Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon.
Department of Radiation Oncology, Loyola University Stritch School of Medicine, Chicago, Illinois.
Int J Radiat Oncol Biol Phys. 2022 Nov 15;114(4):676-683. doi: 10.1016/j.ijrobp.2022.08.027. Epub 2022 Aug 13.
The successes of local therapy for oligometastatic cancers cannot be extrapolated to oligoprogressive disease (OPD) because they are distinct clinical entities. Given the limited prospective data on OPD to date, summative analyses are urgently needed.
Inclusion criteria for this Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review were as follows. First, only prospective data were included. Second, progression had to have occurred on active/ongoing systemic therapy. Third, the number of progressing areas of disease had to be explicitly listed and ≤5 in number. Fourth, all progressing sites had to undergo local therapy (radiation therapy [RT] /surgery/nonradiation ablative procedures).
Eight trials met criteria (summing 290 patients), the vast majority of which used stereotactic RT as the local modality (most commonly, 19-20 Gy in 1 fraction, 27-33 Gy in 3 fractions, or 35-50 Gy in 5 fractions). A study on non-small cell lung cancer (NSCLC) demonstrated that stereotactic RT improved progression-free survival (PFS) and overall survival compared with historical values with systemic therapy alone. Two additional studies on epidermal growth factor receptor mutated (EGFRm) NSCLC also showed acceptable PFS with local therapy, particularly in patients who oligoprogressed on osimertinib. The only randomized trial analyzed herein showed that local therapy improved PFS for NSCLC but not breast cancer. Two trials in castration-resistant prostate cancer illustrated that a substantial proportion of patients did not require any changes in hormonal therapy or delayed the need to change systemic therapies. Lastly, 2 trials of renal cell carcinoma showed high (90%-100%) local control and median PFS of 9 months, and potentially a prolonged time to change systemic therapy. Lastly, from all patients in all trials, local therapy was tolerated well, with only 7 instances of grade 3+ toxicities.
Based on the limited data, local therapy for oligoprogression is safe and yields encouraging short-term preliminary outcomes, but trials with larger sample sizes and longer follow-up are required for more robust conclusions.
局部治疗寡转移癌症的成功经验不能外推至寡进展性疾病（OPD），因为它们是不同的临床实体。鉴于目前关于 OPD 的前瞻性数据有限，迫切需要进行总结性分析。
本系统评价遵循首选报告项目进行综述和荟萃分析（PRISMA）的纳入标准如下。首先，仅纳入前瞻性数据。其次，进展必须发生在正在进行的系统治疗中。第三，必须明确列出进展疾病区域的数量，且数量≤5。第四，所有进展部位均需接受局部治疗（放射治疗[RT]/手术/非放射消融治疗）。
八项试验符合标准（共 290 例患者），其中绝大多数采用立体定向 RT 作为局部治疗手段（最常见的方案是 1 次 19-20Gy、3 次 27-33Gy 或 5 次 35-50Gy）。一项非小细胞肺癌（NSCLC）的研究表明，与单独接受系统治疗相比，立体定向 RT 可改善无进展生存期（PFS）和总生存期。另外两项针对表皮生长因子受体突变（EGFRm）NSCLC 的研究也表明，局部治疗可获得可接受的 PFS，尤其是在奥希替尼治疗中寡进展的患者中。本研究中唯一的随机试验表明，局部治疗可改善 NSCLC 的 PFS，但不能改善乳腺癌。两项前列腺癌试验表明，相当一部分患者无需改变激素治疗或延迟改变系统治疗的需求。最后，两项肾细胞癌试验显示局部控制率高（90%-100%），中位 PFS 为 9 个月，可能延长了改变系统治疗的时间。最后，所有试验的所有患者均能耐受局部治疗，仅出现 7 例 3 级及以上毒性。
基于有限的数据，寡进展性疾病的局部治疗是安全的，并且取得了令人鼓舞的短期初步结果，但需要更大规模的试验和更长时间的随访，以得出更可靠的结论。
