Impact of Thoracic Tumor Radiotherapy on Survival in Non-small-cell Lung Cancer with Malignant Pleural Effusion Treated with Targeted Therapy: Propensity Score Matching Study

Overview

Journal Cancer Med

Specialty Oncology

Date 2023 Jun 8

PMID 37288833

Authors

Qingsong Li

Cheng Hu

Shengfa Su

Zhu Ma

Yichao Geng

Yinxiang Hu

Haijie Jin

Huiqin Li

Bing Lu

Affiliations

Soon will be listed here.

Abstract

Background: EGFR-mutant (EGFR-M) and ALK-positive (ALK-P)are common in malignant pleural effusion (MPE) with metastatic non-small-cell lung cancer (NSCLC) (MPE-NSCLC). The impact of thoracic tumor radiotherapy on survival in such patients remains unclear. We aimed to investigate whether thoracic tumor radiotherapy could improve overall survival (OS) in such patients.

Methods: According to whether or not patients accepted thoracic tumor radiotherapy, 148 patients with EGFR-M or ALK-P MPE-NSCLC treated with targeted therapy were classified into two groups: DT group without thoracic tumor radiotherapy and DRT group with thoracic tumor radiotherapy. Propensity score matching (PSM) was performed to balance clinical baseline characteristics. Overall survival was analyzed by Kaplan-Meier, compared by log-rank test, and evaluated using Cox proportional hazards model.

Results: Median survival time (MST) was 25 months versus 17 months in the DRT group and DT group. The OS rates at 1, 2, 3, 5 years in the DRT group and DT group were 75.0%, 52.8%, 26.8%, 11.1% and 64.5%, 28.4%, 9.2%, 1.8%, respectively (χ = 12.028, p = 0.001). Compared with DT group, the DRT group still had better survival after PSM (p = 0.007). Before and after PSM, factors associated with better OS through multivariable analysis were that thoracic tumor radiotherapy, radiotherapy, N , and ALK-TKIs. Grades 4-5 radiation toxicities were not observed in patients; 8 (11.6%) and 7 (10.1%) out of the DRT group suffered from Grade 3 radiation esophagitis and radiation pneumonitis, respectively.

Conclusion: Our results for EGFR-M or ALK-P MPE-NSCLC showed that thoracic tumor radiotherapy may be crucial factor in improving OS with acceptable toxicities. Potential biases should not be neglected: Further randomized controlled trials are necessary to confirm this result.

Citing Articles

Efficacy and safety of tyrosine kinase inhibitors with thoracic radiotherapy for patients with oncogene-mutated non-small cell lung cancer: a meta-analysis.

Li W, Wu P, Liang Z, Li L, Chen Y, Zhang W Radiat Oncol. 2024; 19(1):154.

PMID: 39506792 PMC: 11542371. DOI: 10.1186/s13014-024-02538-y.

Impact of thoracic tumor radiotherapy on survival in non-small-cell lung cancer with malignant pleural effusion treated with targeted therapy: Propensity score matching study.

Li Q, Hu C, Su S, Ma Z, Geng Y, Hu Y Cancer Med. 2023; 12(14):14949-14959.

PMID: 37288833 PMC: 10417183. DOI: 10.1002/cam4.6130.

References

Ryu J, Ryu H, Lee S, Memon A, Lee S, Nam H . Prognostic impact of minimal pleural effusion in non-small-cell lung cancer. J Clin Oncol. 2014; 32(9):960-7. DOI: 10.1200/JCO.2013.50.5453. View

Clive A, Kahan B, Hooper C, Bhatnagar R, Morley A, Zahan-Evans N . Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014; 69(12):1098-104. PMC: 4251306. DOI: 10.1136/thoraxjnl-2014-205285. View

Yang J, Lee O, Son S, Woo C, Jeong Y, Yang Y . EGFR Mutation Status in Lung Adenocarcinoma-Associated Malignant Pleural Effusion and Efficacy of EGFR Tyrosine Kinase Inhibitors. Cancer Res Treat. 2017; 50(3):908-916. PMC: 6056963. DOI: 10.4143/crt.2017.378. View

Al-Halabi H, Sayegh K, Digamurthy S, Niemierko A, Piotrowska Z, Willers H . Pattern of Failure Analysis in Metastatic EGFR-Mutant Lung Cancer Treated with Tyrosine Kinase Inhibitors to Identify Candidates for Consolidation Stereotactic Body Radiation Therapy. J Thorac Oncol. 2015; 10(11):1601-7. DOI: 10.1097/JTO.0000000000000648. View

Schiller J, Harrington D, Belani C, Langer C, Sandler A, Krook J . Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002; 346(2):92-8. DOI: 10.1056/NEJMoa011954. View

