Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature

Ashworth, A.; Rodrigues, George; Boldt, Gabriel; Palma, David A.

doi:10.1016/j.lungcan.2013.07.026

Cited by 260 publications

(186 citation statements)

References 27 publications

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“…Recently, Ashworth et al did a systematic review of literature considering NSCLC patients with 1-5 metastases treated with local therapy and found that definitive treatment of the primary tumor was a good prognostic factor for survival (14). Moreover, they further did an individual patient data (IPD) meta-analysis and found that long-term survival is common in selected patients with metachronous oligometastases, while patients with synchronous metastases and N1/N2 disease experienced the poorest survival (15).…”

Section: Original Articlementioning

confidence: 99%

“…More and more studies reported favorable long-term survivals in oligometastatic NSCLC treated with aggressive local therapy (11-13). However, these studies are retrospective and the validity of the survival benefit are challenging due to patient selection.Recently, Ashworth et al did a systematic review of literature considering NSCLC patients with 1-5 metastases treated with local therapy and found that definitive treatment of the primary tumor was a good prognostic factor for survival (14). Moreover, they further did an individual patient data (IPD) meta-analysis and found that long-term survival is common in selected patients with metachronous oligometastases, while patients with synchronous metastases and N1/N2 disease experienced the poorest survival (15).…”

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confidence: 99%

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Should aggressive thoracic therapy be performed in patients with synchronous oligometastatic non-small cell lung cancer? A meta-analysis

Li¹,

Zhu²,

Wang³

et al. 2017

J. Thorac. Dis.

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Background: We performed a meta-analysis to compare overall survival (OS) outcomes in patients with synchronous oligometastatic non-small cell lung cancer (NSCLC) who underwent aggressive thoracic therapy (ATT) with those who did not. Methods: A systematic review of controlled trials of ATT on survival in synchronous oligometastatic NSCLC was conducted. Hazard ratio (HR) for the main endpoint OS was pooled using a fixed-effects model. Subgroup analysis was performed in patients with single organ metastases, or with different numbers of brain metastases, or with different stages of thoracic disease. Pooled survival curves of OS were constructed. Results: Seven eligible retrospective observational cohort studies were identified including 668 synchronous oligometastatic NSCLC patients, of whom 227 (34.0%) received ATT. For patients with synchronous oligometastatic NSCLC, ATT was associated with a significant improvement of OS (HR, 0.48; 95% CI, 0.39-0.60; P<0.00001). In subgroup analysis, the association with OS was similar or even strengthened, with a HR of 0.42 (95% CI, 0.31-0.56) in single organ metastases group, 0.49 (95% CI, 0.31-0.75) in solitary brain metastasis group, and 0.38 (95% CI, 0.20-0.73) in thoracic stage I-II group, respectively. The pooled cumulative survival rates for patients received ATT were 74.9% at 1 year, 52.1% at 2 years, 23.0% at 3 years, and 12.6% at 4 years. The corresponding pooled survival for patients who did not receive ATT were 32.3%, 13.7%, 3.7%, and 2.0%, respectively. Conclusions: Survival benefit from ATT is common in synchronous oligometastatic patients. Selected patients with synchronous oligometastatic NSCLC could also achieve long-term survival with ATT. Targeted therapy have shown efficacy in the treatment of advanced NSCLC, however, most patients progress after a median survival of 12 months because of resistance (4-6).Hellman and Weichselbaum proposed the existence of a clinically recognisable state termed 'oligometastases', which is an intermediate state of metastases characterized by a limited number and site of metastatic tumors. In these selected patients, eradication of oligometastases could be curative (7,8). However, whether the aggressive thoracic therapy (ATT) could potentially improve overall survival (OS) in oligometastatic NSCLC remains unclear. Removal of the primary tumor was shown to improve OS in patients with metastatic renal cancer (9), by contrast, locoregional treatment of the primary tumor did not affect OS in patients with metastatic breast cancer (10). More and more studies reported favorable long-term survivals in oligometastatic NSCLC treated with aggressive local therapy (11-13). However, these studies are retrospective and the validity of the survival benefit are challenging due to patient selection.Recently, Ashworth et al. did a systematic review of literature considering NSCLC patients with 1-5 metastases treated with local therapy and found that definitive treatment of the primary tumor was a good prognostic factor for survival (14). Moreo...

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Section: Original Articlementioning

confidence: 99%

mentioning

confidence: 99%

Should aggressive thoracic therapy be performed in patients with synchronous oligometastatic non-small cell lung cancer? A meta-analysis

Li¹,

Zhu²,

Wang³

et al. 2017

J. Thorac. Dis.

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“…Based on several systematic reviews of the literature (8,(35)(36)(37), RCT data showing a survival benefit for the use of surgery or stereotactic radiotherapy for oligometastases exist only for the case of a single brain metastasis. In these patients, separate trials demonstrated that the addition of surgery (9), or stereotactic radiotherapy (38), to whole-brain radiotherapy results in a prolongation of OS, although long-term survival was rare in both trials.…”

Section: Can Sabr or Surgery Improve Os?mentioning

confidence: 99%

New Strategies in Stereotactic Radiotherapy for Oligometastases

Palma

Louie

Rodrigues

2015

Clinical Cancer Research

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Patients with metastatic solid tumors are usually treated with palliative intent. Systemic therapy and palliative radiation are often used, with the goals of prolonging survival or maintaining quality of life, but not of cure. In contrast to this paradigm, the theory of oligometastasis suggests that some patients who have a small number of metastases may be amenable to cure if all lesions can be eradicated. Aggressive treatment of patients with oligometastases, using either surgery or radiotherapy, has become more common in the past decade, yet in most situations, no randomized evidence is available to support such an approach. Stereotactic ablative radiotherapy (SABR) is a novel treatment for oligometastases, delivering large doses of radiotherapy in only a few treatments, with excellent rates of local control, and appears to be an excellent noninvasive alternative to surgical resection of metastases. This article reviews recent biologic and clinical data that support the existence of the oligometastatic state and discusses gaps in this evidence base. The emerging role for SABR in the management of this challenging patient population is discussed with a focus on ongoing clinical trials in an attempt to improve overall survival, delay progression, or induce immunologic anticancer effects through the abscopal effect.

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“…56 Other prognostic factors include definitive control of the primary tumor, and lower intrathoracic disease burden in patients undergoing thoracic radiotherapy. 56,58,59 5.5.…”

Section: Sbrt For Oligometastatic Nsclcmentioning

confidence: 99%

Stereotactic radiotherapy for early lung cancer: Evidence-based approach and future directions

Chehade

Palma

2015

Reports of Practical Oncology & Radiotherapy

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Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature

Cited by 260 publications

References 27 publications

Should aggressive thoracic therapy be performed in patients with synchronous oligometastatic non-small cell lung cancer? A meta-analysis

Should aggressive thoracic therapy be performed in patients with synchronous oligometastatic non-small cell lung cancer? A meta-analysis

New Strategies in Stereotactic Radiotherapy for Oligometastases

Stereotactic radiotherapy for early lung cancer: Evidence-based approach and future directions

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