Oligometastatic Disease in Non-Small-Cell Lung Cancer: An Update

Abstract

Oligometastatic non-small-cell lung cancer (NSCLC) is a distinct entity that is different from localized and disseminated diseases. The definition of oligometastatic NSCLC varies across studies in past decades owing to the use of different imaging modalities; however, a uniform definition of oligometastatic NSCLC has been proposed, and this may facilitate trial design and evaluation of certain interventions. Patients with oligometastatic NSCLC are candidates for curative-intent management, in which local ablative treatment, such as surgery or stereotactic radiosurgery, should be instituted to improve clinical outcomes. Although current guidelines recommend that local therapy for thoracic and metastatic lesions should be considered for patients with oligometastatic NSCLC with stable disease after systemic therapy, optimal management strategies for different oligometastatic sites have not been established. Additionally, the development of personalized therapies for individual patients with oligometastatic NSCLC to improve their quality of life and overall survival should also be addressed. Here, we review relevant articles on the management of patients with oligometastatic NSCLC and categorize the disease according to the site of metastases. Ongoing trials are also summarized to determine future directions and expectations for new treatment modalities to improve patient management.

Defining Oligometastatic Disease in the New Era of PSMA-PET Imaging for Primary Staging of Prostate Cancer

“…Generally speaking, the term oligometastatic disease is defined as either a limited number and/or volume of metastatic lesions and applies to a number of different malignancies [ 6 , 7 , 8 ]. Typically, studies defining and evaluating outcomes of patients with oligometastatic disease use their own study-specific definition of oligometastatic disease, which often ranges from 1–5 metastatic lesions.…”

A ‘Hybrid’ Radiotherapy Regimen Designed for Immunomodulation: Combining High-Dose Radiotherapy with Low-Dose Radiotherapy

“…In 1995, Hellman and Weichselbaum first proposed oligometastatic disease as a distinct cancer state between locally confined and systemic metastatic disease [ 100 ], which refers to a metastatic tumor with no more than three to five metastases [ 101 , 102 , 103 , 104 , 105 , 106 ]. For these patients, some researchers claim oligometastasis-directed SBRT should be delivered to all tumor lesions to yield efficient tumor control and immune-stimulating effect [ 76 , 107 , 108 ].…”

Optimal timing for local ablative treatment of bone oligometastases in non-small cell lung cancer

“…One multicenter study showed that, among individuals with non-small cell lung cancer (NSCLC) and bone metastatic lesions, skeletal-related events occurred in 57.7%, median time until first skeletal-related event was six months, and median survival was 9.5 months [3] . Bone metastases can show complications such as pathological fractures, compression of the spinal cord, pain, and hypercalcemia, and skeletal-related adverse events can severely damage patients’ general condition and function [6] .…”