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Failure patterns and oligometastasis after concurrent chemoradiotherapy for stage III-IV non-small cell lung cancer
Liu Hui,Su Shengfa,Ouyang Weiwei,Ma Zhu,Li Qingsong,Wang Yu,Li Huiqin,He Zhixu,Lu Bing
Guizhou Medical University,Guiyang 550004,China (Liu H);Department of Thoracic Oncology,Affiliated Hospital of Guizhou Meidical University;Department of Thoracic Oncology,Guizhou Province Tumor Hospital;Guiyang 550004,China (Su SHF,Ouyang WW,Ma Z,Li QS,Wang Y,Li HQ,Lu B);Tissue Engineering and Stem Cell Center of Guizhou Medical University(He ZHX)
Abstract Objective To investigate the failure patterns and oligometastasis after concurrent chemoradiotherapy for stage III-IV non-small cell lung cancer (NSCLC),and to discuss the significance of local radiotherapy. Methods The patterns of failure including oligometastasis were analyzed in 299 previously untreated patients with stage III-IV NSCLC who underwent concurrent chemoradiotherapy from 2007 to 2014. Results Of all the patients with NSCLC,88 patients with stage III NSCLC failed,among whom 22(22.7%) experienced primary tumor recurrence with or without distant metastasis and 27(30.7%) experienced oligometastasis,and brain metastasis was the most common failure pattern. A total of 211 patients with stage IV NSCLC failed,among whom 11.4% experienced primary tumor recurrence with or without distant metastasis,10.0% experienced recurrence of the primary metastatic lesions,and 9.0% experienced new lesions in the organs with metastasis;9 out of 94 patients with oligometastasis and 12 out of 117 patients without oligometastasis,respectively,experienced recurrence of the primary metastatic lesions. Brain metastasis had the highest incidence rate (38.2%). Conclusions After concurrent chemoradiotherapy,nearly 1/3 patients with stage III NSCLC and 10% patients with stage Ⅳ NSCLC experience the failure of oligometastasis,and brain metastasis is the most common pattern of failure. Radical radiotherapy for primary tumors in stage IV NSCLC can reduce local recurrence.
Corresponding Authors:
Lu Bing,Email:lbgymaaaa@163.com
Cite this article:
Liu Hui,Su Shengfa,Ouyang Weiwei et al. Failure patterns and oligometastasis after concurrent chemoradiotherapy for stage III-IV non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2016, 25(1): 20-23.
Liu Hui,Su Shengfa,Ouyang Weiwei et al. Failure patterns and oligometastasis after concurrent chemoradiotherapy for stage III-IV non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2016, 25(1): 20-23.
[1]Paulson DL,Reisch JS.Long-term survival after resection for bronchogenic carcinoma[J].Ann Surg,1976,184(3):324-332. [2]Dautzenberg B,Arriagada R,Chammard AB,et al. A controlled study of postoperative radiotherapy for patients with completely resected nonsmall cell lung carcinoma. Groupe d′Etude et de Traitement des Cancers Bronchiques[J].Cancer,1999,86(2):265-273. [3]Sawyer TE,Bonner JA,Gould PM,et al. The impact of surgical adjuvant thoracic radiation therapy for patients with nonsmall cell lung carcinoma with ipsilateral mediastinal lymph node involvement[J].Cancer,1997,80(8):1399-1408. [4]Nesbitt JC,Putnam JB,Jr,Walsh GL,et al. Survival in early-stage non-small cell lung cancer[J].Ann Thorac Surg,1995,60(2):466-472. [5]Siegel R,Naishadham D,Jemal A.Cancer statistics[J].CA Cancer J Clin,2012,62:10-29.DOI:10.3322/caac.20138. [6]Hellman S,Weichselbaum RR.Oligometastases[J].J Clin Oncol,1995,13(1):8-10. [7]Niibe Y,Chang JY.Novel insights of oligometastases and oligo-recurrence and review of the literature[J].Pulm Med,2012:261096[2015-09-01].http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3432385/.DOI:10.1155/2012/261096. [8]康晓征,陈克能.非小细胞肺癌“寡转移”的概念及治疗策略[J].中国肺癌杂志,2012,15(4):242-245.DOI:10.3779/j.issn.1009-3419.2012.04.09. Kang XZH,Chen KN.[J].The conceptual oligometastatic non-small cell lung cancer and therapeutic strategies[J].Chin J Lung Cancer,2012,15(4):242-245.DOI:10.3779/j.issn.1009-3419.2012.04.09. [9]李凤虎,卢冰,付和谊,等.546例Ⅳ期非小细胞肺癌远处转移特点的放疗意义分析[J].