TITLE:
Local Consolidation Therapy versus Observation for Oligometastatic Non Small Cell Lung Cancer Patients: Phase II Randomized Trial
AUTHORS:
Ghada Ezzat Eladawei, Rasha Mohamed Abdellatif, Sheref Mohamed El-Taher
KEYWORDS:
Lung Cancer, Oligometastatic, Conformal Thoracic Radiotherapy
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.9 No.11,
November
26,
2018
ABSTRACT: Background and Objective: Based on retrospective trials, most progression sites after first line
systemic therapy for metastatic non small cell lung cancer (NSCLC) were the
primary disease sites rather than new sites. Therefore we conducted phase II
randomized study to determine whether oligometastatic NSCLC without disease
progression after first line chemotherapy, have prolonged progression free
survival when treated with local consolidation therapy of residual disease
followed by surveillance compared with no local consolidation therapy
(observation). Patients and Methods: Forty eight eligible patients were
randomized to either immediate or no local consolidation radiotherapy. 26
patients of immediate local consolidation radiotherapy received 3 D-conformal
radiation therapy to primary tumor site and metastatic sites of disease. 22
patients were followed up by observation. Results: Patients in local
consolidation arm had significantly better progression free survival (PFS)
compared with patients in observation group. Median PFS was 9.5 months (95% CI
7.8 - 11.08) in local consolidation arm and 4.5 months (95%CI 3.9 - 5.7) in
observation arm. Patients in local consolidation arm had longer median time to
appearance of new metastatic sites (10 months CI 9.3 - 12.6) than those
patients in observation arm (4.5 months CI 4.2 - 6.9). Median overall survival
(OS) of patients in local consolidation arm was 12 months (95% CI 12.1 - 18.01)
and in observation arm 10 months (95% CI 8.7 - 13.8). One year OS rate was
42.3% in local consolidation arm and 31.8% in observation arm; 2 year OS rate was 23.1%
in local consolidation arm and only 4.5% in observation arm. Conclusion: Local consolidation radiotherapy is simple, safe, efficient, and not expensive
treatment for oligometastatic non small cell lung cancer after upfront
chemotherapy. Local consolidation radiotherapy achieved significantly prolonged
progression free survival and delayed appearance of new metastatic sites. Phase
III studies are recommended to test benefit of local consolidation radiotherapy
to gain prolonged progression free survival and overall survival. Also, define
optimal patients’ subgroups that are more likely to benefit of local
consolidation radiotherapy.