Progression-directed ablative radiotherapy improves event-free survival in oligoprogressive NSCLC

Area of Science:

• Oncology
• Radiation Oncology
• Medical Physics

Background:

• Non-small cell lung cancer (NSCLC) management often involves systemic therapy followed by radiation for limited progression.
• Oligoprogression, defined by limited metastatic sites, presents a challenge in optimizing treatment strategies.
• Progression-directed radiation therapy (PDRT) is an emerging strategy for localized disease recurrence.

Purpose of the Study:

• To evaluate the efficacy of PDRT in patients with oligoprogressive NSCLC.
• To assess the impact of PDRT on disease progression and the need for subsequent systemic therapy.
• To identify predictors of oncological outcomes in NSCLC patients treated with PDRT.

Main Methods:

• Retrospective analysis of 87 NSCLC patients treated with PDRT for oligoprogressive disease (Jan 2020-Oct 2025).
• Oligoprogression defined by <5 extracranial lesions or ≤14 cc intracranial disease volume.
• Primary endpoint: event-free survival (EFS); secondary endpoints: time to next treatment (TTNT), progression-free survival (PFS); multivariate Cox regression used.

Main Results:

• Median EFS was 5 months, with a one-year actuarial EFS rate of 52.1%.
• Median TTNT was 8 months, indicating a delay in subsequent systemic therapy.
• PDRT to the primary tumor and achieving complete response prior to oligoprogression were associated with improved EFS; chemotherapy use and larger CTV volumes correlated with worse outcomes.

Conclusions:

• PDRT demonstrates efficacy in maintaining disease control and postponing systemic treatment in oligoprogressive NSCLC.
• The findings suggest PDRT is a viable strategy for selected NSCLC patients.
• Further prospective studies are needed to validate these outcomes and optimize PDRT protocols.