Consolidative Hypofractionated Radiotherapy for Oligometastatic Non-Small-Cell Lung Cancer

Local consolidative therapy (LCT) has emerged as a widely recognized treatment strategy for patients with oligometastatic non-small-cell lung cancer (NSCLC), but clinical trial populations often do not reflect real-world complexities. This study evaluated the efficacy and safety of consolidative hypofractionated radiotherapy in a routine clinical cohort.

We retrospectively reviewed 216 patients with oligometastatic NSCLC treated with consolidative hypofractionated radiotherapy (biologically effective dose [BED] ≥ 50 Gy, < 10 fractions) between 2013 and 2024. Outcomes included local control (LC), progression-free survival (PFS), overall survival (OS), and toxicity. Patients were classified as having "genuine" or "induced" oligometastatic disease (OMD) according to ESTRO/EORTC criteria.

The median patient age was 73 years. At a median follow-up of 1.8 years, the 1-year LC, PFS, and OS rates were 88.7%, 51.2%, and 79.7%, respectively. Median PFS was 1.0 year and median OS was 2.6 years. In multivariable analysis, "induced" OMD was an independent predictor of worse LC (hazard ratio [HR], 2.546, P = .001) and PFS (HR, 1.863, P < .001) compared to "genuine" OMD. Radiotherapy parameters, including gross tumor volume and BED, were not significantly associated with survival outcomes. Grade 3 radiation pneumonitis occurred in 1.8% of patients; no grade 4-5 toxicities were observed.

Consolidative hypofractionated radiotherapy is safe and effective for patients with oligometastatic NSCLC, including elderly patients. The OMD classification system provides superior prognostic value over technical radiotherapy parameters, suggesting that treatment strategies should be tailored to the biological trajectory of the disease.