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Published on: February 12, 2017
Failure pattern and radiotherapy exploration in malignant pleural effusion non-small cell lung cancer treated with
Qingsong Li1,2,3, Cheng Hu1,2,3, Shengfa Su1,2,3
1Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
Purpose:
Actionable mutations are common in non-small cell lung cancer(NSCLC)with malignant pleural effusion(MPE)(MPE-NSCLC). The pattern of failure in MPE-NSCLC treated with targeted therapy after MPE control remains unclear. We aimed to investigate the failure pattern of such patients in a cohort study and explore the possibility of radiotherapy.
Patients And Methods:
Computed tomography scans of 86 patients were reviewed in this study. We classified first pattern of failure after MPE control as initial disease sites only (IF), new distant sites only (NF), or IF and NF detected simultaneously (INF). Patients evaluated suitable for radiotherapy after disease progression were divided into two groups: D group without radiotherapy and RD group with radiotherapy. The Kaplan-Meier method and log-rank test were used for survival analyses.
Results:
Disease progression after MPE control was observed in 42 patients with complete serial imaging. Median time to any progression was 9.5 months. Rate of the IF, NF and INF were 50%, 17% and 33% for all patients,60%,0% and 40% for patients with MPE recurrence (n=10,23.8%) and 47%, 22% and 31% for patients (n=32,76.2%) without MPE recurrence, respectively. Out of 10 patients(23.8%) with MPE recurrence, 7 patients simultaneous underwent primary tumor progression and 5 MPE were cytologically confirmed in 7 patients with examination. The overall survival (OS )rates at 1, 2, 3 years for the RD group and D group were 88.2%, 50.5%, 21.7% and 80.0%, 20.3%, 0%, respectively; the corresponding MST were 26.1 months and 17.5 months, respectively (χ2 = 4.959, p =0.026).
Conclusions:
Our data indicates that 50% of patients with actionable mutations MPE- NSCLC after MPE control are likely to fail at their initial sites of disease and the use of radiotherapy may bring OS benefits during the course of their disease. Multicenter RCT is necessary to confirm the result in the future.
Insights
In non-small cell lung cancer with malignant pleural effusion (MPE-NSCLC), disease progression often occurs at initial sites. Radiotherapy may improve overall survival (OS) in these patients, warranting further investigation.
Area of Science:
- Oncology
- Medical Imaging
- Clinical Research
Background:
- Actionable mutations are prevalent in non-small cell lung cancer (NSCLC) with malignant pleural effusion (MPE).
- The failure patterns in MPE-NSCLC patients receiving targeted therapy after MPE control are not well-defined.
- Understanding these patterns is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate the failure patterns in MPE-NSCLC patients treated with targeted therapy after achieving MPE control.
- To explore the potential role and benefit of radiotherapy in managing disease progression in this patient cohort.
Main Methods:
- A cohort study reviewed CT scans of 86 MPE-NSCLC patients.
- Failure patterns were classified as initial failure (IF), new distant failure (NF), or simultaneous IF and NF (INF).
- Survival analyses were performed using Kaplan-Meier method and log-rank test, comparing patients with and without radiotherapy post-progression.
Main Results:
- Disease progression was observed in 42 patients, with a median time to progression of 9.5 months.
- The rates of IF, NF, and INF were 50%, 17%, and 33%, respectively.
- Patients receiving radiotherapy (RD group) showed improved overall survival (OS) rates (1, 2, 3 years: 88.2%, 50.5%, 21.7%) compared to the non-radiotherapy group (D group: 80.0%, 20.3%, 0%), with a median survival of 26.1 months vs. 17.5 months (p=0.026).
Conclusions:
- Approximately 50% of MPE-NSCLC patients with actionable mutations experience disease failure at initial sites after MPE control.
- Radiotherapy may offer survival benefits for MPE-NSCLC patients experiencing disease progression.
- Multicenter randomized controlled trials are needed to validate these findings.
