Where a cancer spreads in the lung might change how long a person lives. This analysis looked at patients who received radiation for a specific number of metastases. The team compared those with tumors in the ultracentral area to those with tumors elsewhere. The results were stark. People with ultracentral tumors had significantly shorter times before the cancer grew or spread. Their median time without progression was 5.8 months. In contrast, people with nonultracentral tumors lasted 15.8 months. The difference was very clear and statistically strong. Overall survival followed the same pattern. The median time for the ultracentral group was 29.0 months. For the other group, survival had not yet been reached. This means many people in the second group are still alive. The risk of developing new metastases was also higher for the ultracentral group. About 69.2 percent developed new spots within two years. Only 31.4 percent of the other group did. Safety looked similar for both groups. Rates of serious side effects were low and not significantly different. Local control of the original tumors was also similar. However, the study had limits. It was a single-arm trial with limited data on this specific tumor location. These findings suggest that where the tumor sits is an important factor. Doctors may need to weigh this location carefully when planning treatment. Larger studies are needed to confirm these results before changing standard care.
SABR shows worse survival in ultracentral pulmonary oligometastases compared to nonultracentral tumorsTumor location matters: ultracentral spots linked to worse survival in lung metastasis patients
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Key Takeaway
Note that ultracentral location is an adverse prognostic feature for survival in patients treated with SABR.
This secondary analysis of the SABR-5 trial examined patients with ultracentral pulmonary oligometastases and nonultracentral pulmonary oligometastases. The study included 41 patients with 45 ultracentral metastases and 93 patients with 172 nonultracentral metastases. The intervention was SABR, and the comparator group consisted of nonultracentral tumors. Follow-up duration was 5.8 months.
Progression-free survival was lower in the ultracentral cohort compared to the nonultracentral cohort. The median progression-free survival was 5.8 months for the ultracentral group versus 15.8 months for the nonultracentral group. The hazard ratio was 2.18 with a P value less than .001. Overall survival was also worse in the ultracentral cohort. Median overall survival was 29.0 months for the ultracentral group versus not yet reached for the nonultracentral group. The hazard ratio was 3.45 with a P value less than .001.
The 2-year cumulative incidence of polymetastatic progression was higher in the ultracentral cohort compared to the nonultracentral cohort. The incidence was 69.2% for the ultracentral group versus 31.4% for the nonultracentral group. The 2-year cumulative incidence of grade 2 toxicity was similar between cohorts at 14.6% versus 9.8%. No grade 4 or 5 toxicities were reported. Local tumor control rates were similar between groups.
Key limitations include the single-arm trial design, retrospective stratification, and limited data on outcomes in patients with ultracentral pulmonary oligometastases treated with SABR. The finding should be validated with larger studies. Ultracentral location is an adverse prognostic feature for survival and may be a factor when weighing benefit versus risk of SABR.
What this means for you:
Ultracentral tumor location is linked to shorter survival and higher risk of new metastases after radiation. More on Chronic Obstructive Pulmonary Disease
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View Original Abstract ↓
PURPOSE/OBJECTIVES: There are limited data on outcomes in patients with ultracentral pulmonary oligometastases treated with SABR. The purpose of this study was to determine whether ultracentral location was prognostic for toxicity and survival.
MATERIAL AND METHODS: Oligometastatic lung lesions treated on the single-arm phase 2 SABR-5 trial were retrospectively stratified into 2 cohorts: ultracentral tumors (UC), defined as planning target volume overlap or direct tumor abutment to the proximal bronchial tree, esophagus, great vessels, or heart, and nonultracentral tumors. Cohorts were compared with respect to grade ≥ 2 toxicity, progression-free survival (PFS), and overall survival (OS).
RESULTS: In total, 41 patients with 45 ultracentral metastases and 93 patients with 172 nonultracentral metastases underwent SABR. The most common primary histologies were colorectal (30%), lung (13%), and renal (13%), and these did not differ between groups. Patients with UC had a lower median PFS of 5.8 months compared with 15.8 months in patients with non ultracentral tumors (P < .001). OS was also worse in the UC cohort: median 29.0 months versus not yet reached (P < .001). On multivariable regression, UC remained prognostic for worse PFS (hazard ratio 2.18, P = .004) and OS (hazard ratio 3.45, P < .001). Groups had similar rates of local tumor control. Patients with UC had higher 2-year cumulative incidence of polymetastatic progression: 69.2% versus 31.4% (P < .001). The 2-year cumulative incidence of grade ≥ 2 toxicity was 14.6% for patients with UC and 9.8% for patients with nonultracentral tumors (P = .74). There were no grade 4 or 5 toxicities.
CONCLUSIONS: In this prospective patient cohort, SABR for ultracentral tumor had low toxicity rates and good local control. However, ultracentral location was an adverse prognostic feature for survival. This finding should be validated with larger studies and may be a factor when weighing the benefit versus risk of SABR in patients with pulmonary oligometastases.
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