[an error occurred while processing this directive] | [an error occurred while processing this directive]
Clinical application and prospect of SBRT in treatment of oligo-metastatic NSCLC
Fang Min, Du Xianghui, Lai Xiaojing
Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China
Abstract The rapid progress on immunotherapy and targeted therapy has brought long-term survival benefits for locally advanced non-small cell lung cancer (NSCLC). The oncology community has also paid more attention to the local treatment for advanced NSCLC, especially for patients with limited metastatic lesions, also known as oligo-metastasis. Many studies have reported that oligo-metastatic NSCLC patients could benefit from the combination of local and systematic treatment, and even to be cured. In recent years, with the advances in radiation technology, stereotactic body radiation therapy (SBRT) has achieved precise high-dose radiotherapy for small target tumors. Currently, SBRT has been widely applied in the treatment of inoperable early lung cancer, and its application value and safety in patients with advanced lung cancer are also being actively explored. In this article, the research status, progress and future development direction of SBRT in the treatment of oligo-metastatic NSCLC were discussed.
Fund:National Natural Science Foundation of China (81703018); Natural Science Foundation of Zhejiang Province (LY21H160004); Medical Health Science and Technology Project of Zhejiang Province (2020KY466, 2022RC110)
Corresponding Authors:
Lai Xiaojing, Email: laixj@zjcc.org.cn
Cite this article:
Fang Min,Du Xianghui,Lai Xiaojing. Clinical application and prospect of SBRT in treatment of oligo-metastatic NSCLC[J]. Chinese Journal of Radiation Oncology, 2023, 32(7): 633-637.
Fang Min,Du Xianghui,Lai Xiaojing. Clinical application and prospect of SBRT in treatment of oligo-metastatic NSCLC[J]. Chinese Journal of Radiation Oncology, 2023, 32(7): 633-637.
[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020[J]. CA Cancer J Clin, 2020,70(1):7-30. DOI: 10.3322/caac.21590. [2] Hellman S, Weichselbaum RR. Oligometastases[J]. J Clin Oncol, 1995,13(1):8-10. DOI: 10.1200/JCO.1995.13.1.8. [3] Lievens Y, Guckenberger M, Gomez D, et al. Defining oligometastatic disease from a radiation oncology perspective: an ESTRO-ASTRO consensus document[J]. Radiother Oncol, 2020,148:157-166. DOI: 10.1016/j.radonc.2020.04.003. [4] Dingemans AC, Hendriks L, Berghmans T, et al.Definition of synchronous oligometastatic non-small cell lung cancer-a consensus report[J]. J Thorac Oncol, 2019,14(12):2109-2119. DOI: 10.1016/j.jtho.2019.07.025. [5] Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer[J]. J Thorac Oncol, 2016,11(1):39-51. DOI: 10.1016/j.jtho.2015.09.009. [6] Niibe Y, Hayakawa K. Oligometastases and oligo-recurrence: the new era of cancer therapy[J]. Jpn J Clin Oncol, 2010,40(2):107-111. DOI: 10.1093/jjco/hyp167. [7] Patel PH, Palma D, McDonald F, et al. The dandelion dilemma revisited for oligoprogression: treat the whole lawn or weed selectively?[J]. Clin Oncol (R Coll Radiol), 2019,31(12):824-833. DOI: 10.1016/j.clon.2019.05.015. [8] Torok JA, Gu L, Tandberg DJ, et al. Patterns of distant metastases after surgical management of non-small-cell lung cancer[J]. Clin Lung Cancer, 2017,18(1):e57-e70. DOI: 10.1016/j.cllc.2016.06.011. [9] Weichselbaum RR, Hellman S. Oligometastases revisited[J]. Nat Rev Clin Oncol, 2011,8(6):378-382. DOI: 10.1038/nrclinonc.2011.44. [10] Chang JY, Liu YH, Zhu Z, et al. Stereotactic ablative radiotherapy: a potentially curable approach to early stage multiple primary lung cancer[J]. Cancer, 2013,119(18):3402-3410. DOI: 10.1002/cncr.28217. [11] Palma DA, Salama JK, Lo SS, et al. The oligometastatic state - separating truth from wishful thinking[J]. Nat Rev Clin Oncol, 2014,11(9):549-557. DOI: 10.1038/nrclinonc.2014.96. [12] Timmerman RD, Herman J, Cho LC. Emergence of stereotactic body radiation therapy and its impact on current and future clinical practice[J]. J Clin Oncol, 2014,32(26):2847-2854. DOI: 10.1200/JCO.2014.55.4675. [13] Bernstein MB, Krishnan S, Hodge JW, et al. Immunotherapy and stereotactic ablative radiotherapy (ISABR): a curative approach?[J]. Nat Rev Clin Oncol, 2016,13(8):516-524. DOI: 10.1038/nrclinonc.2016.30. [14] Gomez DR, Blumenschein GR, Lee JJ, et al. 