TY - JOUR
T1 - Pulmonary resection is associated with long-term survival and should remain a therapeutic option in oligometastatic lung cancer
AU - the MD Anderson Cancer Center Oligometastatic Lung Cancer Working Group
AU - Mitchell, Kyle G.
AU - Farooqi, Ahsan
AU - Ludmir, Ethan B.
AU - Corsini, Erin M.
AU - Sepesi, Boris
AU - Gomez, Daniel R.
AU - Antonoff, Mara B.
AU - Vaporciyan, Ara A.
AU - Swisher, Stephen G.
AU - Heymach, John V.
AU - Zhang, Jianjun
AU - Gandhi, Saumil J.
N1 - Publisher Copyright:
© 2020 The American Association for Thoracic Surgery
PY - 2021/4
Y1 - 2021/4
N2 - Objectives: Comprehensive local consolidative therapy led to improved overall survival in oligometastatic non–small cell lung cancer in a recent phase II trial, yet the role of pulmonary resection in ongoing oligometastatic trials is a matter of controversy. We sought to examine outcomes after pulmonary resection with radiotherapy used as a benchmark comparator. Methods: Patients treated at a single institution (2000-2017) with cT1-3N0-2M1 non–small cell lung cancer, 3 or less synchronous metastases, and performance status 0 to 1, and who received comprehensive local consolidative therapy were analyzed according to local consolidative therapy modality for the primary lesion. Progression was analyzed with death as a competing risk. Results: Of 88 patients meeting inclusion criteria, 63 (71.6%) received radiotherapy for local consolidative therapy modality for the primary lesion and 25 (28.4%) underwent surgery (lobectomy 20/25 [80.0%], pneumonectomy 3/25 [12.0%], sublobar 2/25 [8.0%]). Time from diagnosis to local consolidative therapy modality for the primary lesion was similar. Surgical patients were younger and had lower intrathoracic disease burden. Ninety-day post-treatment mortality was low (surgery 0/25 [0.0%], radiotherapy 1/63 [1.6%]). Median postoperative survival time was 55.2 months (95% confidence interval, 20.1 to not reached), with 1- and 5-year overall survivals of 95.7% and 48.0%, respectively. After radiotherapy, median postoperative survival time was 23.4 months (confidence interval, 17.2-35.9); 1- and 5-year overall survivals were 74.3% and 24.2%, respectively. No differences were observed between modalities in site of first failure, cumulative incidence of locoregional failure (P =.635), or systemic progression (P =.747). Conclusions: Pulmonary resection is feasible and associated with long-term survival in selected patients with synchronous oligometastatic non–small cell lung cancer. Surgery should remain a local consolidative therapeutic option for patients with operable oligometastatic non–small cell lung cancer enrolled in ongoing and future randomized clinical trials.
AB - Objectives: Comprehensive local consolidative therapy led to improved overall survival in oligometastatic non–small cell lung cancer in a recent phase II trial, yet the role of pulmonary resection in ongoing oligometastatic trials is a matter of controversy. We sought to examine outcomes after pulmonary resection with radiotherapy used as a benchmark comparator. Methods: Patients treated at a single institution (2000-2017) with cT1-3N0-2M1 non–small cell lung cancer, 3 or less synchronous metastases, and performance status 0 to 1, and who received comprehensive local consolidative therapy were analyzed according to local consolidative therapy modality for the primary lesion. Progression was analyzed with death as a competing risk. Results: Of 88 patients meeting inclusion criteria, 63 (71.6%) received radiotherapy for local consolidative therapy modality for the primary lesion and 25 (28.4%) underwent surgery (lobectomy 20/25 [80.0%], pneumonectomy 3/25 [12.0%], sublobar 2/25 [8.0%]). Time from diagnosis to local consolidative therapy modality for the primary lesion was similar. Surgical patients were younger and had lower intrathoracic disease burden. Ninety-day post-treatment mortality was low (surgery 0/25 [0.0%], radiotherapy 1/63 [1.6%]). Median postoperative survival time was 55.2 months (95% confidence interval, 20.1 to not reached), with 1- and 5-year overall survivals of 95.7% and 48.0%, respectively. After radiotherapy, median postoperative survival time was 23.4 months (confidence interval, 17.2-35.9); 1- and 5-year overall survivals were 74.3% and 24.2%, respectively. No differences were observed between modalities in site of first failure, cumulative incidence of locoregional failure (P =.635), or systemic progression (P =.747). Conclusions: Pulmonary resection is feasible and associated with long-term survival in selected patients with synchronous oligometastatic non–small cell lung cancer. Surgery should remain a local consolidative therapeutic option for patients with operable oligometastatic non–small cell lung cancer enrolled in ongoing and future randomized clinical trials.
KW - local consolidative therapy
KW - non–small cell lung cancer
KW - oligometastatic
KW - radiotherapy
KW - surgical therapy
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U2 - 10.1016/j.jtcvs.2020.02.134
DO - 10.1016/j.jtcvs.2020.02.134
M3 - Article
C2 - 32331820
AN - SCOPUS:85082656319
SN - 0022-5223
VL - 161
SP - 1497-1504.e2
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -