• Hunter C Gits, Mitra A Khosravi Flanigan, Jamie D Kapplinger, Janani S Reisenauer, Patrick W Eiken, William G Breen, Linh H Vu, Brian T Welch, William S Harmsen, Courtney N Day, Kenneth R Olivier, Sean S Park, Yolanda I Garces, Christopher L Hallemeier, Kenneth W Merrell, Jonathan B Ashman, Steven E Schild, Michael P Grams, J John Lucido, K Robert Shen, Stephen D Cassivi, Dennis Wigle, Francis C Nichols, Shanda Blackmon, Luis F Tapias, Matthew R Callstrom, and Dawn Owen.
• Departments of Radiation Oncology, Mayo Clinic, Rochester, MN.
• Chest. 2024 May 1; 165 (5): 124712591247-1259.

BackgroundProlonged survival of patients with metastatic disease has furthered interest in metastasis-directed therapy (MDT).Research QuestionThere is a paucity of data comparing lung MDT modalities. Do outcomes among sublobar resection (SLR), stereotactic body radiation therapy (SBRT), and percutaneous ablation (PA) for lung metastases vary in terms of local control and survival?Study Design And MethodsMedical records of patients undergoing lung MDT at a single cancer center between January 2015 and December 2020 were reviewed. Overall survival, local progression, and toxicity outcomes were collected. Patient and lesion characteristics were used to generate multivariable models with propensity weighted analysis.ResultsLung MDT courses (644 total: 243 SLR, 274 SBRT, 127 PA) delivered to 511 patients were included with a median follow-up of 22 months. There were 47 local progression events in 45 patients, and 159 patients died. Two-year overall survival and local progression were 80.3% and 63.3%, 83.8% and 9.6%, and 4.1% and 11.7% for SLR, SBRT, and PA, respectively. Lesion size per 1 cm was associated with worse overall survival (hazard ratio, 1.24; P = .003) and LP (hazard ratio, 1.50; P < .001). There was no difference in overall survival by modality. Relative to SLR, there was no difference in risk of local progression with PA; however, SBRT was associated with a decreased risk (hazard ratio, 0.26; P = .023). Rates of severe toxicity were low (2.1%-2.6%) and not different among groups.InterpretationThis study performs a propensity weighted analysis of SLR, SBRT, and PA and shows no impact of lung MDT modality on overall survival. Given excellent local control across MDT options, a multidisciplinary approach is beneficial for patient triage and longitudinal management.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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