Repeated Multimodality Ablative Therapies for Oligorecurrent Pulmonary Metastatic Disease

Stereotactic body radiotherapy (SBRT) and percutaneous thermal ablation (TA) are alternatives to surgery for the management of pulmonary oligometastases. In this collaborative work, we retrospectively analyzed patients who had undergone iterative focal ablative treatments of pulmonary oligometastases. We hypothesized that repeated ablative therapies could benefit patients with consecutive oligometastatic relapses. Patients treated with SBRT and/or TA for pulmonary oligometastases in two French academic centers between October 2011 and November 2016 were included. A total of 102 patients with 198 lesions were included; 45 patients (44.1%) received repeated focal treatments at the pulmonary site for an oligorecurrent disease (the multiple courses group). Median follow-up was 22.5 months. The 3-year overall survival rates of patients who had a single treatment sequence (the single course group) versus the multiple courses were 73.9% and 78.8%, respectively, which was not a statistically significant difference (p = 0.860). The 3-year systemic therapy-free survival tended to be longer in the multiple courses group (50.4%) than in the single course group (44.7%) (p = 0.081). Tolerance of repeated treatments was excellent with only one grade 4 toxicity. Thereby, multimodality repeated ablative therapy is effective in patients with pulmonary oligorecurrent metastases. This strategy may delay the use of more toxic systemic therapy.

Automated summary

SBRT and TA are alternative treatments for pulmonary oligometastases. This study showed that repeated ablative therapy can be effective in delaying the use of more toxic systemic therapy for patients with pulmonary oligorecurrent metastases.