Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Oligometastatic non-small cell lung cancer

Michael T Milano, MD, PhD
Everett E Vokes, MD
Howard J West, MD
Joseph K Salama, MD
Section Editors
Rogerio C Lilenbaum, MD, FACP
Joseph S Friedberg, MD
Steven E Schild, MD
Deputy Editor
Sadhna R Vora, MD


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.

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.


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 [1], even though patients with limited metastases had been aggressively treated with surgical resection and/or radiation therapy for many decades [2,3].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 15, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol 1995; 13:8.
  2. Rosenberg SA. Surgical treatment of metastatic cancer, Lippincott Williams & Wilkins, Philadelphia 1987.
  3. Rubin P, Green J. Solitary Metastases, CC Thomas, Springfield, IL 1968.
  4. Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11:39.
  5. Niibe Y, Hayakawa K. Oligometastases and oligo-recurrence: the new era of cancer therapy. Jpn J Clin Oncol 2010; 40:107.
  6. Mehta N, Mauer AM, Hellman S, et al. Analysis of further disease progression in metastatic non-small cell lung cancer: implications for locoregional treatment. Int J Oncol 2004; 25:1677.
  7. Rusthoven KE, Hammerman SF, Kavanagh BD, et al. Is there a role for consolidative stereotactic body radiation therapy following first-line systemic therapy for metastatic lung cancer? A patterns-of-failure analysis. Acta Oncol 2009; 48:578.
  8. Yano T, Okamoto T, Haro A, et al. Local treatment of oligometastatic recurrence in patients with resected non-small cell lung cancer. Lung Cancer 2013; 82:431.
  9. Torok J, Kelsey CR, Salama JK. Patterns of Distant Metastases in Surgically Managed Early Stage Non-Small Cell Lung Cancer. Paper presentation, 55th Annual ASTRO Meeting. Atlanta, GA, September 2013.
  10. Parikh RB, Cronin AM, Kozono DE, et al. Definitive primary therapy in patients presenting with oligometastatic non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2014; 89:880.
  11. Albain KS, Crowley JJ, LeBlanc M, Livingston RB. Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol 1991; 9:1618.
  12. Torok JA, Gu L, Tandberg DJ, et al. Patterns of Distant Metastases After Surgical Management of Non-Small-cell Lung Cancer. Clin Lung Cancer 2017; 18:e57.
  13. Ashworth AB, Senan S, Palma DA, et al. An individual patient data metaanalysis of outcomes and prognostic factors after treatment of oligometastatic non-small-cell lung cancer. Clin Lung Cancer 2014; 15:346.
  14. Lussier YA, Xing HR, Salama JK, et al. MicroRNA expression characterizes oligometastasis(es). PLoS One 2011; 6:e28650.
  15. Lussier YA, Khodarev NN, Regan K, et al. Oligo- and polymetastatic progression in lung metastasis(es) patients is associated with specific microRNAs. PLoS One 2012; 7:e50141.
  16. De Ruysscher D, Wanders R, van Baardwijk A, et al. Radical treatment of non-small-cell lung cancer patients with synchronous oligometastases: long-term results of a prospective phase II trial (Nct01282450). J Thorac Oncol 2012; 7:1547.
  17. Ashworth A, Rodrigues G, Boldt G, Palma D. Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature. Lung Cancer 2013; 82:197.
  18. Ambrogi V, Tonini G, Mineo TC. Prolonged survival after extracranial metastasectomy from synchronous resectable lung cancer. Ann Surg Oncol 2001; 8:663.
  19. Lopez Guerra JL, Gomez D, Zhuang Y, et al. Prognostic impact of radiation therapy to the primary tumor in patients with non-small cell lung cancer and oligometastasis at diagnosis. Int J Radiat Oncol Biol Phys 2012; 84:e61.
