Author of

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  P19 - Locoregional and Oligometastatic Disease - Oligometastatic Disease (ID 129)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Locoregional and Oligometastatic Disease
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall

  • 35166

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    P19.05 - Postoperative Recurrence of Early-Stage Non-Small Cell Lung Cancer (NSCLC): Clinical Outcomes of Oligo versus Poly-recurrence Disease (ID 3593)

    00:00 - 00:00  |  Presenting Author(s): Maria Aimé Giorlando
    • Abstract
    • Slides

    Introduction
    

    The concept of oligo-metastatic disease was originally proposed by Hellman and Weichselbaum in 1995 as an intermediate state of cancer spread between localized and widespread disease. In this subset of patients, eradication of oligometastases with definitive local therapies (e.g., surgery and radiotherapy) could be curative. This concept has recently drawn specific attention and different definitions of oligometastatic disease have been proposed. However, there have been few comprehensive studies about postoperative oligo-recurrence of NSCLC. The aim of this study is to identify the clinical features and prognostic factors of surgically removed early stage NSCLC and to analyze the differences and predictive factors between the subgroups of patients with oligo-recurrence, poly-recurrence and those who have remained disease-free to date.

    Methods
    

    We retrospectively reviewed 107 patients with stage I to IIIA NSCLC who underwent thoracic surgery at our institution between 2010 and 2020. To define Oligo-recurrence we used the Dublin Consensus (5 or less loco-regional or distant lesions, restricted to up to 3 organs) and the ESMO criteria (3 or less lesions). Other recurrences were classified as poly-recurrence. We analyzed and compared clinical characteristics, treatment, and outcome between groups: without recurrence, with oligo-recurrence, and with poly-recurrence.

    Results
    

    A total of 107 patients with resected early-stage NSCLC were analyzed. Forty-five patients (42%) developed recurrence. Of this subgroup, 26 (57.8%) had oligo-recurrence, and 50% (n=13) of these cases presented as a solitary lesion mainly localized in the lungs (n=5), brain (n=4), regional lymph nodes (n=2) and bone (n=2). Compared to poly-recurrences, patients with oligo-recurrence had more early-staged disease at initial diagnosis (stage I: 50% (n=13) vs 10,5% (n=2) p=0.011), better performance status (ECOG 0: 57.7% (n=15) vs 26.3% (n=5) p=0.013) and a greater percentage of histological grade 3 tumors (50% p=0.007). The recurrence free survival (RFS) was similar for the group with oligo-metastases and poly-recurrence (median RFS 13 vs 11 months, p=0.19). For oligo-recurrence, Definitive Local Therapy (DLT) was conducted in 11 (42.3%) patients as initial treatment and concurrent chemo-radiation therapy was indicated for 5 subjects with inoperable locoregional disease. In the subgroup of poly-recurrence, systemic treatment with chemotherapy (n=9) and tyrosine kinase inhibitors (n=4) were the preferred options. DLT was not associated with improved Post-Recurrence Survival (median PRS 29 vs 24 months p=0.74). The entire population of oligo-recurrence patients had longer overall survival (OS) than those with poly-recurrence (median OS 42.5 vs 25 months respectively, p=0.005), with a non-statically significant improvement in progression free survival (PFS) (median PFS 10 vs 3 months, p=0.17)

    Conclusion
    

    Postoperative oligo-recurrences can predict a better prognosis for patients with NSCLC. The survival benefit of DLT for oligo-recurrence should be carefully evaluated in future prospective studies.

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