Willmann Jonas, Vlaskou Badra Eugenia, Adilovic Selma, Ahmadsei Maiwand, Christ Sebastian M, Tanadini-Lang Stephanie, Mayinger Michael, Guckenberger Matthias, Andratschke Nicolaus
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Clin Transl Radiat Oncol. 2024 Feb 23;45:100748. doi: 10.1016/j.ctro.2024.100748. eCollection 2024 Mar.
Oligoprogression is defined as cancer progression of a limited number of metastases under active systemic therapy. The role of metastasis-directed therapy, using stereotactic body radiotherapy (SBRT), is controversial as is the continuation versus switch of systemic therapy. We report outcomes of oligoprogressive patients after SBRT, and compare those patients that continued or switched their current line of systemic therapy.
MATERIAL/METHODS: We included patients who developed up to 5 progressive extracranial metastases under systemic therapy for any solid organ malignancy and were treated with SBRT to all lesions at our institution between 01/2014 and 12/2019. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method, and the interval to the next systemic therapy line determined using cumulative incidence functions. Multivariable Cox regression models were used to analyze the influence of baseline and post-progression variables on OS, PFS and survival with the next systemic therapy after SBRT.
Among 135 patients with oligoprogressive disease of which the most common primary tumor was lung cancer (n = 46, 34.1 %), 96 continued their current line of systemic therapy after oligoprogression. Among 39 who switched systemic therapy, 28 (71.8 %) paused or discontinued, while 11 (28.2 %) immediately started another systemic treatment. After a median follow-up of 27.2 months, patients that switched and those who continued systemic therapy after oligoprogression had comparable median OS (32.1 vs. 38.2 months, p = 0.47) and PFS (4.3 vs. 3.4 months, p = 0.6). The intervals to the next systemic therapy line were comparable between both cohorts (p = 0.6). An ECOG performance status of 2 and immediately starting a new systemic therapy after oligoprogression were associated with a poorer survival without next systemic therapy, while the de-novo OMD state was associated with better survival without next systemic therapy compared to the induced state.
Oncological outcomes of patients that continued or switched systemic therapy after SBRT for oligoprogression were comparable, potentially indicating that further lines of treatment may be safely delayed in selected cases.
寡进展被定义为在积极的全身治疗下少数转移灶的癌症进展。使用立体定向体部放疗（SBRT）的转移灶定向治疗的作用存在争议，全身治疗是继续还是更换也存在争议。我们报告了SBRT治疗后寡进展患者的结局，并比较了继续或更换当前全身治疗方案的患者。
材料/方法：我们纳入了在全身治疗下出现多达5个进展性颅外转移灶的任何实体器官恶性肿瘤患者，这些患者于2014年1月至2019年12月在我们机构接受了针对所有病灶的SBRT治疗。使用Kaplan-Meier方法分析总生存期（OS）和无进展生存期（PFS），并使用累积发病率函数确定至下一线全身治疗的间隔时间。使用多变量Cox回归模型分析基线和进展后变量对OS、PFS以及SBRT后接受下一线全身治疗的生存期的影响。
在135例寡进展疾病患者中，最常见的原发肿瘤是肺癌（n = 46，34.1%），96例在寡进展后继续其当前的全身治疗方案。在39例更换全身治疗方案的患者中，28例（71.8%）暂停或停止治疗，而11例（28.2%）立即开始另一种全身治疗。中位随访27.2个月后，寡进展后更换治疗方案和继续全身治疗的患者的中位OS（32.1对38.2个月，p = 0.47）和PFS（4.3对3.4个月，p = 0.6）相当。两个队列至下一线全身治疗的间隔时间相当（p = 0.6）。ECOG体能状态为2以及寡进展后立即开始新的全身治疗与无下一线全身治疗时较差的生存期相关，而与诱导状态相比，新发寡转移疾病状态与无下一线全身治疗时较好的生存期相关。
SBRT治疗寡进展后继续或更换全身治疗方案的患者的肿瘤学结局相当，这可能表明在某些情况下可以安全地延迟进一步的治疗线数。