Zhang Q, Cai X, Zhu Z, Yu W, Liu Q, Feng W . Full-dose pemetrexed plus cisplatin combined with concurrent thoracic radiotherapy for previously untreated advanced nonsquamous non-small cell lung cancer. Anticancer Drugs. 2015; 26(4):456-63. DOI: 10.1097/CAD.0000000000000215. View

Ashworth A, Rodrigues G, Boldt G, Palma D . Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature. Lung Cancer. 2013; 82(2):197-203. DOI: 10.1016/j.lungcan.2013.07.026. View

Terra R, Dela Vega A . Treatment of malignant pleural effusion. J Vis Surg. 2018; 4:110. PMC: 5994464. DOI: 10.21037/jovs.2018.05.02. View

Herrera Lara S, Fernandez-Fabrellas E, Samper G, Marco Buades J, Andreu Lapiedra R, Pinilla Moreno A . Cytotoxic Natural Killer Subpopulations as a Prognostic Factor of Malignant Pleural Effusion. Lung. 2018; 197(1):53-60. DOI: 10.1007/s00408-018-0186-7. View

10.

Wu S, Gow C, Yu C, Chang Y, Yang C, Hsu Y . Frequent epidermal growth factor receptor gene mutations in malignant pleural effusion of lung adenocarcinoma. Eur Respir J. 2008; 32(4):924-30. DOI: 10.1183/09031936.00167407. View

11.

Yu H, Sima C, Huang J, Solomon S, Rimner A, Paik P . Local therapy with continued EGFR tyrosine kinase inhibitor therapy as a treatment strategy in EGFR-mutant advanced lung cancers that have developed acquired resistance to EGFR tyrosine kinase inhibitors. J Thorac Oncol. 2013; 8(3):346-51. PMC: 3673295. DOI: 10.1097/JTO.0b013e31827e1f83. View

12.

Shaw A, Yeap B, Solomon B, Riely G, Gainor J, Engelman J . Effect of crizotinib on overall survival in patients with advanced non-small-cell lung cancer harbouring ALK gene rearrangement: a retrospective analysis. Lancet Oncol. 2011; 12(11):1004-12. PMC: 3328296. DOI: 10.1016/S1470-2045(11)70232-7. View

13.

Patel S, Rimner A, Foster A, Zhang Z, Woo K, Yu H . Patterns of initial and intracranial failure in metastatic EGFR-mutant non-small cell lung cancer treated with erlotinib. Lung Cancer. 2017; 108:109-114. PMC: 5477661. DOI: 10.1016/j.lungcan.2017.03.010. View

14.

Westover D, Zugazagoitia J, Cho B, Lovly C, Paz-Ares L . Mechanisms of acquired resistance to first- and second-generation EGFR tyrosine kinase inhibitors. Ann Oncol. 2018; 29(suppl_1):i10-i19. PMC: 6454547. DOI: 10.1093/annonc/mdx703. View

15.

Arrieta O, Barron F, Maldonado F, Cabrera L, Corona-Cruz J, Blake M . Radical consolidative treatment provides a clinical benefit and long-term survival in patients with synchronous oligometastatic non-small cell lung cancer: A phase II study. Lung Cancer. 2019; 130:67-75. DOI: 10.1016/j.lungcan.2019.02.006. View

16.

Socinski M, Jotte R, Cappuzzo F, Orlandi F, Stroyakovskiy D, Nogami N . Atezolizumab for First-Line Treatment of Metastatic Nonsquamous NSCLC. N Engl J Med. 2018; 378(24):2288-2301. DOI: 10.1056/NEJMoa1716948. View

17.

Weickhardt A, Scheier B, Burke J, Gan G, Lu X, Bunn Jr P . Local ablative therapy of oligoprogressive disease prolongs disease control by tyrosine kinase inhibitors in oncogene-addicted non-small-cell lung cancer. J Thorac Oncol. 2012; 7(12):1807-1814. PMC: 3506112. DOI: 10.1097/JTO.0b013e3182745948. View

18.

Liu B, Liu H, Ma Y, Ding Q, Zhang M, Liu X . EGFR-mutated stage IV non-small cell lung cancer: What is the role of radiotherapy combined with TKI?. Cancer Med. 2021; 10(18):6167-6188. PMC: 8446557. DOI: 10.1002/cam4.4192. View

19.

Goldmacher G, Conklin J . The use of tumour volumetrics to assess response to therapy in anticancer clinical trials. Br J Clin Pharmacol. 2012; 73(6):846-54. PMC: 3391506. DOI: 10.1111/j.1365-2125.2012.04179.x. View

20.

Citak N, Aksoy Y, Isgorucu O, Obuz C, Acikmese B, Buyukkale S . A Comparison of the Currently Used Nodal Stage Classification with the Number of Metastatic Lymph Nodes and the Number of Metastatic Lymph Node Stations for Non-Small Cell Lung Cancer; Which of These Is the Best Prognostic Factor?. Zentralbl Chir. 2019; 145(6):565-573. DOI: 10.1055/a-1008-9598. View