Oligometastatic Non-Small Cell Lung Cancer: A Significant Entity outside of Specialized Cancer Centers?

Abstract

Objective: To report the incidence, patterns of care, and outcomes of oligometastatic non-small cell lung cancer (NSCLC) in a rural practice setting in Norway. Materials and Methods: A retrospective analysis was conducted of all patients with stage IV NSCLC at the initial diagnosis who received active treatment in the central part of Nordland, a rural county in northern Norway, during the period of 2006-2012. We analyzed overall survival and prognostic factors. Results: The initial study population included 113 patients with stage IV disease who received active therapy; of these, 23 (20%) had oligometastatic spread (a maximum of 3 metastases to 1 organ). The median age was 71 years. Of the 23 patients, 16 (70%) did not receive radical or at least moderately aggressive local treatment for their thoracic disease. Of the remaining 7 patients, 4 (17.4%) did not receive systemic therapy. The median actuarial survival was 5.6 months in patients with more advanced metastases and 11.7 months in those with oligometastases (p = 0.03). Significant differences were also seen between the 2 oligometastatic patient groups with and without more intense thoracic treatment (median 19.7 vs. 7.6 months, p = 0.004). Further significant predictors of survival in patients with oligometastases were nodal stage (p = 0.028) and weight loss (p = 0.045). Trends were seen for T stage (p = 0.058) and performance status (p = 0.07). Conclusion: Oligometastatic NSCLC was diagnosed in a relevant proportion of patients; therefore, warranting prospective studies are recommended. Such studies are also needed to confirm the treatment-dependent survival differences observed in our patient population.

The biology and treatment of oligometastatic cancer

“…There was one large study ( n = 2176), although it was retrospective and a nonconsecutive case series (Level 3iii) [ 76 ]. Of the remaining 17 studies, two were population-based consecutive case series (Level 3i) [ 82 , 83 ], two were non population–based consecutive case series (Level 3ii) [ 84 , 85 ], and twelve were nonconsecutive case series (Level 3iii) [ 76 , 86 – 97 ], one of which was prospective [ 98 ]. Therapies given varied not only among the studies but within most of them as well, for patients with diversely defined oligometastases.…”

M1b Disease in the 8th Edition of TNM Staging of Lung Cancer: Pattern of Single Extrathoracic Metastasis and Clinical Outcome

“…The observation in the present study falls into this range and confirms that M1b disease is relatively uncommon among stage IV NSCLC. Prior to the 8th edition of lung cancer staging, the incidence of oligometastasis was reported with a wider range, from 14.8% to 26% , likely because of nonuniform definitions of oligometastasis. Most of the previous studies defined oligometastatic disease as a maximum of five extrathoracic metastatic lesions , resulting in creating a heterogeneous subgroup of patients.…”

Solitary breast metastasis from oestrogen receptor-positive pulmonary adenocarcinoma: report of a case with a potential pitfall

“…The proper identification of the metastasis as a secondary tumour allowed the omission of systemic treatment used for breast cancers and resulted in a change in the systemic palliative therapy of the lung tumour. The patient has a survival characteristic of oligometastatic disease, which is better than that of patients with advanced metastases [7]. The majority of breast cancers are ER-positive, and ER expression is often considered as evidence in favour of mammary origin.…”