Radiotherapy is increasingly used to treat oligometastatic patients. We sought to identify prognostic criteria in oligometastatic patients undergoing definitive hypofractionated image-guided radiotherapy (HIGRT).
Exclusively extracranial oligometastatic patients treated with HIGRT were pooled. Characteristics including age, sex, primary tumor type, interval to metastatic diagnosis, number of treated metastases and organs, metastatic site, prior systemic therapy for primary tumor treatment, prior definitive metastasis-directed therapy, and systemic therapy for metastasis associated with overall survival (OS), progression-free survival (PFS), and treated metastasis control (TMC) were assessed by the Cox proportional hazards method. Recursive partitioning analysis (RPA) identified prognostic risk strata for OS and PFS based on pretreatment factors.
361 patients were included. Primary tumors included non-small cell lung (17%), colorectal (19%), and breast cancer (16%). Three-year OS was 56%, PFS was 24%, and TMC was 72%. On multivariate analysis, primary tumor, interval to metastases, treated metastases number, and mediastinal/hilar lymph node, liver, or adrenal metastases were associated with OS. Primary tumor site, involved organ number, liver metastasis, and prior primary disease chemotherapy were associated with PFS. OS RPA identified five classes: class 1: all breast, kidney, or prostate cancer patients (BKP) (3-year OS 75%, 95% CI 66-85%); class 2: patients without BKP with disease-free interval of 75+ months (3-year OS 85%, 95% CI 67-100%); class 3: patients without BKP, shorter disease-free interval, ≤ two metastases, and age < 62 (3-year OS 55%, 95% CI 48-64%); class 4: patients without BKP, shorter disease-free interval, ≥ three metastases, and age < 62 (3-year OS 38%, 95% CI 24-60%); class 5: all others (3-year OS 13%, 95% CI 5-35%). Higher biologically effective dose (BED) (p < 0.01) was associated with OS.
We identified clinical factors defining oligometastatic patients with favorable outcomes, who we hypothesize are most likely to benefit from metastasis-directed therapy.
PloS one. 2018 Apr 12*** epublish ***
Julian C Hong, Diandra N Ayala-Peacock, Jason Lee, A William Blackstock, Paul Okunieff, Max W Sung, Ralph R Weichselbaum, Johnny Kao, James J Urbanic, Michael T Milano, Steven J Chmura, Joseph K Salama
Department of Radiation Oncology, Duke University, Durham, NC, United States of America., Department of Radiation Oncology, Vanderbilt University, Nashville, TN, United States of America., Memorial & St. Elizabeth's Cancer Treatment Center, Swansea, IL, United States of America., Department of Radiation Oncology, Wake Forest University, Winston-Salem, NC, United States of America., Department of Radiation Oncology, University of Florida, Gainesville, FL, United States of America., Division of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, NY, United States of America., Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States of America., Department of Radiation Oncology, Good Samaritan Hospital Medical Center, West Islip, NY, United States of America., Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States of America., Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States of America.