Late metastatic presentation is associated with improved survival and delayed wide‐spread progression after ablative stereotactic body radiotherapy for oligometastasis

Cancer Medicine

Arjun Sahgal¹  Ian Poon¹  Darby Erler¹  Alexander V. Louie¹  Hanbo Chen¹  Roi Dagan²  Matthew Foote³  Xuguang Chen⁴  Kristin J. Redmond⁴  Umberto Ricardi⁵  Serena Badellino⁵  Tithi Biswas⁶ 

[1] Department of Radiation Oncology Sunnybrook Odette Cancer Center University of Toronto Toronto ON Canada;Department of Radiation Oncology University of Florida Jacksonville FL USA;Department of Radiation Oncology University of QueenslandPrincess Alexandra Hospital Queensland Australia;Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins University School of Medicine Baltimore USA;Oncology Department University of Turin Turin Italy;University Hospitals Seidman Cancer CenterCase Western Reserve University Cleveland OH USA;

关键词: late metastasis;    metastasis‐directed radiotherapy;    oligometastasis;    SABR;    SBRT;    wide‐spread progression;   

DOI  :  10.1002/cam4.4133

来源: DOAJ

【 摘 要 】

Abstract Background Stereotactic body radiotherapy (SBRT) is increasingly used to treat oligometastatic disease (OMD), but the effect of metastasis timing on patient outcomes remains uncertain. Methods An international database of patients with OMD treated with SBRT was assembled with rigorous quality assurance. Early versus late metastases were defined as those diagnosed ≤24 versus >24 months from the primary tumor. Overall survival (OS), progression‐free survival (PFS), and incidences of wide‐spread progression (WSP) were estimated using multivariable Cox proportional hazard models stratified by primary tumor types. Results The database consists of 1033 patients with median follow‐up of 24.1 months (0.3–104.7). Late metastatic presentation (N = 427) was associated with improved OS compared to early metastasis (median survival 53.6 vs. 33.0 months, hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.47–0.72, p < 0.0001). Patients with non‐small cell lung cancer (NSCLC, N = 255, HR 0.49, 95% CI: 0.33–0.74, p = 0.0005) and colorectal cancer (N = 235, HR 0.50, 95% CI: 0.30–0.84, p = 0.008) had better OS if presenting with late metastasis. Late metastasis correlated with longer PFS (median 17.1 vs. 9.0 months, HR 0.71, 95% CI: 0.61–0.83, p < 0.0001) and lower 2‐year incidence of WSP (26.1% vs. 43.6%, HR 0.60, 95% CI: 0.49–0.74, p < 0.0001). Fewer WSP were observed in patients with NSCLC (HR 0.52, 95% CI: 0.33–0.83, p = 0.006) and kidney cancer (N = 63, HR 0.37, 95% CI: 0.14–0.97, p = 0.044) with late metastases. Across cancer types, greater SBRT target size was a significant predictor for worse OS. Conclusion Late metastatic presentation is associated with improved survival and delayed progression in patients with OMD treated with SBRT.

【 授权许可】

Unknown