Consolidate.
Top Line: Consolidative radiation for oligometastatic non-small cell lung cancer (NSCLC) may be here to stay.
The Study: We often focus on the initial steps in the NCCN algorithms, but there can be some interesting options in the final twigs of the tree. For patients with limited metastatic disease from NSCLC and good performance statuses, for instance, definitive local therapy (aka consolidative therapy) is recommended if there’s no progression after initial systemic therapy. We’ve got another phase 2 trial of consolidative local therapy for metastatic NSCLC with promising results. Important to note is that this trial doesn’t specifically focus on consolidative therapy to the primary thoracic site, but rather all sites of residual disease—which isn’t new. Patients could have up to 5 total sites of active disease, including up to 3 extracranial sites, with no progression on post-chemo PET. A large variety of radiation techniques were allowed, many of which were SBRT regimens. Among this selective group, median progression-free survival (PFS) was 12 months, and median overall survival (OS) was an impressive 28 months. Even more impressive considering these patients didn’t routinely receive maintenance chemo. Sure there’s some serious selection bias here, but this approach undoubtedly shifted patterns of failure away from treated sites: Half of recurrences were distant and a third occurred in the brain.
Bottom Line: More data supports that consolidative radiation for oligometastatic NSCLC is associated with favorable local control and even survival outcomes. | Petty, Int J Radiat Oncol Biol Phys 2018
The Study: We often focus on the initial steps in the NCCN algorithms, but there can be some interesting options in the final twigs of the tree. For patients with limited metastatic disease from NSCLC and good performance statuses, for instance, definitive local therapy (aka consolidative therapy) is recommended if there’s no progression after initial systemic therapy. We’ve got another phase 2 trial of consolidative local therapy for metastatic NSCLC with promising results. Important to note is that this trial doesn’t specifically focus on consolidative therapy to the primary thoracic site, but rather all sites of residual disease—which isn’t new. Patients could have up to 5 total sites of active disease, including up to 3 extracranial sites, with no progression on post-chemo PET. A large variety of radiation techniques were allowed, many of which were SBRT regimens. Among this selective group, median progression-free survival (PFS) was 12 months, and median overall survival (OS) was an impressive 28 months. Even more impressive considering these patients didn’t routinely receive maintenance chemo. Sure there’s some serious selection bias here, but this approach undoubtedly shifted patterns of failure away from treated sites: Half of recurrences were distant and a third occurred in the brain.
Bottom Line: More data supports that consolidative radiation for oligometastatic NSCLC is associated with favorable local control and even survival outcomes. | Petty, Int J Radiat Oncol Biol Phys 2018
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