  20. Mordant P, Arame A, De Dominicis F, et al. Which metastasis management allows long-term survival of synchronous solitary M1b non-small cell lung cancer? Eur J Cardiothorac Surg 2012; 41:617.
  21. Congedo MT, Cesario A, Lococo F, et al. Surgery for oligometastatic non-small cell lung cancer: long-term results from a single center experience. J Thorac Cardiovasc Surg 2012; 144:444.
  22. De Pas TM, de Braud F, Catalano G, et al. Oligometastatic non-small cell lung cancer: a multidisciplinary approach in the positron emission tomographic scan era. Ann Thorac Surg 2007; 83:231.
  23. Tönnies M, Pfannschmidt J, Bauer TT, et al. Metastasectomy for synchronous solitary non-small cell lung cancer metastases. Ann Thorac Surg 2014; 98:249.
  24. Yano T, Haro A, Yoshida T, et al. Prognostic impact of local treatment against postoperative oligometastases in non-small cell lung cancer. J Surg Oncol 2010; 102:852.
  25. Bartlett EK, Simmons KD, Wachtel H, et al. The rise in metastasectomy across cancer types over the past decade. Cancer 2015; 121:747.
  26. Dahele M, Senan S. The role of stereotactic ablative radiotherapy for early-stage and oligometastatic non-small cell lung cancer: evidence for changing paradigms. Cancer Res Treat 2011; 43:75.
  27. Lewis SL, Porceddu S, Nakamura N, et al. Definitive Stereotactic Body Radiotherapy (SBRT) for Extracranial Oligometastases: An International Survey of >1000 Radiation Oncologists. Am J Clin Oncol 2015.
  28. Fernando HC. Radiofrequency ablation to treat non-small cell lung cancer and pulmonary metastases. Ann Thorac Surg 2008; 85:S780.
  29. de Baère T, Palussière J, Aupérin A, et al. Midterm local efficacy and survival after radiofrequency ablation of lung tumors with minimum follow-up of 1 year: prospective evaluation. Radiology 2006; 240:587.
  30. Lee JM, Jin GY, Goldberg SN, et al. Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: preliminary report. Radiology 2004; 230:125.
  31. Lencioni R, Crocetti L, Cioni R, et al. Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study). Lancet Oncol 2008; 9:621.
  32. Palussière J, Gómez F, Cannella M, et al. Single-session radiofrequency ablation of bilateral lung metastases. Cardiovasc Intervent Radiol 2012; 35:852.
  33. Simon CJ, Dupuy DE, DiPetrillo TA, et al. Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology 2007; 243:268.
  34. von Meyenfeldt EM, Prevoo W, Peyrot D, et al. Local progression after radiofrequency ablation for pulmonary metastases. Cancer 2011; 117:3781.
  35. Bang HJ, Littrup PJ, Currier BP, et al. Percutaneous cryoablation of metastatic lesions from non-small-cell lung carcinoma: initial survival, local control, and cost observations. J Vasc Interv Radiol 2012; 23:761.
  36. Gan GN, Weickhardt AJ, Scheier B, et al. Stereotactic radiation therapy can safely and durably control sites of extra-central nervous system oligoprogressive disease in anaplastic lymphoma kinase-positive lung cancer patients receiving crizotinib. Int J Radiat Oncol Biol Phys 2014; 88:892.
  37. Weickhardt AJ, Scheier B, Burke JM, et al. Local ablative therapy of oligoprogressive disease prolongs disease control by tyrosine kinase inhibitors in oncogene-addicted non-small-cell lung cancer. J Thorac Oncol 2012; 7:1807.
  38. Gomez DR, Blumenschein GR Jr, Lee JJ, et al. Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study. Lancet Oncol 2016; 17:1672.
  39. Griffioen GH, Toguri D, Dahele M, et al. Radical treatment of synchronous oligometastatic non-small cell lung carcinoma (NSCLC): patient outcomes and prognostic factors. Lung Cancer 2013; 82:95.
