiotherapy and consolidation chemotherapy. Short-term outcome, adverse reactions, and survival rate were assessed for the patients after treatment. Results Sixty-four patients completed the treatment. The median biologically equivalent dose for planning target volume of thoracic primary tumor lesions was 72 Gy, with a median number of chemotherapy cycles of 4. The Objective response rate for thoracic lesions was 70%. The follow-up rate was 97%. The 1-, 2-, and 3-year overall survival (OS) rates were 72%, 53%, and 31%, respectively, with a median OS time of 25 months;the 1-, 2-, and 3-year progression-free survival (PFS) rates were 56%, 26%, and 7%, respectively, with a median PFS time of 14 months. The incidence of grade 2-3 acute radiation pneumonitis and radiation esophagitis was 1% and 17%, respectively, and the incidence of grade 3-4 decreases in leukocytes, hemoglobin, and platelet count was 39%, 11%, and 16%, respectively. Conclusions Radical radiotherapy combined with concurrent and consolidation chemotherapy for oligometastatic NSCLC can achieve good short-term outcome and long-term survival, with tolerable adverse effects.
Lyu Jiahua,Li Tao,Liu Li et al. A prospective phase II study of consolidation chemotherapy after concurrent chemoradiotherapy for oligometastatic stage IV non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2015, 24(6): 611-614.
[1] Jemal A,Bray F,Center MM,et al. Global cancer statistics[J].CA Cancer J Clin,2011,61(2):69-90.DOI:10.3322/caac.20107. [2] Rami-Porta R,Bolejack V,Giroux DJ,et al. The IASLC lung cancer staging project:the new database to inform the eighth edition of the TNM classification of lung cancer[J].J Thorac Oncol,2014,9(11):1618-1624.DOI:10.1097/JTO.0000000000000334. [3] Walters S,Maringe C,Coleman MP,et al. Lung cancer survival and stage at diagnosis in Australia,Canada,Denmark,Norway,Sweden and the UK:a population-based study,2004-2007[J].Thorax,2013,68(6):551-564.DOI:10.1136/thoraxjnl-2012-202297. [4] Hellman S,Weichselbaum RR.Oligometastases[J].J Clin Oncol,1995,13(1):8-10. [5] Gupta GP,Massagué J.Cancer metastasis:building a framework[J].Cell,2006,127(4):679-695.DOI:10.1016/j.cell.2006.11.001. [6] Grossi F,Kubota K,Cappuzzo F,et al. Future scenarios for the treatment of advanced non-small cell lung cancer:focus on taxane-containing regimens[J].Oncologist,2010,15(10):1102-1112.DOI:10.1634/theoncologist.2010-0322. [7] Torre M,Barbieri B,Bera E,et al. Surgical therapy in lung cancer with single brain metastasis[J].Eur J Cardiothorac Surg,1988,2(5):336-339.DOI:10.1016/1010-7940(88)90009-7. [8] D′Addario G,Früh M,Reck M,et al. Metastatic non-small-cell lung cancer:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2014,21 Suppl 5:v116-v119.DOI:10.1093/annonc/mdq189. [9] Azzoli CG,Temin S,Giaccone G.2011 focused update of 2009 American society of clinical oncology clinical practice guideline update on chemotherapy for stage iv non-small-cell lung cancer[J].J Oncol Pract,2012,8(1):63-66.DOI:10.1200/JOP.2011.000374. [10] Sau S,Sau S,Dutta P,et al. A comparative study of different dose fractionations schedule of thoracic radiotherapy for pain palliation and health-related quality of life in metastatic NSCLC[J].Lung India,2014,31(4):348-353.DOI:10.4103/0970-2113.142111. [11] Rusthoven KE,Hammerman SF,Kavanagh BD,et al. Is there a role for consolidative stereotactic body radiation therapy following first-line systemic therapy for metastatic lung cancer? A patterns-of-failure analysis[J].Acta Oncol,2009,48(4):578-583.DOI:10.1080/02841860802662722. [12] Yano T,Okamoto T,Haro A,et al. Local treatment of oligometastatic recurrence in patients with resected non-small cell lung cancer[J].Lung Cancer,2013,82(3):431-435.DOI:10.1016/j.lungcan.2013.08.006. [13] Ashworth A,Rodrigues G,Boldt G,et al. Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature[J].Lung Cancer,2013,82(2):197-203.DOI:10.1016/j.lungcan.2013.07.026. [14] Lopez-Guerra JL,Gomez D,Zhuang Y,et al. Prognostic impact of radiation therapy to the primary tumor in patients with non-small cell lung cancer and oligometastasis at diagnosis[J].Int J Radiat Oncol Biol Phys,2012,84(1):e61-e67.DOI:10.1016/j.ijrobp.2012.02.054. [15] Hasselle MD,Haraf DJ,Rusthoven KE,et al. Hypofractionated image-guided radiation therapy for patients with limited volume metastatic non-small cell lung cancer[J].J Thorac Oncol,2012,7(2):376-381.DOI:10.1097/JTO.0b013e31824166a5. [16] De Ruysscher D,Wanders R,van Baardwijk A,et al. Radical treatment of non-small-cell lung cancer patients with synchronous oligometastases:long-term results of a prospective phase Ⅱ trial (Nct01282450)[J].J Thorac Oncol,2012,7(10):1547-1555.DOI:10.1097/JTO.0b013e318262caf6.