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Stereotactic radiotherapy in targeted therapy treated oligo-metastatic oncogene-addicted (non-small-cell) lung cancer
N Giraud1, S Abdiche2, R Trouette1
1Service d'oncologie-radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France.
Abstract:
While the prognosis of metastatic non-small-cell lung cancer has shown significant progress these last years, notably with the discovery of oncogen-driven subtypes and the development of targeted therapies, significant improvements are still needed. More recently, numerous authors studied the oligo-metastasis concept, where the metastasis are limited in number and sites involved, and that could benefit from an aggressive approach of these lesions, for instance with the help of stereotactic radiotherapy. Nevertheless, there is no clear consensus existing for the time being for the treatment of these tumors. Three main clinical situations can be distinguished: oligo-metastasis state de novo at diagnosis (synchronous) or as first metastatic event of an initially locally limited affection (metachronous); oligo-progression during systemic treatment of a pluri-metastatic disease; and finally oligo-persistence of some remaining metastatic lesions at the nadir of the systemic therapy effect. In this review, we will discuss the place of stereotactic radiotherapy in the treatment of non-small-cell oligo-metastatic oncogene-addicted cancers treated with targeted therapies, differentiating these three main clinical situations. In all these indications, this technique could provide a benefit in terms of local control, possibly even in specific survival, when associated with targeted therapy continuation, related to local control of the oligo-metastatic cerebral or extracerebral lesions.
Insights
Stereotactic radiotherapy may improve local control and survival for non-small-cell lung cancer patients with limited metastases (oligometastasis) when combined with targeted therapies. This approach is being explored across different clinical scenarios of oligometastatic disease.
Area of Science:
- Oncology
- Radiotherapy
- Medical Physics
Background:
- Metastatic non-small-cell lung cancer (NSCLC) prognosis has improved with targeted therapies for oncogene-driven subtypes.
- The oligometastasis concept, characterized by limited metastatic sites, suggests potential benefit from aggressive local treatment.
- Current treatment consensus for oligometastatic NSCLC remains unclear, necessitating further investigation.
Purpose of the Study:
- To review the role of stereotactic radiotherapy in treating oligometastatic NSCLC, specifically in oncogene-addicted cancers receiving targeted therapies.
- To differentiate the application and potential benefits of stereotactic radiotherapy across three distinct clinical situations of oligometastasis.
Main Methods:
- Literature review focusing on stereotactic radiotherapy in oligometastatic NSCLC treated with targeted therapies.
- Analysis of clinical data and outcomes differentiating synchronous, metachronous, oligo-progression, and oligo-persistence scenarios.
- Evaluation of local control and survival benefits associated with combined-modality treatment.
Main Results:
- Stereotactic radiotherapy shows promise for local control of oligometastatic lesions (cerebral and extracerebral).
- Continuation of targeted therapy alongside stereotactic radiotherapy may enhance specific survival outcomes.
- The technique's efficacy is being evaluated across distinct oligometastatic presentations.
Conclusions:
- Stereotactic radiotherapy is a potential therapeutic option for select patients with oligometastatic NSCLC, particularly when combined with ongoing targeted therapy.
- Further research is needed to establish clear treatment guidelines for oligometastatic NSCLC.
- The integration of stereotactic radiotherapy offers a promising strategy for improving outcomes in specific NSCLC patient populations.
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