title: Hypofractionated image-guided radiation therapy for patients with limited volume metastatic non-small cell lung cancer.
abstract: BACKGROUND
  Outcomes data treating patients with oligometastatic (≤ 5 metastases) non-small cell lung carcinoma (NSCLC) with hypofractionated image-guided radiotherapy (HIGRT) are limited.
  
  
  METHODS
  Consecutive oligometastatic NSCLC patients were reviewed from a prospective database. Patients were included if all active diseases were treated with HIGRT. Lesions that had received prior radiation or had radiographic/metabolic resolution after chemotherapy were not treated with HIGRT. Local control of all treated lesions, distant control, progression-free survival (PFS), overall survival (OS), and control of individual lesions (LeC) were calculated.
  
  
  RESULTS
  Twenty-five patients with median of 2 treated oligometastatic lesions were included. Median follow-up was 14 months. Median age was 66 years. Nineteen patients received systemic therapy before HIGRT and 11 had progressive disease after their most recent systemic therapy before HIGRT. Median OS and PFS were 22.7 and 7.6 months. The 18 months local control, distant control, OS, and PFS were 66.1%, 31.7%, 52.9%, and 28.0%. Greater than two sites treated with HIGRT, nonadenocarcinoma histology, prior systemic therapy, and progression after systemic therapy were associated with worse PFS. Sixty-two individual lesions of median size 2.7 cm were treated. For extracranial lesions, median total and fraction dose were 50 and 5 Gy. Median standard equivalent dose in 2 Gy fractions for extracranial lesions was 64.6 Gy yielding 18 months LeC of 70.7%. Standard equivalent dose ≥64.6 Gy increased LeC (p = 0.04). Two patients experienced grade 3 toxicity.
  
  
  CONCLUSIONS
  HIGRT for oligometastatic NSCLC provides durable LeC and may provide long-term PFS in some patients. Future HIGRT studies should optimize patient selection and integration with systemic therapy.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hasselle
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Haraf
authors.forename: Kyle E
authors.initials: KE
authors.lastname: Rusthoven
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Golden
authors.forename: Ravi
authors.initials: R
authors.lastname: Salgia
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Villaflor
authors.forename: Niket
authors.initials: N
authors.lastname: Shah
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hoffman
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Chmura
authors.forename: Philip P
authors.initials: PP
authors.lastname: Connell
authors.forename: Everett E
authors.initials: EE
authors.lastname: Vokes
authors.forename: Ralph R
authors.initials: RR
authors.lastname: Weichselbaum
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D000328:Adult; D000368:Aged; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D061089:Radiotherapy, Image-Guided; D012189:Retrospective Studies; D015996:Survival Rate