Effect of histology on stereotactic body radiotherapy for non-small cell lung cancer oligometastatic pulmonary lesions

Alexander J Allen; Dominic A Labella; Roman O Kowalchuk; Michael R Waters; Charles R Kersh

doi:10.21037/tlcr-22-538

Effect of histology on stereotactic body radiotherapy for non-small cell lung cancer oligometastatic pulmonary lesions

Transl Lung Cancer Res. 2023 Jan 31;12(1):66-78. doi: 10.21037/tlcr-22-538. Epub 2023 Jan 16.

Authors

Alexander J Allen¹, Dominic A Labella¹, Roman O Kowalchuk², Michael R Waters³, Charles R Kersh¹

Affiliations

¹ Chesapeake Regional, Riverside & University of Virginia Radiosurgery Center, Riverside Regional Medical Center, Newport News, VA, USA.
² Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
³ Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.

Abstract

Background: Stereotactic body radiotherapy (SBRT) is commonly used to provide targeted treatment to metastatic lung disease. Investigation is needed to understand the influence of histology on treatment outcomes. We report how tumor histology affects local control (LC) in a cohort of patients with non-small cell lung cancer (NSCLC) receiving SBRT for oligometastatic and recurrent pulmonary lesions.

Methods: Patients who received SBRT to recurrent or oligometastatic NSCLC pulmonary lesions from 2015-2019 at our institution were included in this retrospective cohort study. Minimum follow-up was 2 months. Kaplan-Meier (KM) analysis was performed to assess local progression-free survival (LPFS). Local failure cumulative incidence curves using death as a competing risk factor were also generated.

Results: A total of 147 treated lesions from 83 patients were included: 95 lesions from 51 patients with lung adenocarcinoma and 52 lesions from 32 patients with lung squamous cell carcinoma (SqCC). Median follow-up was 23 [interquartile range (IQR): 9.5-44.5] months for adenocarcinoma, and 11.5 (6-32.25) months for SqCC. Two-year LC was 89% for adenocarcinoma and 77% for SqCC (P=0.04). Median overall survival (OS) was 24.5 (10-46.25) months for adenocarcinoma and 14.5 (7.75-23.25) months for SqCC. Adenocarcinoma had improved LPFS over SqCC (P=0.014). SqCC was associated with increased local failure risk that approached statistical significance (P=0.061) with death as a competing risk. Overall toxicity incidence was 8.2% with no G3+ toxicities.

Conclusions: For SBRT-treated oligometastatic or recurrent NSCLC pulmonary lesions, adenocarcinoma histology is associated with improved 2-year LC and LPFS compared to SqCC and reduced incidence of local recurrence (LR) with death as a competing risk.

Keywords: Pulmonary oligometastasis; adenocarcinoma; non-small cell lung cancer (NSCLC); squamous cell carcinoma (SqCC); stereotactic body radiotherapy (SBRT).