Oligometastatic non-small cell lung cancer
- Michael T Milano, MD, PhD
Michael T Milano, MD, PhD
- Associate Professor
- Department of Radiation Oncology
- University of Rochester
- Everett E Vokes, MD
Everett E Vokes, MD
- John E. Ultmann Professor
- Chairman, Department of Medicine
- Physician-in-Chief, University of Chicago Medicine and Biologic Sciences
- Howard J West, MD
Howard J West, MD
- Medical Director
- Thoracic Oncology Program
- Swedish Cancer Institute (Seattle)
- Joseph K Salama, MD
Joseph K Salama, MD
- Associate Professor
- Department of Radiation Oncology
- Duke University Cancer Institute
- Section Editors
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Joseph S Friedberg, MD
Joseph S Friedberg, MD
- Section Editor — Thoracic Surgery
- Charles Reid Edwards Professor of Surgery
- University of Maryland
- Steven E Schild, MD
Steven E Schild, MD
- Section Editor — Radiation Therapy
- Professor of Radiation Oncology
- Mayo Clinic College of Medicine
An important goal for many physicians is the ability to offer curative intent treatment, with a reasonable rate of success, to a group of patients previously only considered for palliation. As cancer treatments have evolved, patients once considered incurable are sometimes seen as potentially curable.
As an example, this has led to a "stage migration" from stage IV to earlier stages of disease in some cancers. For non-small cell lung cancer (NSCLC), multiple tumors in the same lobe are now classified as T3, and multiple tumors in the same lung but in a different lobe are classified as T4, where they were once considered metastatic (table 1).
For patients with American Joint Committee on Cancer (AJCC) stage IV NSCLC with one or a limited number of metastases, an emerging approach has been to use definitive treatment modalities to render them disease free.
This chapter reviews the basis of the oligometastatic state and discusses outcomes among patients with oligometastatic NSCLC.
THE OLIGOMETASTATIC STATE
Definition — The clinical state of oligometastasis consists of patients with metastases limited in number and organ site(s) who may have a more indolent biology and progression at existing sites without widespread metastases. This concept was best elucidated in 1995 , even though patients with limited metastases had been aggressively treated with surgical resection and/or radiation therapy for many decades [2,3].
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- THE OLIGOMETASTATIC STATE
- RATIONALE FOR TREATMENT OF OLIGOMETASTASES
- Systemic therapy
- Incidence of oligometastasis
- Natural history of oligometastatic disease
- PATIENT SELECTION
- - Surgery
- - Radiation therapy
- - Other modalities
- Radiofrequency ablation
- Systemic therapy
- Outcomes of curative intent treatment
- Specific sites of oligometastases
- - Brain metastases
- - Adrenal metastases
- - Lung metastases
- - Hepatic metastases
- - Other metastatic locations
- Timing and role of systemic therapy
- SUMMARY AND RECOMMENDATIONS