Multi-modality radical intent treatment in synchronous oligometastatic non-small cell lung cancer: how many patients complete the full treatment regime recommended by the MDT?

Abstract

Introduction: Management of oligometastatic disease in non-small cell lung cancer (NSCLC) identified at initial diagnosis (synchronous) often provokes treatment dilemmas within multi-disciplinary teams (MDTs). Suitable patients are sometimes considered for multi-modality radical-intent treatment including systemic therapy and local treatment to both the metastasis and the primary tumour. We sought to assess how many patients complete all components of this multi-modality treatment when recommended in our MDT as a surrogate marker of appropriate patient selection and practice. Methods: A retrospective review of our electronic lung cancer MDT database at Wythenshawe Hospital, South Manchester, between April 2016 and April 2018. Synchronous oligometastatic NSCLC cases were defined as a single metastasis in a single organ. We recorded patient demographics, performance status, TNM staging, pathology, and site of oligometastasis. MDT recommended treatment was compared to treatment completed. Results: 1754 individual MDT cases were identified. Synchronous oligometastatic NSCLC was found in 26 (1.5%) patients (Table 1). Thirteen patients (50%) with a single metastasis were recommended to have multi-modality treatment. The remaining patients were recommended for palliative systemic therapy (31%, 8/26) and best supportive care (19%, 5/26). Of the 13 patients recommended for multi-modality treatment, 12 were offered chemotherapy prior to local therapies to the primary tumour and metastatic site. The exception was the treatment of a brain metastasis first prior to systemic therapy. 13 (69%) managed to complete their entire treatment pathway. Failure to complete the treatment regime was commonly due to rapid disease progression. Conclusion: Synchronous oligometastatic NSCLC represents a small fraction of our MDT discussions (1.5%). Our MDT recommends multimodality radical-intent treatment in half of these cases and twothirds of patients complete the full treatment course suggesting appropriate patient selection. Our standard practice appears to be systemic therapy first followed by local treatment to the metastatic site and primary tumour.