Patients with lung cancer with a few metastases (mainly adrenal and bone metastases) are very common cases. They are usually treated with drug therapy, taking into account the presence of certain genetic mutations. Despite being able to reduce the tumor, these are not as effective against metastases.
As explained by Professor Marta Scorsetti, Head of Radiotherapy and Radiosurgery at Humanitas, the scientific community has queried the role that radiotherapy might play in such cases. A study by American researchers, published in the Lancet Oncology journal at the end of 2016, provided some interesting answers.
About 100 patients were enrolled in the study with stage IV lung adenocarcinoma with up to three metastatic sites, with the aim of showing the effectiveness of an innovative therapy.
Following international guidelines, patients underwent a drug treatment focused in the presence of gene mutations EGFR and ALK – or platinum-based chemotherapy, which, in the absence of mutations can attack with specific drugs.
Patients were divided (randomly by a computer system) into two possible treatments. In the experimental category, after four cycles of chemotherapy, or at least three months of targeted therapy, a local radiation treatment or sometimes surgery against all residual lesions was used. The standard treatment instead, provided only the isolated medical therapy followed by periodic checkups.
Radiation therapy and improvement in survival
Although the published results are partial as they concern on average 50 patients (half treated with standard therapy, half treated with the experimental treatment), they go beyond the best expectations. “Patients undergoing radiotherapy showed a significant improvement in disease-free survival. In practice, it took an average of 12 months for the tumor to grow back, compared to only 4 months in the group receiving the standard therapy. Another positive fact that emerged from the study is that local treatments were very well tolerated and there was no increase in toxicity in relation to patients kept only on medication. Since the results strongly supported the association of local therapy with drug therapy, the study was terminated early because it was not considered ethical to deny radiotherapy or surgical treatments to potential patients who were randomly assigned to the drug therapy alone,” says Professor Scorsetti.
Synergy between medical therapies and local treatments
“As we await for the overall survival results, which require a longer monitoring time, the results of this study are already in itself very important and can significantly change the treatment approach for patients with metastatic lung adenocarcinoma. Radiotherapy and/or surgery, traditionally excluded in this group of patients, have been proven to play an important and synergistic role with medical therapies. Given that the prognosis of metastatic lung adenocarcinoma is generally severe, this study allows the addition of an extra weapon which is added to the existing ones with a significant outlook improvement in the lives of patients“, concludes Professor Scorsetti.