title: Definitive dose thoracic radiation therapy in oligometastatic non-small cell lung cancer: A hypothesis-generating study.
abstract: OBJECTIVE
  A subset of patients with minimal extrathoracic disease may benefit from aggressive primary tumor treatment. We report comparative outcomes in oligometastatic non-small cell lung cancer (NSCLC) treated with and without definitive, conventionally fractionated thoracic radiation therapy.
  
  
  METHODS
  We identified consecutive patients with stage IV NSCLC who had an Eastern Cooperative Oncology Group performance status ≤2 and ≤4 total sites of metastatic disease and who had been prescribed ≥50 Gy of thoracic radiation.
  
  
  RESULTS
  Twenty-nine patients with oligometastatic NSCLC were identified between January 2004 and August 2010. Median survival was 22 months from diagnosis. Four patients (14%) experienced pneumonitis greater than or equal to grade 3; 6 (21%) had esophagitis greater than or equal to grade 3. Local control was associated with improved survival (P = .02). In matched subset analysis, median survival was 9 months (P < .01) in patients who received chemotherapy alone. Median time to local failure was 18 versus 6 months (P = .01). On multivariable analysis, radiation (P < .01; odds ratio [OR], 0.33), fewer metastases (P < .01; OR, 2.14), and female sex (P < .01; OR, 0.41) were associated with improved survival.
  
  
  CONCLUSIONS
  Definitive dose radiation therapy may improve survival in a select subset of patients with minimal extrathoracic disease in whom local progression is of primary concern. Prospective trials are needed to further evaluate the role of local control in oligometastatic NSCLC.
authors: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Currently at Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors: Eric P
authors: EP
authors: Xanthopoulos
authors: Currently at Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Currently at Biostatistics and Bioinformatics Facility, Fox Chase Cancer Research Center, Philadelphia, Pennsylvania.
authors: Elizabeth
authors: E
authors: Handorf
authors: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Charles B
authors: CB
authors: Simone
authors: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Surbhi
authors: S
authors: Grover
authors: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Annemarie T
authors: AT
authors: Fernandes
authors: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Sonam
authors: S
authors: Sharma
authors: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Currently at Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts.
authors: Michael N
authors: MN
authors: Corradetti
authors: Department of Internal Medicine, Division of Hematology and Medical Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Tracey L
authors: TL
authors: Evans
authors: Department of Internal Medicine, Division of Hematology and Medical Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Corey J
authors: CJ
authors: Langer
authors: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Nandita
authors: N
authors: Mitra
authors: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Currently at Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors: Anand
authors: A
authors: Shah
authors: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Smith
authors: S
authors: Apisarnthanarax
authors: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Lilie L
authors: LL
authors: Lin
authors: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Currently at Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington. Electronic address: rengan@uw.edu.
authors: Ramesh
authors: R
authors: Rengan
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome