Classification for long-term survival in oligometastatic patients treated with ablative radiotherapy: A multi-institutional pooled analysis

• Published in: PloS one Vol. 13; no. 4; p. e0195149
• Main Authors: Hong, Julian C, Ayala-Peacock, Diandra N, Lee, Jason, Blackstock, A William, Okunieff, Paul, Sung, Max W, Weichselbaum, Ralph R, Kao, Johnny, Urbanic, James J, Milano, Michael T, Chmura, Steven J, Salama, Joseph K
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12-04-2018; Public Library of Science (PLoS)
• Subjects: Age; Aged; Algorithms; Biological effects; Biology and Life Sciences; Brain cancer; Breast cancer; Cancer; Cancer metastasis; Cancer therapies; Care and treatment; Chemotherapy; Colorectal cancer; Disease; Disease-Free Survival; Drug dosages; Female; Follow-Up Studies; Hazard assessment; Hazard identification; Humans; Hypotheses; Kaplan-Meier Estimate; Liver; Lung cancer; Lymph nodes; Male; Medical prognosis; Medicine and Health Sciences; Metastases; Metastasis; Middle Aged; Multivariate analysis; Neoplasm Metastasis; Neoplasms - mortality; Neoplasms - pathology; Neoplasms - radiotherapy; Oncology; Organs; Patient outcomes; Patients; Physiological aspects; Prognosis; Proportional Hazards Models; Prostate cancer; Radiation therapy; Radiosurgery; Radiotherapy; Radiotherapy - methods; Recursive methods; Retrospective Studies; Risk analysis; Risk Factors; Studies; Survival; Treatment Outcome; Tumors; United States; United States > US; Chicago Illinois
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0195149

Radiotherapy is increasingly used to treat oligometastatic patients. We sought to identify prognostic criteria in oligometastatic patients undergoing definitive hypofractionated image-guided radiotherapy (HIGRT).
Exclusively extracranial oligometastatic patients treated with HIGRT were pooled. Characteristics including age, sex, primary tumor type, interval to metastatic diagnosis, number of treated metastases and organs, metastatic site, prior systemic therapy for primary tumor treatment, prior definitive metastasis-directed therapy, and systemic therapy for metastasis associated with overall survival (OS), progression-free survival (PFS), and treated metastasis control (TMC) were assessed by the Cox proportional hazards method. Recursive partitioning analysis (RPA) identified prognostic risk strata for OS and PFS based on pretreatment factors.
361 patients were included. Primary tumors included non-small cell lung (17%), colorectal (19%), and breast cancer (16%). Three-year OS was 56%, PFS was 24%, and TMC was 72%. On multivariate analysis, primary tumor, interval to metastases, treated metastases number, and mediastinal/hilar lymph node, liver, or adrenal metastases were associated with OS. Primary tumor site, involved organ number, liver metastasis, and prior primary disease chemotherapy were associated with PFS. OS RPA identified five classes: class 1: all breast, kidney, or prostate cancer patients (BKP) (3-year OS 75%, 95% CI 66-85%); class 2: patients without BKP with disease-free interval of 75+ months (3-year OS 85%, 95% CI 67-100%); class 3: patients without BKP, shorter disease-free interval, ≤ two metastases, and age < 62 (3-year OS 55%, 95% CI 48-64%); class 4: patients without BKP, shorter disease-free interval, ≥ three metastases, and age < 62 (3-year OS 38%, 95% CI 24-60%); class 5: all others (3-year OS 13%, 95% CI 5-35%). Higher biologically effective dose (BED) (p < 0.01) was associated with OS.
We identified clinical factors defining oligometastatic patients with favorable outcomes, who we hypothesize are most likely to benefit from metastasis-directed therapy.