When should we irradiate the primary in metastatic lung cancer? Journal Article

Authors: Shiarli, A. M.; McDonald, F.; Gomez, D. R.
Article Title: When should we irradiate the primary in metastatic lung cancer?
Abstract: Metastatic lung cancer encompasses a heterogenous group of patients in terms of burdens of disease, ranging from patients with extensive metastases to those with a limited number of metastatic lesions (oligometastatic disease). Histopathological heterogeneity also exists within two broad categories, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), portraying different patterns and evolution of disease. Local consolidative therapy to the primary tumour and metastatic sites, including surgery and/or radical dose radiotherapy, is increasingly being used to improve survival outcomes, particularly in the context of oligometastatic disease, with or without the use of molecular targeted therapy and immunotherapy. Recently, randomised studies in oligometastatic NSCLC have shown that local consolidative therapy may confer a survival advantage. This review explores whether treating just the primary tumour with radiotherapy may similarly produce improved clinical outcomes. Such a treatment strategy may carry less potential toxicity than treating multiple sites upfront. The biological rationale behind the potential benefits of treating just the primary in metastatic malignancy is discussed. The clinical evidence of such an approach across tumour sites, such as breast and prostate cancer, is also explored. Then the review focuses on treating the primary in NSCLC and SCLC with radiotherapy, by first exploring patterns of failure in metastatic NSCLC and second exploring evidence on survival outcomes from studies in metastatic NSCLC and SCLC. It is challenging to draw conclusions on the clinical benefit of treating the primary cancer in isolation from the evidence available. This highlights the need to collect data within the ongoing clinical trials on the clinical outcome and toxicity of radiotherapy delivery to primary thoracic disease specifically. This challenge also identifies the need to design future clinical trials to produce randomised evidence for such an approach. © 2019 The Royal College of Radiologists
Keywords: cancer survival; primary tumor; overall survival; cancer radiotherapy; evidence based medicine; ipilimumab; ticilimumab; progression free survival; radiotherapy; lung cancer; information processing; lung metastasis; lung adenocarcinoma; platinum derivative; stereotactic body radiation therapy; non-small cell lung cancer; chemoradiotherapy; small cell lung cancer; non small cell lung cancer; nivolumab; hypofractionated radiotherapy; disease burden; human; priority journal; article; durvalumab; osimertinib; oligometastatic disease; primary tumour
Journal Title: Clinical Oncology
Volume: 31
Issue: 12
ISSN: 0936-6555
Publisher: Elsevier Science, Inc.  
Date Published: 2019-12-01
Start Page: 815
End Page: 823
Language: English
DOI: 10.1016/j.clon.2019.07.012
PUBMED: 31383534
PROVIDER: scopus
Notes: Article -- Export Date: 2 December 2019 -- Source: Scopus
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  1. Daniel R Gomez
    33 Gomez