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Stereotactic Ablative Radiation Therapy Improves Progression-free Survival and Local Control In Patients with Oligometastatic Lung Cancer

      Purpose/Objective(s)

      Non-small cell lung cancer (NSCLC) represents approximately 75% of the histological types of lung cancer. In patients with oligometastatic NSCLC, definitive treatment to primary tumor and low thoracic tumor burden are associated with better outcomes. The use of stereotactic ablative radiotherapy (SABR) has demonstrated high rates of local control for lung metastases and long-term survival improvement. The aim of this study is to evaluate Local Control (LC), Progression Free Survival (PFS) and toxicity of patients with oligometastatic NSCLC treated with SABR.

      Materials/Methods

      A prospective study was conducted with oligometastatic NSCLC patients. From July 2016 to December 2017, with a median follow up of 21.7 months, eighteen patients were enrolled. All patients received systemic therapy, those with partial response (PR), assessed by PET CT, were referred for SABR treatment (45-60 Gy in 3-7 fractions) to the thoracic lesion (primary or metastatic) depending on location, size and number of lesions, always keeping BED (Biologically Effective Dose) >100 Gy for tumor.

      Results

      Eighteen patients were treated with SABR, response to treatment was as follows: global response was 94%, partial response 22% and complete response 72.2%. Mean time to progression after SABR treatment was 7.04 months (CI 95% 0.27-17.84 months). Progression free survival since beginning of any treatment was 20.14 months (CI 95% 12.92 - 27.35 months). The pattern of recurrence/progression was as follows: local (in field) 1/18, regional (mediastinal lymph node) 1/18 and systemic 4/18, 12/18 did not show any recurrence. Sixteen patients developed grade 1 pneumonitis; one patient developed grade 2 pneumonitis and grade 3 pneumonitis was reported in one patient. Only three patients required treatment with steroids (16.7%).

      Conclusion

      SABR is a suitable and well-tolerated therapeutic option for patients with oligometastatic NSCLC. SABR have shown to improve local control and increase progression-free survival. Future clinical trials are required to fully evaluate the effects of this treatment.

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