Patients with lung cancer with few metastases (especially adrenal and bone metastases) are quite common cases; they are usually treated with pharmacological therapy, taking into account the presence of certain genetic mutations, which often succeeds in reducing cancer but it is not as effective against metastases.

As Professor Marta Scorsetti, Head of Radiotherapy and Radiosurgery in Humanitas explains, the scientific community questioned the role that radiotherapy could play in these cases and a study conducted by American scholars, published in the scientific journal Lancet Oncology at the end of 2016, provided some interesting answers.


The study

About one hundred patients with stage IV pulmonary adenocarcinoma were enrolled, with a maximum of three metastatic locations, with the aim of demonstrating the effectiveness of innovative therapy.

Following the international guidelines, patients were given targeted pharmacological treatment – in the presence of mutations of EGFR or ALK genes – or platinum-based chemotherapy, in the absence of mutations that could be attacked with specific drugs.

Patients were then randomized into two possible treatments: the experimental treatment, after four cycles of chemotherapy or at least three months of targeted therapy, also involving local treatment (radiotherapy or in some cases surgery) against all residual lesions. The standard treatment provided only for medical therapy followed by periodic checks.


Radiotherapy and survival improvement

Although the published results are partial because they concern about fifty or so patients (half of them undergoing standard therapy, half treated with experimental treatment), they go beyond the best expectations. Patients undergoing radiotherapy have seen a marked improvement in the progression-free survival of the disease: in practice it took on average 12 months for the tumor to resume growth, compared to only 4 months for the group undergoing standard therapy. In addition, another very positive finding from the study was that local treatments were very well tolerated and there was no increase in toxicity compared to patients treated only with drugs. Given that the results are so strongly in favor of the association of local therapies with medical therapy, the study was closed early because it was not considered ethical to continue to deny a radiotherapy or surgical treatment to future patients who had been randomized in the group of only pharmacological therapy,” explains Professor Scorsetti.


Synergy between medical therapies and local treatments

Waiting for results of overall survival, which require a longer control time, the results of this study are already very important by themselves and can significantly change the therapeutic approach for patients with metastatic pulmonary adenocarcinoma. Radiotherapy and/or surgery, traditionally excluded from this group of patients, have shown that they can play an important and synergistic role with medical therapies. Considering that the prognosis of a metastatic pulmonary adenocarcinoma is normally severe, this study makes it possible to add an extra weapon to those already existing with a significant improvement in patients’ life prospects,” concludes Professor Scorsetti.