中华放射肿瘤学杂志,2012,21(2):122-125.DOI:10.3760/cma.j.issn.1004-4221.2012.02.008 Li FH,Lu B,Fu YHY,et al. Metastasis features of 546 patients with stage Ⅳ non-small cell lung cancer at firstvisit and the significance in radiotherapy[J].Chin J Radiat Oncol,2012,21(2):122-125.DOI:10.3760/cma.j.issn.1004-4221.2012.02.008. [10]Postmus PE,Brambilla E,Chansky K,et al. The IASLC lung cancer staging project:proposals for revision of the M descriptors in the forthcoming (seventh) edition of the TNM classification of lung cancer[J].J Thorac Oncol,2007,2(8):686-693. [11]Salama JK,Chmura SJ,Mehta N,et al. An initial report of a radiation dose-escalation trial in patients with one to five sites of metastatic disease[J].Clin Cancer Res,2008,14(16):5255-5259. [12]Sheu T,Heymach JV,Swisher SG,et al. Propensity score-matched analysis of comprehensive local therapy for oligometastatic non-small cell lung cancer that did not progress after front-line chemotherapy[J].Int J Radiat Oncol Biol Phys,2014,90(4):850-857. [13]Auperin A,Arriagada R,Pignon JP,et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic cranial irradiation overview collaborative group[J].N Engl J Med,1999,341(7):476-484. [14]龙金华,卢冰,欧阳伟炜,等.Ⅳ期非小细胞肺癌化疗同期胸部三维放疗的前瞻性临床研究(三)——不同放疗剂量对生存的影响[J].中华放射肿瘤学杂志,2012,21(1):23-27.DOI:10.3760/cma.j.issn.1004-4221.2012.01.008. Long JH,Lu B,Ouyang WW,et al. A prospective study on concurrent chemotherapy and thoracic three-dimensional radiotherapy for stage Ⅳ non-small cell lung cancer (3)-The impact of radiation dose to thoracic primary tumor on survival[J].Chin J Radiat Oncol,2012,21(1):23-27.DOI:10.3760/cma.j.issn.1004-4221.2012.01.008. [15]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. [16]Sheu T,Heymach JV,Swisher SG,et al. Propensity score-matched analysis of comprehensive local therapy for oligometastatic non-small cell lung cancer that did not progress after front-line chemotherapy[J].Int J Radiat Oncol Biol Phys,2014,90(4):850-857.DOI:10.1016/j.ijrobp.2014.07.012. [17]Mehta N,Mauer AM,Hellman S,et al. Analysis of further disease progression in metastatic non-small cell lung cancer:implications for locoregional treatment[J].Int J Oncol,2004,25(6):1677-1683. [18]Modi A,Vohra HA,Weeden DF.Does surgery for primary non-small cell lung cancer and cerebral metastasis have any impact on survival?[J].Interact Cardiovasc Thorac Surg,2009,8(4):467-473.DOI:10.1510/icvts.2008.195776. [19]Flannery TW,Suntharalingam M,Regine WF,et al. Long-term survival in patients with synchronous,solitary brain metastasis from non–small-cell lung cancer treated with radiosurgery[J].Int J Radiat Oncol Biol Phys,2008,72(1):19-23.DOI:10.1016/j.ijrobp.2007.12.031. [20]Milano MT,Katz AW,Muhs AG,et al. A prospective pilot study of curative-intent stereotactic body radiation therapy in patients with 5 or fewer oligometastatic lesions[J].Cancer,2008,112(3):650-658. [21]Parikh RB,Cronin AM,Kozono DE,et al. Definitive primary therapy in patients presenting with oligometastatic non-small cell lung cancer[J].Int J Radiat Oncol Biol Phys,2014,89(4):880-887.DOI:10.1016/j.ijrobp.2014.04.007. [22]王刚,卢冰,苏胜发,等.Ⅳ期非小细胞肺癌化疗同期胸部三维放疗的前瞻性临床研究(二)——不同器官转移状态对生存的影响[J].中华放射肿瘤学杂志,2011,20(6):473-477.DOI:10.3760/cma.j.issn.1004-4221.2011.06.007 Wang G,Lu B,Su SHF,et al. A prospective study on concurrent chemotherapy and thoracic three-dimensional radiotherapy for stage Ⅳ non-small cell lung cancer (2) — The impact of different metastasis organs on survival[J].Chin J Radiat Oncol,2011,20(6):473-477.DOI:10.3760/cma.j.issn.1004-4221.2011.06.007. [23]0 Topkan E,Parlak C,Kotek A,et al. Impact of prophylactic cranial irradiation timing on brain relapse rates in patients with stage ⅢB non-small-cell lung carcinoma treated with two different chemoradiotherapy regimens[J].Int J Radiat Oncol Biol Phys,2012,83(4):1264–1271.DOI:10.1016/j.ijrobp.2011.09.031. [24]苏胜发,卢冰,欧阳伟炜,等.伴骨转移的非小细胞肺癌化疗同期三维放疗预后分析[J].中华放射肿瘤学杂志,2013,22(5):374-377.DOI:10.3760/cma.j.issn.1004-4221.2013.05.010. Su SHF,Lu B,Ouyang WW,et al. Prognostic analysis of chemotherapy with concurrent three-dimensional radiotherapy in non-small cell lung cancer patients with bone metastases[J].Chin J Radiat Oncol,2013,22(5):374-377.DOI:10.3760/cma.j.issn.1004-4221.2013.05.010. [25]Kondziolka D,Patel A,Lunsford LD,et al. Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases[J].Int J Radiat Oncol Biol Phys,1999,45(2):427-434. [26]Hu C,Chang EL,Hassenbusch SJ,et al. Nonsmall cell lung cancer presenting with synchronous solitary brain metastasis[J].Cancer,2006,106(9):1998-2004. [27]Su S,Hu Y,Ouyang W,et al. The survival outcomes and prognosis of stage ⅠV non-small-cell lung cancer treated with thoracic three-dimensional radiotherapy combined with chemotherapy[J].Radiat Oncol,2014,9:290.DOI:10.1186/s13014-014-0290-7.
2016, Vol. 25 