  40. Cheruvu P, Metcalfe SK, Metcalfe J, et al. Comparison of outcomes in patients with stage III versus limited stage IV non-small cell lung cancer. Radiat Oncol 2011; 6:80.
  41. Hasselle MD, Haraf DJ, Rusthoven KE, et al. Hypofractionated image-guided radiation therapy for patients with limited volume metastatic non-small cell lung cancer. J Thorac Oncol 2012; 7:376.
  42. Lucchi M, Dini P, Ambrogi MC, et al. Metachronous adrenal masses in resected non-small cell lung cancer patients: therapeutic implications of laparoscopic adrenalectomy. Eur J Cardiothorac Surg 2005; 27:753.
  43. Mercier O, Fadel E, de Perrot M, et al. Surgical treatment of solitary adrenal metastasis from non-small cell lung cancer. J Thorac Cardiovasc Surg 2005; 130:136.
  44. Porte H, Siat J, Guibert B, et al. Resection of adrenal metastases from non-small cell lung cancer: a multicenter study. Ann Thorac Surg 2001; 71:981.
  45. Raz DJ, Lanuti M, Gaissert HC, et al. Outcomes of patients with isolated adrenal metastasis from non-small cell lung carcinoma. Ann Thorac Surg 2011; 92:1788.
  46. Luketich JD, Burt ME. Does resection of adrenal metastases from non-small cell lung cancer improve survival? Ann Thorac Surg 1996; 62:1614.
  47. Higashiyama M, Doi O, Kodama K, et al. Surgical treatment of adrenal metastasis following pulmonary resection for lung cancer: comparison of adrenalectomy with palliative therapy. Int Surg 1994; 79:124.
  48. Tanvetyanon T, Robinson LA, Schell MJ, et al. Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: a systematic review and pooled analysis. J Clin Oncol 2008; 26:1142.
  49. Pfannschmidt J, Schlolaut B, Muley T, et al. Adrenalectomy for solitary adrenal metastases from non-small cell lung cancer. Lung Cancer 2005; 49:203.
  50. Sastry P, Tocock A, Coonar AS. Adrenalectomy for isolated metastasis from operable non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2014; 18:495.
  51. Okubo K, Bando T, Miyahara R, et al. Resection of pulmonary metastasis of non-small cell lung cancer. J Thorac Oncol 2009; 4:203.
  52. Ileana E, Greillier L, Moutardier V, Barlesi F. Surgical resection of liver non-small cell lung cancer metastasis: a dual weapon? Lung Cancer 2010; 70:221.
  53. Nagashima A, Abe Y, Yamada S, et al. Long-term survival after surgical resection of liver metastasis from lung cancer. Jpn J Thorac Cardiovasc Surg 2004; 52:311.
  54. Ercolani G, Ravaioli M, Grazi GL, et al. The role of liver resections for metastases from lung carcinoma. HPB (Oxford) 2006; 8:114.
  55. Di Carlo I, Grasso G, Patane' D, et al. Liver metastases from lung cancer: is surgical resection justified? Ann Thorac Surg 2003; 76:291.
  56. Salah S, Tanvetyanon T, Abbasi S. Metastatectomy for extra-cranial extra-adrenal non-small cell lung cancer solitary metastases: systematic review and analysis of reported cases. Lung Cancer 2012; 75:9.
  57. Agarwala AK, Hanna NH. Long-term survival in a patient with stage IV non-small-cell lung carcinoma after bone metastasectomy. Clin Lung Cancer 2005; 6:367.
  58. Ambrogi V, Nofroni I, Tonini G, Mineo TC. Skin metastases in lung cancer: analysis of a 10-year experience. Oncol Rep 2001; 8:57.
  59. Oxnard GR, Lo P, Jackman DM, et al. Delay of chemotherapy through use of post-progression erlotinib in patients with EGFR-mutant lung cancer. 2012 ASCO Annual Meeting. J Clin Oncol 30: Abstr 7547.