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[J]. Lancet Oncol, 2016,17(12):1672-1682. DOI: 10.1016/S1470-2045(16)30532-0. [15] Gomez DR, Tang C, Zhang J, et al. Local consolidative therapy vs. maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer: long-term results of a multi-institutional, phase II, randomized study[J]. J Clin Oncol, 2019,37(18):1558-1565. DOI: 10.1200/JCO.19.00201. [16] Petty WJ, Urbanic JJ, Ahmed T, et al. Long-term outcomes of a phase 2 trial of chemotherapy with consolidative radiation therapy for oligometastatic non-small cell lung cancer[J]. Int J Radiat Oncol Biol Phys, 2018,102(3):527-535. DOI: 10.1016/j.ijrobp.2018.06.400. [17] Collen C, Christian N, Schallier D, et al.Phase II study of stereotactic body radiotherapy to primary tumor and metastatic locations in oligometastatic nonsmall-cell lung cancer patients[J]. Ann Oncol, 2014,25(10):1954-1959. DOI: 10.1093/annonc/mdu370. [18] Iyengar P, Wardak Z, Gerber DE, et al.Consolidative radiotherapy for limited metastatic non-small-cell lung cancer: a phase 2 randomized clinical trial[J]. JAMA Oncol, 2018,4(1):e173501. DOI: 10.1001/jamaoncol.2017.3501. [19] Palma DA, Olson R, Harrow S, et al.Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial[J]. Lancet, 2019,393(10185):2051-2058. DOI: 10.1016/S0140-6736(18)32487-5. [20] Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy for the comprehensive treatment of oligometastatic cancers: long-term results of the SABR-COMET phase II randomized trial[J]. J Clin Oncol, 2020,38(25):2830-2838. DOI: 10.1200/JCO.20.00818. [21] Shaverdian N, Lisberg AE, Bornazyan K, et al. Previous radiotherapy and the clinical activity and toxicity of pembrolizumab in the treatment of non-small-cell lung cancer: a secondary analysis of the KEYNOTE-001 phase 1 trial[J]. Lancet Oncol, 2017,18(7):895-903. DOI: 10.1016/S1470-2045(17)30380-7. [22] Theelen W, Peulen H, Lalezari F, et al. Effect of pembrolizumab after stereotactic body radiotherapy vs pembrolizumab alone on tumor response in patients with advanced non-small cell lung cancer: results of the PEMBRO-RT phase 2 randomized clinical trial[J]. JAMA Oncol, 2019,5(9):1276-1282. DOI: 10.1001/jamaoncol. 2019.1478. [23] Welsh J, Menon H, Chen D, et al.Pembrolizumab with or without radiation therapy for metastatic non-small cell lung cancer: a randomized phase I/II trial[J]. J Immunother Cancer, 2020,8(2):e001001. DOI: 10.1136/jitc-2020-001001. [24] Theelen W, Chen D, Verma V, et al. Pembrolizumab with or without radiotherapy for metastatic non-small-cell lung cancer: a pooled analysis of two randomised trials[J]. Lancet Respir Med, 2021,9(5):467-475. DOI: 10.1016/S2213-2600(20)30391-X. [25] Bauml JM, Mick R, Ciunci C, et al. Pembrolizumab after completion of locally ablative therapy for oligometastatic non-small cell lung cancer: a phase 2 trial[J]. JAMA Oncol, 2019,5(9):1283-1290. DOI: 10.1001/jamaoncol.2019. 1449. [26] Chicas-Sett R, Morales-Orue I, Castilla-Martinez J, et al. Stereotactic ablative radiotherapy combined with immune checkpoint inhibitors reboots the immune response assisted by immunotherapy in metastatic lung cancer: a systematic review[J]. Int J Mol Sci, 2019,20(9):2173. DOI: 10.3390/ijms20092173. [27] Weickhardt AJ, Scheier B, Burke JM, et al. Local ablative therapy of oligoprogressive disease prolongs disease control by tyrosine kinase inhibitors in oncogene-addicted non-small-cell lung cancer[J]. J Thorac Oncol, 2012,7(12):1807-1814. DOI: 10.1097/JTO.0b013e3182745948. [28] Iyengar P, Kavanagh BD, Wardak Z, et al. Phase II trial of stereotactic body radiation therapy combined with erlotinib for patients with limited but progressive metastatic non-small-cell lung cancer[J]. J Clin Oncol, 2014,32(34):3824-3830. DOI: 10.1200/JCO.2014. 56.7412. [29] Chan O, Lee V, Mok T, et al.The role of radiotherapy in epidermal growth factor receptor mutation-positive patients with oligoprogression: a matched-cohort analysis[J]. Clin Oncol (R Coll Radiol), 2017,29(9):568-575. DOI: 10.1016/j.clon.2017.04.035. [30] Qiu B, Liang Y, Li QW, et al.Local therapy for oligoprogressive disease in patients with advanced stage non-small-cell lung cancer harboring epidermal growth factor receptor mutation[J]. Clin Lung Cancer, 2017,18(6):e369-e373. DOI: 10.1016/j.cllc.2017.04.002. [31] Wang XS, Bai YF, Verma V, et al.Randomized trial of first-line tyrosine kinase inhibitor with or without radiotherapy for synchronous oligometastatic EGFR-mutated NSCLC[J]. J Natl Cancer Inst, 2022,115(6):742-748. DOI: 10.1093/jnci/djac015.